Familial risk factors required to predict earlier adolescent substance use in youth with externalizing…

Cohort studyPsychology of addictive behaviors : journal of the Society of Psychologists in Addictive Behaviors· May 2026

Familial risk factors required to predict earlier adolescent substance use in youth with externalizing disorders.

Michael P Smoker, Paola P Mattey-Mora, Kathleen I Crum … Leslie A Hulvershorn

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Adolescent MedicineCohort studyPrognosisQ1IF 2.7

High-risk youth with externalizing disorders and family substance-use history initiate substance use earlier.

Familial risk factors required to predict earlier adolescent substance use in youth with externalizing disorders.

Michael P Smoker … Leslie A Hulvershorn

Psychology of addictive behaviors · May 2026 · Q1 in General Medicine

Background

Externalizing behaviors and family history of substance-use disorders (substance-use disorders) are well-established childhood predictors of adolescent and adult substance use/substance-use disorders.

Purpose

This study aimed to disentangle these risk factors and determine to what extent familial-substance-use disorders history enhances risk for substance-use/substance-use disorders development in youth with externalizing disorders.

Methods

Substance-use disorders risk status of substance-naïve youth ( n = 212), aged 11-12 years at baseline, was categorized as high-risk (HR; externalizing disorders and family history of substance-use disorders), psychiatric comparison (PC; externalizing disorders only), or typically developing comparison (typically developing comparison).

n = 212

Results

High-risk youth started substance use over twice as fast as psychiatric comparison youth.

aHR 2.31 (95% CI 1.39 to 3.83)

CI excludes the null - significant

More results

HR youth also transitioned more rapidly than PC/typically developing comparison youth to problematic substance use (aHR's 2.16/2.32, CI's [1.19-3.91, 1.05-5.11]) and to risky substance use (aHR's 2.50/2.56, CI's 1.34, 4.59/1.15, 5.67).

PC and typically developing comparison youth did not differ in substance-use trajectories.

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Conclusion · 1 of 2

Although there is considerable support for an externalizing behavioral phenotype in youth as a driver toward adolescent substance use, this predictive association was found to manifest only in the context of familial-substance-use disorders history.

Conclusion · 2 of 2

Familial substance-use disorders status may warrant particular consideration in the identification of and intervention with youth at risk for substance-use disorders. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Familial risk factors required to predict earlier adolescent substance use in youth with externalizing disorders.

Familial risk factors required to predict earlier adolescent substance use in youth with externalizing disorders.

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