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Which adolescents develop persistent substance dependence in adulthood? Using population-representative longitudinal data to inform universal risk assessment

  • M. H. Meier (a1), W. Hall (a2) (a3), A. Caspi (a4) (a5) (a6), D. W. Belsky (a7) (a8), M. Cerdá (a9), H. L. Harrington (a4) (a5), R. Houts (a4) (a5), R. Poulton (a10) and T. E. Moffitt (a4) (a5) (a6)...



To our knowledge, there are no universal screening tools for substance dependence that (1) were developed using a population-based sample, (2) estimate total risk briefly and inexpensively by incorporating a relatively small number of well-established risk factors, and (3) aggregate risk factors using a simple algorithm. We created a universal screening tool that incorporates these features to identify adolescents at risk for persistent substance dependence in adulthood.


Participants were members of a representative cohort of 1037 individuals born in Dunedin, New Zealand in 1972–1973 and followed prospectively to age 38 years, with 95% retention. We assessed a small set of childhood and adolescent risk factors: family history of substance dependence, childhood psychopathology (conduct disorder, depression), early exposure to substances, frequent substance use in adolescence, sex, and childhood socioeconomic status. We defined the outcome (persistent substance dependence in adulthood) as dependence on one or more of alcohol, tobacco, cannabis, or hard drugs at ⩾3 assessment ages: 21, 26, 32, and 38 years.


A cumulative risk index, a simple sum of nine childhood and adolescent risk factors, predicted persistent substance dependence in adulthood with considerable accuracy (AUC = 0.80).


A cumulative risk score can accurately predict which adolescents in the general population will develop persistent substance dependence in adulthood.


Corresponding author

*Address for correspondence: M. H. Meier, PhD., Department of Psychology, Arizona State University, PO Box 871104, Tempe, AZ 85287-1104, USA. (Email:


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APA (1987). Diagnostic and Statistical Manual of Mental Disorders, 3rd edn, revised. American Psychiatric Association: Washington, DC.
APA (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. American Psychiatric Association: Washington, DC.
Brook, JS, Lee, JY, Brown, EN, Finch, SJ, Brook, DW (2011). Developmental trajectories of marijuana use from adolescence to adulthood: personality and social role outcomes. Psychological Reports 108, 339357.
Carter, A, Hall, W (2011). Addiction Neuroethics: The Promises and Perils of Neuroscience Research on Addiction. Cambridge University Press: Cambridge.
Chassin, L, Flora, DB, King, KM (2004). Trajectories of alcohol and drug use and dependence from adolescence to adulthood: the effects of familial alcoholism and personality. Journal of Abnormal Psychology 113, 483498.
Chung, T, Smith, GT, Donovan, JE, Windle, M, Faden, VB, Chen, CM, Martin, CS (2012). Drinking frequency as a brief screen for adolescent alcohol problems. Pediatrics 129, 205212.
Clark, , Chung, T, Martin, C (2006). Alcohol use frequency as a screen for alcohol use disorders in adolescents. International Journal of Adolescent Medicine and Health 18, 181188.
Cook, RJ, Sackett, DL (1995). The number needed to treat: a clinically useful measure of treatment effect. British Medical Journal 310, 452454.
Copeland, WE, Angold, A, Shanahan, L, Dreyfuss, J, Dlamini, I, Costello, EJ (2012). Predicting persistent alcohol problems: a prospective analysis from the Great Smoky Mountain Study. Psychological Medicine 42, 19251935.
Costello, A, Edelbrock, C, Kalas, R, Kessler, M, Klaric, S (1982). Diagnostic Interview Schedule for Children (DISC). National Institute of Mental Health: Rockville, MD.
D'Agostino, RB, Vasan, RS, Pencina, MJ, Wolf, PA, Cobain, M, Massaro, JM, Kannel, WB (2008). General cardiovascular risk profile for use in primary care - the Framingham Heart Study. Circulation 117, 743753.
Elley, W, Irving, J (1976). Revised socio-economic index for New Zealand. New Zealand Journal of Educational Studies 11, 2536.
Evans, GW, Li, D, Whipple, SS (2013). Cumulative risk and child development. Psychological Bulletin 139, 13421396.
Felitti, VJ, Anda, RF, Nordenberg, D, Williamson, DF, Spitz, AM, Edwards, V, Koss, MP, Marks, JS (1998). Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults - the Adverse Childhood Experiences (ACE) Study. American Journal of Preventive Medicine 14, 245258.
Fergusson, DM, Horwood, LJ, Ridder, EM (2007). Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: results of a 25-year longitudinal study. Drug and Alcohol Dependence 88, S14S26.
Grant, BF, Dawson, DA (1998). Age of onset of drug use and its association with DSM-IV drug abuse and dependence: results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse 10, 163173.
Grant, BF, Goldstein, RB, Saha, TD, Chou, SP, Jung, J, Zhang, H, Pickering, RP, Ruan, WJ, Smith, SM, Huang, B (2015). Epidemiology of DSM-5 alcohol use disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions III. JAMA Psychiatry 72, 757766.
Grant, BF, Hasin, DS, Chou, SP, Stinson, FS, Dawson, DA (2004). Nicotine dependence and psychiatric disorders in the United States - Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, 11071115.
Hall, WD, Carter, A, Yücel, M (2015). Ethical issues in the neuroprediction of addiction risk and treatment response. In Handbook of Neuroethics, (ed. Clausen, J. and Levy, N.), pp. 10251044. Dordrecht, The Netherlands: Springer.
Heyman, GM (2013). Quitting drugs: quantitative and qualitative features. Annual Review of Clinical Psychology 9, 2959.
Hussong, AM, Jones, DJ, Stein, GL, Baucom, DH, Boeding, S (2011). An internalizing pathway to alcohol use and disorder. Psychology of Addictive Behaviors 25, 390404.
Kendler, KS, Jacobson, KC, Prescott, CA, Neale, MC (2003). Specificity of genetic and environmental risk factors for use and abuse/dependence of cannabis, cocaine, hallucinogens, sedatives, stimulants, and opiates in male twins. American Journal of Psychiatry 160, 687695.
Kendler, KS, Myers, J, Damaj, MI, Chen, XG (2013). Early smoking onset and risk for subsequent nicotine dependence: a monozygotic co-twin control study. American Journal of Psychiatry 170, 408413.
Kirisci, L, Reynolds, M, Carver, D, Tarter, R (2013). Quick screen to detect current substance use disorder in adolescents and the likelihood of future disorder. Drug and Alcohol Dependence 128, 116122.
Krueger, RF, Hicks, BM, Patrick, CJ, Carlson, SR, Iacono, WG, McGue, M (2002). Etiologic connections among substance dependence, antisocial behavior, and personality: modeling the externalizing spectrum. Journal of Abnormal Psychology 111, 411424.
Levy, S, Weiss, R, Sherritt, L, Ziemnik, R, Spalding, A, Van Hook, S, Shrier, LA (2014). An electronic screen for triaging adolescent substance use by risk levels. JAMA Pediatrics 168, 822828.
McGue, M, Iacono, WG, Krueger, R (2006). The association of early adolescent problem behavior and adult psychopathology: a multivariate behavioral genetic perspective. Behavior Genetics 36, 591602.
Meier, MH, Caspi, A, Houts, R, Slutske, WS, Harrington, H, Jackson, KM, Belsky, DW, Poulton, R, Moffitt, TE (2013). Prospective developmental subtypes of alcohol dependence from age 18 to 32 years: implications for nosology, etiology, and intervention. Development and Psychopathology 25, 785800.
Milne, BJ, Caspi, A, Crump, R, Poulton, R, Rutter, M, Sears, MR, Moffitt, TE (2009a). The validity of the family history screen for assessing family history of mental disorders. American Journal of Medical Genetics, Part B: Neuropsychiatric Genetics 150B, 4149.
Milne, BJ, Caspi, A, Harrington, H, Poulton, R, Rutter, M, Moffitt, TE (2009b). Predictive value of family history on severity of illness: the case for depression, anxiety, alcohol dependence, and drug dependence. Archives of General Psychiatry 66, 738747.
Moffitt, T, Caspi, A, Rutter, M, Silva, P (2001). Sex differences in Antisocial Behaviour: Conduct Disorder, Delinquency, and Violence in the Dunedin Longitudinal Study. Cambridge University Press: Cambridge, UK.
Moffitt, TE, Caspi, A, Taylor, A, Kokaua, J, Milne, BJ, Polanczyk, G, Poulton, R (2010). How common are common mental disorders? Evidence that lifetime prevalence rates are doubled by prospective versus retrospective ascertainment. Psychological Medicine 40, 899909.
Odgers, CL, Caspi, A, Nagin, DS, Piquero, AR, Slutske, WS, Milne, BJ, Dickson, N, Poulton, R, Moffitt, TE (2008). Is it important to prevent early exposure to drugs and alcohol among adolescents? Psychological Science 19, 10371044.
Odgers, CL, Milne, BJ, Caspi, A, Crump, R, Poulton, R, Moffitt, TE (2007). Predicting prognosis for the conduct-problem boy: can family history help? Journal of the American Academy of Child and Adolescent Psychiatry 46, 12401249.
Pardini, D, White, HR, Stouthamer-Loeber, M (2007). Early adolescent psychopathology as a predictor of alcohol use disorders by young adulthood. Drug and Alcohol Dependence 88, S38S49.
Pepe, MS, Janes, H, Longton, G, Leisenring, W, Newcomb, P (2004). Limitations of the odds ratio in gauging the performance of a diagnostic, prognostic, or screening marker. American Journal of Epidemiology 159, 882890.
Poulton, R, Hancox, R, Milne, B, Baxter, J, Scott, K, Wilson, N (2006). The Dunedin Multidisciplinary Health and Development Study: are its findings consistent with the overall New Zealand population? New Zealand Medical Journal 119, 4555.
Poulton, R, Moffitt, TE, Silva, PA (2015). The Dunedin Multidisciplinary Health and Development Study: overview of the first 40 years, with an eye to the future. Soc Psychiatry Psychiatr Epidemiol 50, 679693.
Rice, ME, Harris, GT (2005). Comparing effect sizes in follow-up studies: ROC area, Cohen's d, and r. Law and Human Behavior 29, 615620.
Robins, L, Cottler, L, Bucholz, K, Compton, W (1995). Diagnostic Interview Schedule for DSM-IV. Washington University School of Medicine: St. Louis.
Robins, LN, Helzer, JE, Croughan, J, Ratcliff, KS (1981). National Institute of Mental Health Diagnostic Interview Schedule - its history, characteristics, and validity. Archives of General Psychiatry 38, 381389.
Rutter, M (1981). Stress, coping and development - some issues and some questions. Journal of Child Psychology and Psychiatry and Allied Disciplines 22, 323356.
Sameroff, AJ, Seifer, R, Barocas, R, Zax, M, Greenspan, S (1987). Intelligence quotient scores of 4-year-old children - social-environmental risk-factors. Pediatrics 79, 343350.
Stone, AL, Becker, LG, Huber, AM, Catalano, RF (2012). Review of risk and protective factors of substance use and problem use in emerging adulthood. Addictive Behaviors 37, 747775.
Subramaniam, GA, Volkow, ND (2014). Substance misuse among adolescents: to screen or not to screen? Jama Pediatrics 168, 798799.
Vanyukov, MM, Kirisci, L, Moss, L, Tarter, RE, Reynolds, MD, Maher, BS, Kirillova, GP, Ridenour, T, Clark, DB (2009). Measurement of the risk for substance use disorders: phenotypic and genetic analysis of an index of common liability (vol 39, pg 233, 2009). Behavior Genetics 39, 596596.
Ware, JH (2006). Statistics and medicine - the limitations of risk factors as prognostic tools. New England Journal of Medicine 355, 26152617.
Weissman, MM, Wickramaratne, P, Adams, P, Wolk, S, Verdeli, H, Olfson, M (2000). Brief screening for family psychiatric history - the family history screen. Archives of General Psychiatry 57, 675682.
Whelan, R, Watts, R, Orr, CA, Althoff, RR, Artiges, E, Banaschewski, T, Barker, GJ, Bokde, AL, Buchel, C, Carvalho, FM, Conrod, PJ, Flor, H, Fauth-Buhler, M, Frouin, V, Gallinat, J, Gan, G, Gowland, P, Heinz, A, Ittermann, B, Lawrence, C, Mann, K, Martinot, JL, Nees, F, Ortiz, N, Paillere-Martinot, ML, Paus, T, Pausova, Z, Rietschel, M, Robbins, TW, Smolka, MN, Strohle, A, Schumann, G, Garavan, H, the IC (2014). Neuropsychosocial profiles of current and future adolescent alcohol misusers. Nature 512, 185189.
Wilson, PWF, D'Agostino, RB, Levy, D, Belanger, AM, Silbershatz, H, Kannel, WB (1998). Prediction of coronary heart disease using risk factor categories. Circulation 97, 18371847.
Wright, BRE, Caspi, A, Moffitt, TE, Miech, RA, Silva, PA (1999). Reconsidering the relationship between SES and delinquency: causation but not correlation. Criminology 37, 175194.


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Which adolescents develop persistent substance dependence in adulthood? Using population-representative longitudinal data to inform universal risk assessment

  • M. H. Meier (a1), W. Hall (a2) (a3), A. Caspi (a4) (a5) (a6), D. W. Belsky (a7) (a8), M. Cerdá (a9), H. L. Harrington (a4) (a5), R. Houts (a4) (a5), R. Poulton (a10) and T. E. Moffitt (a4) (a5) (a6)...


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