Subjective effects as predictors of substance use disorders in a clinical sample: A longitudinal study

Abstract

Background: The literature on the association between subjective effects (SEs; i.e., how an individual perceives their physiological and psychological reactions to a drug) and substance use disorders (SUDs) is largely limited to community samples. The present study addressed the following aims in a clinical sample: whether SEs predict general versus substance-specific SUD in adolescence and adulthood after controlling for conduct disorder symptoms (CDsymp); whether SEs predict SUDs across drug classes; whether SEs predict change in SUD from adolescence to adulthood; and whether there are racial/ethnic differences in associations.

Methods: Longitudinal analyses were conducted using data from a sample of 744 clinical probands recruited from residential and outpatient SUD treatment facilities in CO during adolescence (M_age = 16.26) and re-assessed twice in adulthood (M_ages = 22.56 and 28.96), approximately seven and twelve years after first assessment. SEs and CDsymp were assessed in adolescence. SUD severity was assessed at adolescence and twice during adulthood.

Results: SEs assessed in adolescence robustly predicted general SUD for legal and illegal substances in adolescence and adulthood, whereas CDsymp predicted SUD primarily in adolescence. Higher positive and negative SEs in adolescence were associated with greater SUD severity after controlling for CDsymp, with similar magnitudes. Results indicated cross-substance effects of SEs on SUD. We found no evidence for racial/ethnic differences in associations.

Conclusions: We investigated the progression of SUD in a high-risk sample with greater odds of sustained SUD. In contrast to CDsymp, both positive and negative SEs consistently predicted general SUD across substances in adolescence and adulthood.

Keywords: Adolescents; Adults; Clinical sample; Conduct disorder; Longitudinal; Polysubstance use; Subjective effects; Substance use disorder.

Figure 1.

Results of Confirmatory Factor Analyses for Positive and Negative Subjective Effects (See Figure 1 File). Note: Standardized factor loadings are presented from models examining positive SEs/negative SEs. All factor loadings and correlations significant at p ≤ .001. SEs = Subjective Effects

Figure 2.

Results of Confirmatory Factor Analyses for Substance Use Disorder Factors at Waves 1, 2, and 3 (See Figure 2 File) Note: Standardized factor loadings from models examining SUD criteria assessed in Wave1/Wave 2/Wave 3 are presented. All factor loadings and correlations significant at p ≤ .001. SUD = substance use disorder.

Figure 3.

Example Growth Model Examining Associations between SEs, CD Symptoms, Initial SUD, and Change in SUD Over Time, After Controlling for Sex (See Figure 3 File). Note: For each model, the TYPE = RANDOM and TSCORES (time scores) options were used to allow time scores to vary across individuals (i.e., different ages of assessment at Waves 1 through 3), incorporated into the model using the AT command. Latent basis growth models with freed slope loadings are more efficient than separate models for linear, quadratic, and high polynomials while allowing estimation of nonlinear change without collinearity and are simpler to interpret (Ram & Grimm, 2007). The latent SUD intercept had unstandardized loadings of 1.0 for each timepoint (capturing individual stability of SUD across time). The latent slope factor reflected individual change in SUDs over time (Bollen & Curran, 2006). Results after controlling for sex are reported. SEs = subjective effects. SUD = substance use disorder.