Family History of Substance Problems among African Americans: Associations with Drug Use, Drug Use Disorder, and Prescription Drug Misuse

Background: Understanding individual risk for substance use and substance use disorders is important in the efforts of reducing risk and prevention of these problems. A family history of alcohol and/or drug problems often increases the risk for these problems, however the majority of research in this area is conducted in samples that are predominantly White. African Americans face disparate outcomes from substance use and substance use disorders, and the risks for substance problems may not be the same as for Whites. A systematic review of the literature identified nine studies that examined a family history of either substance problems or substance use as a risk for substance use and substance use disorders in African Americans. Results indicate that family history is a risk factor for drug use and related problems, particularly for adolescents and young adults, but may be less of a risk factor in later adulthood. The primary aim of the current research study was to examine whether a family history of substance problems is associated with drug use, risk for drug use disorder, and prescription drug misuse in African American adults. Methods: A secondary analysis of a non-probability sample was conducted and data analyzed from participants who identified as non-Hispanic and African American. Family history was categorized by the relationship and density of the family members with substance problems. Outcome variables measured were drug use, risk for drug use disorder, and prescription drug misuse. Multivariable logistic regressions were conducted to assess the impact of family history density and sociodemographic variables (age, gender, employment status, education) on drug use, risk for drug use disorder, and prescription drug misuse. Multivariable logistic regressions were repeated for women and men separately. Results: Results indicate that male gender, those age 26 to 44 years, and family history density of substance problems increased the risk for drug use and drug use disorder in the full sample. Only family history density of substance problems was a significant risk for prescription drug misuse. However, when subgroup analyses by gender were conducted, women had more risk factors (age groups 18 to 25 and 26 to 44 years, unemployment), and family history was no longer a risk factor for prescription drug misuse in the men. Employment status was not a significant risk or protective factor for any drug outcome in the full sample, and education was not significant in the entire group or for men and women when examined separately. Conclusions: For African Americans, those with a family history of substance problems were at a higher risk for drug use, drug use disorder, and prescription drug misuse. These results were different for men and women. For men family history density was not a risk factor for prescription drug misuse. The younger age group and unemployment status were unique risk factors in women. Implications for future research and prevention efforts include considering the role of a family history of substance problems in the risk for drug use, drug use disorder, and prescription drug misuse among African Americans. Recommendations include investigating age appropriate contemporary risk factors in adult African Americans with further exploration of the gender-specific risk factors related to drug and substance use and related disorders in order to better inform intervention and prevention efforts in this population