IMPORTANCERecent information on the trends in past-year alcohol abstinence and marijuana abstinence, co-use of alcohol and marijuana, alcohol use disorder, and marijuana use disorder among US young adults is limited.OBJECTIVES To assess national changes over time in past-year alcohol and marijuana abstinence, co-use, alcohol use disorder, and marijuana use disorder among US young adults as a function of college status (2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013)(2014)(2015)(2016)(2017)(2018) and identify the covariates associated with abstinence, co-use, and marijuana use disorder in more recent cohorts (2015)(2016)(2017)(2018). DESIGN, SETTING, AND PARTICIPANTSThis study examined cross-sectional survey data collected in US households annually between 2002 and 2018 as part of the National Survey on Drug Use and Health. The survey used an independent, multistage area probability sample for all states to produce nationally representative estimates. The sample included 182 722 US young adults aged 18 to 22 years. The weighted screening and weighted full interview response rates were consistently above 80% and 70%, respectively. MAIN OUTCOMES AND MEASURESMeasures included past-year abstinence, alcohol use, marijuana use, co-use, alcohol use disorder, marijuana use disorder, prescription drug use, prescription drug misuse, prescription drug use disorder, and other drug use disorders based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria. RESULTSThe weighted sample comprised 51.1% males. Between 2002 and 2018, there was an annual increase in past-year alcohol abstinence among young adults (college students: 0.54%; 95% CI, 0.44%-0.64%; non-college students: 0.33%; 95% CI, 0.24%-0.43%). There was an annual increase in marijuana use from 2002 to 2018 (college: 0.46%; 95% CI, 0.37%-0.55%; non-college: 0.49%; 95% CI, 0.40%-0.59%) without an increase in marijuana use disorder for all young adults. Past-year alcohol use disorder decreased annually (college: 0.66%; 95% CI, 0.60%-0.74%; non-college: 0.61%; 95% CI, 0.55%-0.69%), while co-use of alcohol and marijuana increased annually between 2002 and 2018 among all young adults (college: 0.60%; 95% CI, 0.51%-0.68%; non-college: 0.56%; 95% CI, 0.48%-0.63%). Young adults who reported co-use of alcohol and marijuana or met criteria for alcohol use disorder and/or marijuana use disorder accounted for 82.9% of young adults with prescription drug use disorder and 85.1% of those with illicit drug use disorder. More than three-fourths of those with both alcohol use disorder and marijuana use disorder reported past-year prescription drug use (78.2%) and illicit drug use (77.7%); 62.2% reported prescription drug misuse. CONCLUSIONS AND RELEVANCEThe findings of this study suggest that US colleges and communities should create and maintain supportive resources for young adults as the substance use landscape changes, specifically as alcohol abstinence, marijuana use, and co-use increase. Interventions for polysubstance us...

Objective: To assess the relationships between adverse childhood experiences (ACEs) and comorbid Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) substance use and mental health disorders across 5 sexual orientation subgroups: lesbian/ gay, bisexual, unsure, discordant heterosexual (ie, heterosexualidentified with same-sex attraction or behavior), and concordant heterosexual. Methods: Data were from the 2012−2013 National Epidemiologic Survey on Alcohol and Related Conditions-III, a cross-sectional, nationally representative survey of non-institutionalized US adults. Data were collected in households via structured diagnostic faceto-face interviews; the overall response rate was 60.1%. The sample included 36,309 US adults aged 18 years and older. Results: Sexual minorities (gay, lesbian, bisexual), especially bisexual women, reported the highest prevalence of ACEs and comorbid substance use and mental health disorders.Approximately 43.8% of bisexual women reported 4 or more ACEs, and 38.0% of bisexual women reported comorbid substance use and mental health disorders. Multivariable regression analyses indicated a curvilinear relationship between ACEs and comorbid substance use and mental health disorders, and sexual minorities consistently had a higher ACE mean than concordant heterosexual respondents. The majority of sexual minorities with high levels of ACEs had comorbid substance use and mental health disorders. Conclusions: Sexual minorities are exposed to more ACEs than their heterosexual counterparts in the US. We found evidence that US sexual minorities are at higher risk of comorbid substance use and mental health disorders. These findings reinforce the importance of identifying exposure to ACEs and developing trauma-informed interventions to treat comorbidities in those exposed to multiple ACEs, especially sexual minorities.

Objective To examine whether age of onset, duration, or type of medication therapy for attention-deficit/hyperactivity disorder (ADHD) is associated with substance use during adolescence. Method Nationally representative samples of high school seniors were surveyed via self-administered questionnaires. The sample consisted of 40,358 individuals from ten independent cohorts (2005-2014) and represented a population that was 52% female, 62% White, 10% African-American, 14% Hispanic, and 14% other. Design-based logistic regression analyses were used to test the associations between age of onset, duration, and type of ADHD medication therapy and recent substance use, controlling for potential confounding factors. Results Individuals who initiated stimulant medication therapy for ADHD later (ages 10-14 and 15 years and older) and for shorter duration (2 years or less and 3-5 years) as well as those who reported only non-stimulant medication therapy for ADHD had significantly greater odds of substance use in adolescence relative to individuals who initiated stimulant medication therapy for ADHD earlier (aged 9 or less) and for longer duration (6 or more years). The odds of substance use generally did not differ between population controls (youth without ADHD and unmedicated youth with ADHD) and individuals who initiated stimulant medication for ADHD early (aged 9 or less) and for longer duration (6 or more years). Conclusion Relative to later onset and shorter duration of stimulant treatment for ADHD, early onset and longer duration of stimulant treatment for ADHD was associated with a risk of substance use during adolescence that is lower and similar to that in the general population.

Background: Prescription drug misuse (PDM) is most prevalent during young adulthood. We aimed to identify PDM trajectories for three classes (opioids, stimulants, sedatives/tranquilizers) from adolescence into adulthood, assess the extent to which different trajectories are associated with substance use disorder (SUD) symptoms, and identity factors associated with high-risk PDM trajectories. Methods: Nationally representative probability samples of 51,223 U.S. adolescents were followed longitudinally across eight waves from age 18 (cohorts 1976-1996) to age 35. Data were collected via self-administered paper questionnaires.

Objectives: This study examined the associations between childhood household dysfunction and adulthood past-year DSM-5 alcohol, tobacco, and other substance use disorders across sexual orientation subgroups (eg, lesbian/gay, bisexual, and heterosexual). Methods: Prevalence estimates were based on National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III) data collected from structured diagnostic face-to-face interviews in a nationally representative sample of 36,309 U.S. adults. Multivariable regression was used to examine associations between childhood household dysfunction and past-year substance use disorders in adulthood. Results: Sexual minorities, particularly sexual minority women, reported higher rates of childhood household dysfunction (eg, parental/household history of substance-related problems) and adulthood DSM-5 alcohol, tobacco, and substance use disorders. Results of multivariable analyses indicated that childhood histories of parental/household substance-related problems were associated with greater odds of past-year substance use disorders among sexual minorities than heterosexuals, and that such histories may moderate differences among sexual orientation subgroups. The risk of substance use disorders among sexual minority women relative to exclusively heterosexual women (ie, heterosexual-identified women without same-sex attraction or behavior) remained high, even when accounting for household dysfunction. In contrast, there were no such differences between sexual minority men and exclusively heterosexual men. Conclusions: Sexual minorities are more likely to have childhood household dysfunction which in turn is associated with a higher risk of developing DSM-5 alcohol, tobacco, and substance use disorders in adulthood, especially among sexual minority women. Healthcare providers who care for individuals raised in dysfunctional households should carefully assess risk for substance use disorders and intervene as needed.