Factors Associated with Substance Use Disorder among High-Need Adolescents and Young Adults in North Carolina

Background: Prevalence of substance use disorders (SUD) is high among adolescents and young adults (AYAs) with complex medical needs. Little is known about risk factors for SUD in this population.

Methods: This retrospective cohort study used electronic health record data from a large academic hospital system (2015-2019) to identify adolescents (aged 10-17) and young adults (aged 18-27) with intellectual/developmental disorders, psychiatric conditions, or complex medical conditions. Logistic regression was used to identify demographic, clinical, and neighborhood-level risk factors associated with SUD in this population.

Results: A total of 149 adolescents and 536 young adults had a SUD diagnosis (6.7% and 20.6%, respectively). Among adolescents, notable risk factors for SUD included age (adjusted odds ratio [aOR] = 1.42, 95% confidence interval [CI] = [1.31, 1.54]), Hispanic ethnicity (aOR = 2.10, 95% CI = [1.10, 3.99]), additional psychoactive medication classes (aOR = 1.27, 95% CI = [1.11, 1.46]), and living in a "high" child opportunity index (COI) (aOR = 2.06, 95% CI [1.02, 4.14]) or a "very high" COI (aOR = 3.04, 95% CI [1.56,5.95]) area. Among young adults, notable risk factors included being male (aOR = 2.41, 95% CI [1.91, 3.05]), being Black (aOR = 1.64, 95% CI [1.28, 2.09]), and additional non-psychoactive (aOR = 1.07, 95% CI [1.03, 1.11]) or psychoactive medication classes (aOR = 1.17, 95% CI [1.07, 1.28]).

Limitations: These descriptive analyses are limited to one large academic hospital system in North Carolina and may not be representative of all high-need AYAs in the state.

Conclusions: Several demographic, clinical, and neighborhood risk factors are associated with SUD in high-need AYAs.