The Natural Course of Substance Use and Dependence

Substance use and substance use disorders show normative epidemiological age-related trends, with typically onset in the late adolescent to young adult years, manifesting peak prevalences in emerging adulthood, and decreasing thereafter. Although less prevalent in older adults, substance misuse is more consequential when present and thus represents a public health concern. Careful examination of the population-based empirical literature indicates the necessity of viewing substance involvement in the context of development, with unique developmental factors associated with its onset, course, and resolution. Many individuals who suffer from a substance use disorder appear to “recover” without formal treatment. Despite normative age-related trends, there is considerable individual course variation, and modern statistical techniques have identified several distinct prototypic courses that appear to differ in their determinants and consequences. Research using a lifespan perspective on substance use and misuse has powerful implications for the design of effective, developmentally informed prevention and intervention programs.