Marital Status as a Partial Mediator of the Associations Between Young Adult Substance Use and Subsequent Substance Use Disorder: Application of Causal Inference Methods

Abstract

Yo ung adult substance use is linked with the risk of substance use disorders (SUDs) later in adulthood. Marriage may be part of this pathway because of both selection effects (early substance use reducing marriage) and socialization effects (marriage reducing later substance use and disorder). We examine whether marital status mediates the association between young adult substance use and subsequent SUDs, using causal mediation methods to strengthen inferences. Method: Using panel data from high school seniors in 1990-1998, we examined whether the effects of two exposures (level of alcohol/marijuana use at age 19/20) on the outcomes (alcohol use disorder [AUD]/ marijuana use disorder [MUD], nondisordered use, or abstinence at age 35) were mediated by marital status at age 29/30. Propensity score weights adjusted for potential confounding regarding both the exposures and the mediator. Results: Moderate and heavy alcohol/marijuana use at age 19/20 were associated with higher odds of AUD/MUD and lower odds of abstinence, each relative to nondisordered use, at age 35. The association between heavy alcohol use at age 19/20 and subsequent AUD was partially mediated by being unmarried at age 29/30; the associations between moderate and heavy marijuana use at age 19/20 and subsequent marijuana abstinence were partially mediated by being unmarried at age 29/30. Conclusions: Both selection and socialization effects related to marriage explain the perpetuation of substance use behaviors across adulthood. Selection effects on marriage seem to occur at different thresholds for young adult alcohol and marijuana use.

Gender and age differences in the associations between family social roles and excessive alcohol use

“…Multiple mechanisms may underlie observed associations, including adult social roles increasing informal social control (Elder, 1985;Sampson and Laub, 1992), provision of social support (Cohen and Willis, 1985;Thoits, 2011), and responsibilities to others. Although reverse causality is possible, that is, chronic heavy alcohol use may presage the end of partnership and parenting roles, prospective research that accounts for unobserved differences between groups has suggested that familial social role status precedes changes in excessive alcohol use (Green et al, 2010;Jang et al, 2018;Staff et al, 2014).…”

Differences in Substance Use Disparities Across Age Groups in a National Cross-Sectional Survey of Lesbian, Gay, and Bisexual Adults

“…Broadly, marriage and parenthood are associated with declines in SU in the general population but are less common among LGB adults. [35][36][37][38] A recent study found that although older bisexual adults were similar to older gay and lesbian adults with respect to education level, they reported lower income levels. 34 Studies suggest that these relative disadvantages, including lower SES, begin to emerge in early and middle adulthood.…”

Cohort effects of women's mid‐life binge drinking and alcohol use disorder symptoms in the United States: Impacts of changes in timing of parenthood

“…How many times have you had five or more drinks in a row?’ AUD symptoms were assessed using questions based on Diagnostic and Statistical Manual (DSM)‐criteria for AUD. Although this measure of AUD symptoms does not yield a clinical diagnosis, the items are largely consistent with AUDs measured in other large‐scale surveys [17–19] and have been used in past MTF studies to reflect DSM‐5 AUD [20–26] and DSM‐IV AUD [27]. AUD symptoms were assessed during the past 5 years for those surveyed to 2016 and assessed during the past year for those surveyed between 2017 and 2019; therefore, the most recent cohorts were assessed about only past‐year AUD symptoms.…”

“…AUD symptoms were assessed using questions based on Diagnostic and Statistical Manual (DSM)-criteria for AUD. Although this measure of AUD symptoms does not yield a clinical diagnosis, the items are largely consistent with AUDs measured in other large-scale surveys [17][18][19] and have been used in past MTF studies to reflect DSM-5 AUD [20][21][22][23][24][25][26] and DSM-IV AUD [27]. AUD symptoms were assessed practice [29,30], a dichotomous AUD variable was created wherein respondents were coded as having AUD symptoms if they met two or more criteria.…”