Socio‐demographic risk factors for alcohol and drug dependence: the 10‐year follow‐up of the national comorbidity survey

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Abstract
Aims Continued progress in etiological research and prevention science requires more precise information concerning the specific stages at which socio‐demographic variables are implicated most strongly in transition from initial substance use to dependence. The present study examines prospective associations between socio‐demographic variables and the subsequent onset of alcohol and drug dependence using data from the National Comorbidity Survey (NCS) and the NCS Follow‐up survey (NCS‐2). Design The NCS was a nationally representative survey of the prevalence and correlates of DSM‐III‐R mental and substance disorders in the United States carried out in 1990–2002. The NCS‐2 re‐interviewed a probability subsample of NCS respondents a decade after the baseline survey. Baseline NCS socio‐demographic characteristics and substance use history were examined as predictors of the first onset of DSM‐IV alcohol and drug dependence in the NCS‐2. Participants A total of 5001 NCS respondents were re‐interviewed in the NCS‐2 (87.6% of baseline sample). Findings Aggregate analyses demonstrated significant associations between some baseline socio‐demographic variables (young age, low education, non‐white ethnicity, occupational status) but not others (sex, number of children, residential area) and the subsequent onset of DSM‐IV alcohol or drug dependence. However, conditional models showed that these risk factors were limited to specific stages of baseline use. Moreover, many socio‐demographic variables that were not significant in the aggregate analyses were significant predictors of dependence when examined by stage of use. Conclusions The findings underscore the potential for socio‐demographic risk factors to have highly specific associations with different stages of the substance use trajectory.