Association of Cohort and Individual Substance Use With Risk of Transitioning to Drug Use, Drug Use Disorder, and Remission From Disorder Findings From the World Mental Health Surveys

Source: Degenhardt L, Bharat C, Glantz MD, et al. Association of Cohort and Individual Substance Use With Risk of Transitioning to Drug Use, Drug Use Disorder, and Remission From Disorder: Findings From the World Mental Health Surveys. JAMA Psychiatry. Published online March 13, 201976(7):708–720. doi:10.1001/jamapsychiatry.2019.0163

Key Points

Question  Is the extent to which alcohol and other drugs are used in an individual’s birth cohort associated with an individual’s risk of commencing drug use, transitioning to problematic use, and entering remission?

Findings  This study of cross-national data of 90 027 respondents from the World Mental Health Surveys found that an individual’s personal risk of transitioning to greater involvement with drug use is associated with the substance use histories of their age cohort, as well as their own history of involvement with drugs and alcohol. Results were statistically significant after controlling for sociodemographic factors and were consistent across country income levels.

Meaning  Per this analysis, any intervention to reduce substance use within a cohort may also reduce individual-level risk for transitioning into greater levels of involvement with drug use.

Abstract

Importance  Limited empirical research has examined the extent to which cohort-level prevalence of substance use is associated with the onset of drug use and transitioning into greater involvement with drug use.

Objective  To use cross-national data to examine time-space variation in cohort-level drug use to assess its associations with onset and transitions across stages of drug use, abuse, dependence, and remission.

Design, Setting, and Participants  The World Health Organization World Mental Health Surveys carried out cross-sectional general population surveys in 25 countries using a consistent research protocol and assessment instrument. Adults from representative household samples were interviewed face-to-face in the community in relation to drug use disorders. The surveys were conducted between 2001 and 2015. Data analysis was performed from July 2017 to July 2018.

Main Outcomes and Measures  Data on timing of onset of lifetime drug use, DSM-IV drug use disorders, and remission from these disorders was assessed using the Composite International Diagnostic Interview. Associations of cohort-level alcohol prevalence and drug use prevalence were examined as factors associated with these transitions.

Results  Among the 90 027 respondents (48.1% [SE, 0.2%] men; mean [SE] age, 42.1 [0.1] years), 1 in 4 (24.8% [SE, 0.2%]) reported either illicit drug use or extramedical use of prescription drugs at some point in their lifetime, but with substantial time-space variation in this prevalence. Among users, 9.1% (SE, 0.2%) met lifetime criteria for abuse, and 5.0% (SE, 0.2%) met criteria for dependence. Individuals who used 2 or more drugs had an increased risk of both abuse (odds ratio, 5.17 [95% CI, 4.66-5.73]; P < .001) and dependence (odds ratio, 5.99 [95% CI, 5.02-7.16]; P < .001) and reduced probability of remission from abuse (odds ratio, 0.86 [95% CI, 0.76-0.98]; P = .02). Birth cohort prevalence of drug use was also significantly associated with both initiation and illicit drug use transitions; for example, after controlling for individuals’ experience of substance use and demographics, for each additional 10% of an individual’s cohort using alcohol, a person’s odds of initiating drug use increased by 28% (odds ratio, 1.28 [95% CI, 1.26-1.31]). Each 10% increase in a cohort’s use of drug increased individual risk by 12% (1.12 [95% CI, 1.11-1.14]).

Conclusions and Relevance  Birth cohort substance use is associated with drug use involvement beyond the outcomes of individual histories of alcohol and other drug use. This has important implications for understanding pathways into and out of problematic drug use.