Chronic childhood adversity and stages of substance use involvement in adolescents

Studies have shown that those who experience chronic childhood adversity have a greater likelihood of substance abuse and dependence. However, substance use disorders are first preceded by substance use, and substance use is preceded by substance use opportunities. This study aims to estimate the association of chronic adversity with different stages of substance involvement: opportunities, use given the opportunity and abuse or dependence given use.

3005 adolescents aged 12-17 were interviewed in a stratified multistage general population probability survey of Mexico City, Mexico. Substance involvement and chronic childhood adversities were assessed with the World Mental Health Composite International Diagnostic Interview Adolescent Version (WMH-CIDI-A). Discrete-time survival models were performed; their survival coefficients and standard errors were exponentiated, and reported as odds-ratios (ORs).

Childhood adversities were associated with alcohol opportunity, alcohol use and alcohol abuse/dependence with significant ORs for individual adversities ranging from 1.4 to 4.1. Childhood adversities were also associated with illicit drug opportunity, drug use and drug abuse/dependence with significant ORs for individual adversities ranging from 1.6 to 17.3. Having more adversities was associated with greater incremental odds of substance involvement, particularly drug use given the opportunity.

While adversities are mostly related to transitioning into use and disorder, a few are related to substance opportunities, particularly those which were likely to make substances available through parents. Attending to the needs of youth living in adversity, particularly adversities related to parental dysfunction and child abuse should be integral to addiction prevention efforts.