Citation
Saavedra, Madeline; Trager, Evan; Grace, Sarah M.; Ge, Shaokui; Cheney, Ann M.; Deas, Deborah; & Moss, Howard (2019). 2.15 HOMELESSNESS IS ASSOCIATED WITH THE RISK OF SUBSTANCE USE DISORDERS AND THEIR SEVERITY IN YOUNG ADULTHOOD. Journal of the American Academy of Child & Adolescent Psychiatry.Abstract
Objectives It is well-established that adverse childhood experiences (ACEs) can have negative effects on successful adolescent development, including problematic involvement with substances. However, certain factors, such as homelessness, may increase the risk for adverse exposures and their health effects. Few studies have examined the relationship between ACEs and their impact on substance use disorders and their severity among a sample group of young adults with histories of homelessness. Methods Prospective data were analyzed from the National Longitudinal Study of Adolescent to Adult Health (Add Health). Add Health is a nationally representative longitudinal study of a sample group of adolescents in grades 7–12 in the United States started during the 1994–1995 school year. This cohort has been followed into young adulthood with 4 in-home interviews. The most recent wave was in 2008 when the sample subjects were young adults aged 24–32 years. ACE scores were computed from Add Health items derived from the CDC-Kaiser Permanente Adverse Childhood Experiences study as a template. DSM-5 -classified alcohol use disorder (AUD), tobacco use disorder (TUD), and cannabis use disorder (CUD) diagnoses were derived from Add Health items originally based on DSM-IV criteria. Consistent with DSM-5 , SUD severity was assessed by symptom counts binned into “mild,” “moderate,” and “severe” groupings. Analyses were conducted using survey-based logistic regression models adjusted for sociodemographics, and risks are reported as ORs relative to those with no homelessness exposure. Results Compared with young adults who have never experienced homelessness, those with a history of homelessness had significantly greater odds of developing an AUD (OR = 2.17, p = 0.0002). Mild and moderate AUDs were not associated with homelessness; however, severe AUD was more than 3 times more likely to occur in homeless young adults compared with their peers (OR = 3.96, p < 0.0001). For TUD, young adults who experienced homelessness were at increased risk of TUD (OR = 2.29, p < 0.0001). In terms of TUD severity, subjects who experienced homelessness had a significantly elevated risk of developing severe TUD (OR = 3.93, p < 0.0001). Likewise, young adults who have experienced homelessness had increased risks of CUD (OR = 3.12, p < 0.0001) with the most significant risk peaking at moderate CUD (OR = 4.01, p < 0.0001). Conclusions We found that young adults who were exposed to homelessness during childhood displayed heighten risk and severity for AUD, TUD, and CUD. Future research is needed to determine whether specific interventions can attenuate the impact of childhood adversity on the subsequent development of SUDs.URL
https://doi.org/10.1016/j.jaac.2019.08.107Reference Type
Conference proceedingBook Title
Journal of the American Academy of Child & Adolescent PsychiatryAuthor(s)
Saavedra, MadelineTrager, Evan
Grace, Sarah M.
Ge, Shaokui
Cheney, Ann M.
Deas, Deborah
Moss, Howard