Examination of Early Substance Use and Lifetime Depression on Risky Behavior in Adulthood

Background and Purpose: Driving under the influence is a high-risk behavior that impacts not only the individual engaging in such behavior but also many others. In 2023, the National Highway Traffic Safety Administration recorded 12,429 fatalities and far more injuries associated with driving under the influence. Early substance use and mental health can influence decision-making and engagement in high-risk behaviors during adulthood. The purpose of this study is to examine the associations between early substance use and a history of depression on driving under the influence in adulthood to improve our understanding of this risky behavior.

Methods: The data for this study come from the 2023 National Survey on Drug Use and Health (n=44,560). Depression was measured as a binary variable; respondents were coded as “1” if they met the diagnostic criteria for having experienced a major depressive episode during their lifetime. Early substance use was binary; respondents were asked how old they were when they first used various drugs. If respondents reported any alcohol or illicit drug use before age 18, they were coded as “1”. Risky behavior was also a binary measure; respondents answered several questions regarding driving under the influence of alcohol and illicit drugs in the past year; they were coded as “1” if they reported driving under the influence of any substances. Logistic regression analysis was used to examine the likelihood of driving under the influence based on a history of depression and early substance use while controlling for sex, current age, race, education, and marital status.

Results: Approximately 5.4% of individuals reported driving under the influence of alcohol or illicit substances. Binary analysis indicates that both a history of drug or alcohol use before age 18 (x2=2.4e+3, p<0.001) and a lifetime history of depression (x2=1.1e+3, p<0.001) increase the chance of driving under the influence in adulthood. Logistic regression findings revealed that a history of depression (AOR=4.03, 95% CI [3.22, 5.04], p<0.001) and early substance use (AOR=9.85, 95% CI [8.45, 11.49], p<0.001) significantly affected driving under the influence in adulthood. However, a significant negative interaction effect was noted between depression and early use (AOR=0.49, 95% CI [0.39, 0.62], p<0.001) on driving under the influence. Other significant results include the comparison of females to males (AOR=0.57, 95% CI [0.53, 0.62], p=0.001) and marital status, where being married significantly reduces the likelihood of driving under the influence compared to those who have never been married (AOR=0.55, 95% CI [0.49, 0.62], p<0.001).

Conclusion and Implications: Although only 5.4% of individuals report driving under the influence, the consequences of such behavior can affect anyone, highlighting the need to improve our understanding of contributing factors. Early substance use and a history of depression both positively influence engagement in risky behavior during adulthood; however, the combined effect of these variables negatively impacts driving under the influence in adulthood. These findings indicate that future research is necessary to understand how compounding stressors affect high-risk behaviors associated with substance use.