Substance Use Disorder in Early Midlife: A National Prospective Study on Health and Well-Being Correlates and Long-Term Predictors

This study used national multicohort panel data from the Monitoring the Future study (N = 25,536 from senior year classes 1977–1997 followed up to the age of 35 years in 1994–2014) to examine how early midlife (age 35 years) alcohol use disorder (AUD) and cannabis use disorder (CUD) are associated with adolescent and adult sociodemographics and health and well-being risk factors. Survey items adapted from DSM-5 diagnostic criteria were used to identify individuals who (a) showed symptoms consistent with criteria for AUD or CUD at age 35 years, (b) used the substance without qualifying for a disorder (nondisordered users), and (c) abstained from using alcohol or marijuana during the past five years. At age 35 years, the estimated prevalence of past five-year AUD was 28.0%, and that of CUD was 6.1%. Multinomial logistic regressions were used to identify variations in the relative risk of disorder symptoms as a function of sociodemographic characteristics, age 18 educational and social indices and substance use, and age 35 health and satisfaction indices and substance use. In the full models, age 18 binge drinking and marijuana use were found to be among the strongest predictors of age 35 AUD and CUD, respectively. Among age 35 health and well-being indicators, lower overall health, more frequent cognitive difficulties, and lower satisfaction with spouse/partner were consistently associated with greater risks of AUD and CUD. Some evidence was found for a J-shaped association between age 35 AUD or CUD status and health and well-being indices, such that nondisordered users were sometimes better off than both abstainers and those experiencing disorder. Finally, nondisordered cannabis use, but not CUD, was found to be more common in more recent cohorts. Implications are discussed regarding the importance of placing early midlife substance use disorder within the context of both adolescent substance use and adult health and well-being.