Understanding alcohol use and co-occurring externalizing problems: A longitudinal sibling-comparison study of high-risk individuals

About This Grant

PROJECT ABSTRACT For most people, alcohol use generally peaks before age 25 years and then decreases. For some, however, alcohol use increases throughout adulthood, leading to alcohol use disorder (AUD) and many adverse mental and physical health consequences. Understanding who develops persistent AUD can inform intervention models for AUD and its consequences. Antisocial behavior (ASB) and other substance use disorders (SUDs) are often comorbid with AUD and are associated with more AUD persistence and worse psychosocial functioning among those with AUD. Three key study design features make the proposed project well- positioned to advance the science of AUD and co-occurring ASB and other SUDs. First, studies of AUD, other SUDs, and ASB are often limited by the low prevalence of these behaviors. We propose a new assessment of a highly affected longitudinal sample of 559 participants now in mid-adulthood who have high rates of AUD (67%), ASB (50% arrested), and other SUDs (cannabis = 44%, amphetamine = 16%, cocaine = 16%, opioid = 8%). Second, longitudinal data are critical to understanding when alcohol use is a cause, as opposed to a consequence, of poorer functioning (e.g., psychiatric symptoms, including ASB and other SUDs). The data collected in the proposed project would comprise the fourth assessment wave of these participants (spanning adolescence and mid-adulthood), allowing us to assess the mental and physical health effects of persistent AUD and whether other SUDs and ASB exacerbate such effects. Third, alternative explanations must be considered to understand AUD’s effects fully. We propose a sibling-comparison design that controls familial confounds while testing AUD's potential causes and consequences. Specifically, this project will combine data from the proposed participants with data from their siblings, who have been assessed in parallel with our proposed participants at three prior waves and are currently being assessed for a fourth wave in another project. Leveraging these study design characteristics, we propose to examine two common theoretical models that can help understand the nature and timing of risk/protective factors for AUD and co-occurring ASB and other SUDs. The first is that ASB and other SUDs cause or worsen AUD, or vice versa (Aim 1). The second is that AUD, ASB, and other SUDs are explained by pre-existing risk/protective factors, such as early-life risk factors (e.g., stressful environment, education), personality (e.g., impulsivity), and neurocognitive functioning (Aim 2). A final strength of this project is the inclusion of individuals who are underrepresented in alcohol research, including 36% women and 31% previously incarcerated. These sample characteristics will greatly increase the generalizability of findings from the proposed work and support our ability to examine sex differences in the causes and consequences of persistent AUD (Aim 3).