Predicting Persistent, Limited, and Delayed Problematic Cannabis Use in Early Adulthood: Findings From a Longitudinal Study

Abstract

Objective To identify risk profiles associated with patterns of problematic cannabis use in early adulthood. Method Data came from 1,229 participants in the Great Smoky Mountains Study, a prospective 20-year cohort study from 1993–2015 that is representative of western North Carolina with yearly assessments conducted from ages 9 to 16, and assessments at ages 19, 21, 26, and 30. Patterns of problematic cannabis use (i.e., DSM-5 cannabis use disorder or daily use) in early adulthood included 1) non-problematic use in late-adolescence (ages 19–21) and early adulthood (ages 26–30); 2) limited problematic use in late adolescence only; 3) persistent problematic use in late adolescence and early adulthood; and 4) delayed problematic use in early adulthood only. Multi-nominal logistic regression models examined pairwise associations between these patterns and risk factors in childhood (ages 9–16) and late adolescence (ages 19–21). Risk factors included psychiatric disorders (e.g., anxiety, depressive), other substance use (smoking, alcohol, illicit drugs), and challenging social factors (e.g., low socioeconomic status, family functioning, peers). Sex and race/ethnicity (white, black, American Indian) interactions were tested. Results The persistent pattern (6.7% of sample) was characterized by more anxiety disorders across development and more DSM-5 CUD symptoms during late adolescence compared to the limited pattern (13.3%), which, in turn, had more childhood family instability and dysfunction. The delayed pattern (3.7%) was characterized by more externalizing disorders, maltreatment, and peer bullying in childhood compared to non-problematic users. There were no significant sex/race interactions. Conclusion Problematic cannabis use patterns during early adulthood have distinctive risk profiles, which may be useful in tailoring targeted interventions.

Neurocognitive Precursors of Substance Misuse Corresponding to Risk, Resistance, and Resilience Pathways: Implications for Prevention Science

“…Longitudinal studies have distinguished delayed risk in late adolescence/emerging adulthood by histories of externalizing behaviors, child maltreatment, and being bullied by peers, whereas other patterns of use (e.g., limited use) have been characterized by family instability and anxiety disorders (134). However, a nonlongitudinal study of men with substance abuse reported nearly identical childhood and adolescent risk factors (135), while another longitudinal study (136) found similar factors to be predictive of adolescent and adult illicit drug use, with the addition of early cannabis use as a significant catalyst for both groups, thus complicating our ability to disentangle which factors may be more closely coupled with delayed vs. early risk.…”

Association of Parental Incarceration With Psychiatric and Functional Outcomes of Young Adults

“…For substance use disorders, we focused on ages 25 and 30 years, when substance use is not widespread but associated with a poor long-term prognosis. 36,37…”

Early Risk Factors for Daily Cannabis Use in Young Adults

“…55 Psychological attributes [56][57][58] and mental health challenges are both associated with substance use in youth. 24,59 In the NDIT study, high stress levels, impulsivity, novelty seeking, and lower self-esteem were associated with daily cannabis use. These findings may pertain to the selfmedication hypothesis, which posits that people with mental health-related vulnerability use substances to alleviate symptoms.…”

“…Potential risk factors investigated were selected as associated with cannabis use based on findings of earlier studies, 7,[22][23][24][25][26][27][28][29] as well as the availability of data on the variable in the NDIT study, and included 6 sociodemographic characteristics (i.e., age, sex, mother university educated, language spoken at home, born in Canada, lives with 1 parent only), 7 psychosocial indicators (i.e., depressive symptoms, 32 family stress, 33,34 other stress, 33,34 impulsivity, 35,36 novelty seeking, 37 self-esteem, 38 worry about weight 33 ), 7 lifestyle indicators (i.e., use of alcohol, tobacco products other than cigarettes, smoked cigarettes, 39 number of bouts of participation in moderate and vigorous physical activity [MVPA] in the past week, 40 participation in team sports, computer hours/week, TV hours/week), 3 indicators pertaining to smoking in the social environment (i.e., parent(s) smokes, sibling(s) smoke, friend(s) smoke), and other (i.e., BMI).…”

“…22 In a review of 13 longitudinal studies, consistent risk factors included male sex, tobacco and alcohol use, problematic relationships with parents, and friends’ cannabis use. 23 Psychiatric disorders, substance use, and negative social circumstances (e.g., family dysfunction, school expulsion, bullying) were associated with problematic cannabis use in American youth 24 while male sex, earlier age at onset, smoking, heavy drinking, illicit drug use, poor mental health, and low socioeconomic status (SES) were associated cross-sectionally with problematic cannabis use in Canadian youth. 25 Other factors positively associated with cannabis use include body mass index (BMI), 26 parental substance use, 27,28 and peer smoking.…”