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

John E. Schulenberg, Megan E. Patrick, Deborah D. Kloska, Julie Maslowsky, Jennifer L. Maggs, Patrick M. O'malley

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46 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)41-57
Number of pages17
JournalSubstance Abuse: Research and Treatment
StatePublished - Jan 1 2015
Externally publishedYes

Bibliographical note

Funding Information:
fUNDINg: data collection and work on this study were funded by support from the national Institute on drug abuse (R01 da016575 and R01da001411 to L. Johnston and R01da037902 to meP). Jm is a faculty research associate of the Population Research center at the university of texas at austin, which is supported by the eunice Kennedy Shriver national Institute of child health and human development Grant 5 R24 hd042849. the content here is solely the responsibility of the authors and does not necessarily represent the official views of the sponsors. The authors confirm that the funder had no influence over the study design, content of the article, or selection of this journal.

Publisher Copyright:
© 2015, © 2015 SAGE Publications.


  • J-shaped association
  • alcohol use disorder
  • cannabis use disorder
  • health and well being
  • longitudinal


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