Adolescent polysubstance use is a robust predictor of problematic substance use in adulthood (Moss et al., 2014). One innovative methodological approach to discover distinct individual-level patterns of polysubstance use is latent class analysis (LCA). Recent systematic reviews indicate that the majority of LCA studies identify-three classes among adolescents with polysubstance use: (1) no/low polysubstance use, (2) occasional polysubstance use (or extensive single substance use), and (3) high polysubstance use, with class prevalence decreasing with greater polysubstance use (Halladay et al., 2019, Tomczyk et al., 2016). Studies using this approach have found high stability in those with no polysubstance use and those with high polysubstance use across adolescence, while those with experimental polysubstance use often transition to greater substance use or more harmful substances (Choi et al., 2018, Mistry et al., 2015, Zych et al., 2020). Only a few of these studies have examined substance use outcomes in adulthood, which suggest that high polysubstance use during adolescence is associated with high levels of substance use in adulthood (Jackson et al., 2008, Merrin and Leadbeater, 2018, Merrin et al., 2018, Schweizer et al., 2014). However, possible mediating mechanisms underlying adolescent polysubstance use and adult substance use disorder have yet to be examined. The identification of targetable mediators, such as coping strategies, that may underlie the association between adolescent polysubstance use and the development of alcohol use disorder (AUD) and substance use disorder (SUD) diagnoses in adulthood remains an important goal with critical translational implications.
Distinct coping strategies in response to stress have been identified, which show stability across adolescence and adulthood (Amirkhan and Auyeung, 2007, Compas et al., 2017). Maladaptive coping strategies in response to stressful situations, such as aggressive, reactive, and substance use behaviors, are related to greater psychopathology and substance use in adolescents and adults as these behaviors tend to further increase stress and undermine adaptive responses to stressors (Compas et al., 2017, Hasking et al., 2011, Metzger et al., 2017). Alternatively, cognitive coping is one adaptive coping strategy that involves explicit thought and reflection following exposure to stress which allows individuals to constructively deal with stress (Shapiro et al., 2006). Some research has linked adaptive coping strategies to reduced substance use in adolescence and adulthood (McConnell et al., 2014, Van Gundy et al., 2015). Collectively, aggressive, reactive, substance use, and cognitive coping strategies are distinct but interrelated yet haven’t been investigated in a unified model to tease apart their relative importance to adult substance use or disordered outcomes. Even less is known about how multiple coping strategies may mediate the association between adolescents’ polysubstance use and adult AUD and SUD.
Associations between coping strategies and substance use are likely to be bidirectional. While there is consistent evidence that difficulties with coping predict substance use later in life (Compas et al., 2001, Compas et al., 2017), far less work has examined the possibility that adolescent substance use predicts coping behaviors. In one exception, Magee and Connell (2021) found that early alcohol use predicted escalations in the reliance on substance use to cope with stress across emerging adulthood. Adolescent substance use may lead to stress in various domains, such as problems with school, work, and family, all of which amplify risk for substance use problems later in life (Bugbee et al., 2019, Russell et al., 2019). In turn, exposure to such stress can lead to maladaptive coping (Coyle and Vera, 2013, Dise-Lewis, 1988, van der Linden et al., 2018). Thus, the ability to cope with difficult situations might be an important mechanism in predicting whether adolescent polysubstance use leads to substance use outcomes in adulthood (see Compas et al., 2017 for a review). More specifically, adolescent polysubstance use may be associated with maladaptive or adaptive coping in the face of stress in late adolescence and early adulthood, increasing (or decreasing) subsequent risk for AUD and SUD later in life.
The present study addresses this important gap in the literature by examining late adolescent/early adult aggressive coping, reactive coping, substance use coping, and cognitive coping as multiple mediators in the association between adolescent polysubstance use classes and AUD and SUD in adulthood. First, we hypothesized that three latent classes of adolescent polysubstance use would be identified: (1) no/low use, (2) experimental polysubstance use, and (3) high polysubstance use. Second, we hypothesized direct associations between latent classes of polysubstance use and AUD/SUD diagnoses in adulthood, such that adolescents in a high polysubstance use class would be at the greatest risk for developing an AUD or SUD compared to those in a low polysubstance use class. Finally, we hypothesized that those in the high polysubstance use class would be more likely to engage in aggressive, reactive, and substance use coping and less likely to engage in cognitive coping compared to those in the low polysubstance use class, which in turn would predict AUD and SUD.
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