(40) Family History Density: Impact on Participant Substance Use Onset and Duration

Background & Introduction: Substance use disorders (SUDs) impact millions globally, with family history as a potent risk factor. However, previous research has been limited by small, homogenous samples, a focus on males, and simplistic family history measures. These studies frequently overlooked the influence of extended family members, a range of substances, and sex-specific differences in SUD transmission. Leveraging the National Epidemiological Survey on Alcohol and Related Conditions-III (NESARC-III) dataset, we examine how weighted family history density (FHD) influences the intergenerational transmission of SUDs, age at first substance use, and duration of use, focusing on sex differences.

Methods: A cross-sectional analysis of the National Epidemiological Survey on Alcohol and Related Conditions III (NESARC-III; 2012-2013) included 36,309 adults. WFHD was defined as drug or alcohol problems among first- and second-degree relatives. Linear regression models assessed the relationships between WFHD, age at onset, and duration of substance use, adjusting for sociodemographic factors. The escalation period to peak alcohol use was plotted by WFHD level, and correlation analyses examined the role of affected family members in shaping participant substance preferences and sex-stratified SUD diagnoses.

Results: Each unit increase in weighted FHD was associated with a 0.54-year earlier onset [β = -0.54, SE= 0.02], and 0.48-year longer duration (β = 0.48, SE = 0.03) of substance use. Additional analyses revealed significant substance preference concordance between family members and participants. Sex-stratified analyses indicated that males showed the strongest correlations with paternal SUDs, while females exhibited stronger correlations with maternal SUDs and higher overall correlations with family members.

Conclusion & Discussion: Higher WFHD is strongly associated with earlier initiation, faster escalation to peak use, prolonged duration of substance use, with significant concordance of substance preferences within families and sex-specific patterns in familial transmission of SUDs. These findings emphasize the importance of incorporating family history assessments into prevention and intervention strategies. Future research should explore these associations in diverse populations through longitudinal studies and examine interactions between family history and other genetic and environmental risk factors.

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