BOCA RATON, Fla. – Exposure to a maternal drug use disorder, particularly during adolescence, significantly increases the risk for development of a drug use disorder in children, according to a follow-up study.
Risk was more than seven times greater for girls exposed to maternal drug use disorder, compared with others without such exposure (odds ratio, 7.04), according to secondary analysis of a study of 262 girls and their family members (Pediatrics 2000;106:792-7).
Dr. Amy Yule
The initial study included structured psychiatric interviews of these girls, aged 6-17 years, as well as 290 of their siblings and 238 parents. The current study assessed risks for this cohort over 5 years. The average age of girls at 5-year follow-up was 18 years.
Timing of exposure made a significant difference, Dr. Amy M. Yule said. Risk of any offspring developing a drug use disorder was significantly higher if exposure to maternal drug use disorder occurred during adolescence (OR, 3.61), compared with preschool or childhood.
In a practical sense, these findings suggest physicians who treat children screen parents for drug use regularly, Dr. Yule said at the annual meeting of the American Academy of Addiction Psychiatry meeting. "I’m advocating people to ask parents about substance use. This can make a difference in the child’s risk of having a substance use disorder."
You can ask the questions during family history taking, but be sure not to overlook any relevant responses if this is part of a comprehensive initial consultation, said Dr. Yule, a clinical fellow in psychiatry at Harvard Medical School and Massachusetts General Hospital in Boston. Exposures were primarily to cannabis, she added. There was no significant correlation with maternal alcohol use and subsequent child risk.
Dr. Timothy E. Wilens
"The message is also it’s not okay to smoke marijuana in front of your 14-year-old," study coauthor Dr. Timothy E. Wilens said. Dr. Wilens is director of Substance Abuse Services in Pediatric Psychopharmacology, department of psychiatry, at Massachusetts General. "Pediatricians are really good with the ‘No smoking in front of kids’ message."
"The main point is getting people to ask parents if they are using and engaging parents to seek treatment or do a trial of sobriety," Dr. Yule said.
Researchers controlled for familial risk, socioeconomic status, and presence of attention-deficit/hyperactivity disorder (the original study compared 140 children with ADHD to 162 others without). "We looked at exposure only, not at genetic influence," Dr. Yule said. "You cannot change your genetics, but that could also be a [contributing factor]."
Dr. Yule was surprised that their follow-up study did not reveal the same overall associations with substance use disorder exposure cited in the original study. The 2000 study found risk associated with alcohol use, drug use, and both.
The current study focused primarily on risks between mothers and daughters. "I assume the risk is the same for paternal use," Dr. Yule said, although the smaller number of fathers precluded any such official conclusion.
Ideally, pediatricians and other physicians would start screening for parental drug use disorders when the child is in 5th grade, Dr. Wilens said. Even though most children do not start using drugs until age 12 years or older, "we want them to start asking parents about substance use earlier."
Dr. Yule said she had no relevant disclosures. Dr. Wilens is a researcher and consultant for Abbott, Lilly, Merck, and Shire. He is also a researcher for McNeil; a consultant for Astra-Zeneca; and on the speakers bureau for Lilly, McNeil, Novartis, and Shire. He consults and receives research grants from the National Institutes of Health/National Institute for Drug Abuse.