Substance use and mental health symptoms in adults with prenatal alcohol exposure.

BACKGROUND: Substance use and mental health problems have been documented in individuals with prenatal alcohol exposure (PAE) in young adulthood, but little is known about how these patterns progress over time into midlife. The current study examined rates of substance use in a sample of adults with PAE in mid-life compared to a demographically similar contrast group.

METHODS: Participants (n = 233) were drawn from two longitudinal cohorts of individuals recruited prenatally and followed into adulthood. Measures of cognition, substance use, and self-reported mental health functioning were obtained.

RESULTS: Differences among groups (PAE no dysmorphology, PAE with dysmorphology, No PAE contrast group) were examined on demographic variables of interest and substance use outcomes. Both PAE groups experienced higher levels of Adverse Childhood Experiences (ACEs) compared to the contrast group. We also observed higher rates of current tobacco use in those with PAE; those with PAE and no dysmorphology had almost twice the rate of current tobacco use as the nonexposed contrast group. We observed similar rates of high risk drinking on the Alcohol Use Identification Test (AUDIT) in all groups. Individuals with PAE also showed high rates of cannabis use compared to national averages. Generalized linear regressions examining predictive effects of PAE on substance use outcomes did not show significant results, though female sex at birth was predictive of current cannabis use. Current alcohol use predicted depression and PTSD symptoms, and significant interactions were observed between PAE group and ACEs on depression, PTSD, anxiety, and psychotic symptoms.

CONCLUSION: This is one of the only studies to examine rates of alcohol and other substance use among adults in mid-life with PAE. Results suggest that relationships between PAE, substance use, and mental health symptoms are complex, and it will be important for future studies to examine factors associated with high-risk substance use among this vulnerable population.