- Nearly 20% of U.S. adults ages 18-34 misused prescription opioids between 2002 and 2018. About 2% used heroin.
- Married young adults have lower age-adjusted probability of prescription opioid misuse and heroin use.
- The presence of children in the household protects against opioid misuse, especially among single adults.
- Young adults who are not married and do not have children (“disconnected adults”) have the highest age-adjusted probability of opioid misuse.
- Increases in disconnected young adults may result in continued increases in substance use disorders and overdoses.
- Our findings reflect the importance of social connections in preventing substance misuse. Policymakers and community leaders can intervene by enacting strategies and advocating for policies that help young adults build social and community connections.
Opioid use disorders now affect over 2.1 million people in the United States, and rates of drug overdose have skyrocketed over the past three decades.1 Most people who misuse opioids, which includes nonmedical use of prescription opioids and use of heroin and fentanyl, begin their use during the prime family formation ages.2 In the U.S., declining marriage rates have led to increases in adults without a partner or children – a group we refer to as “disconnected adults”. These family structure changes have coincided with the dismantling of economic and social institutions that once acted as safety nets, leading to increases in opioid misuse as self-medication for psychological pain, distress, and disconnection from work, family, and social institutions.
This brief summarizes findings from our recent peer-reviewed study published in Drug and Alcohol Dependence. Using nationally representative data on adults ages 18-34 from 2002-2018, we examined the links between family structure (marital status and presence of children in the household) and opioid misuse. We found that married young adults have lower age-adjusted probabilities of prescription opioid misuse and heroin use, and that the presence of children in the household is associated with lower age-adjusted probabilities of prescription opioid and heroin use, especially among those who have never been married. These findings persisted even after accounting for several demographic and socioeconomic characteristics of respondents. Our findings suggest that increases in disconnected adults in the U.S. may result in continued increases in substance use disorders and overdoses. Policymakers and practitioners must enact strategies to facilitate social connections that impart meaning and structure for young adults.
Who is at Greater Risk of Opioid Misuse?
Nearly 20% of U.S. adults ages 18-34 misused prescription opioids between 2002 and 2018. About 2% used heroin. Prescription opioid misuse increased between 2002 and 2006, leveled off in 2007-2010, and declined from 2011 to 2018. Heroin use increased from 2002 to 2014, but then declined after 2014.
We found that adults with children and who are married were less likely to report prescription opioid misuse and heroin use (see Figures 1 and 2). Adults who are both single and without children are at greatest risk of opioid misuse. These findings hold even when controlling for factors that might influence marriage, childbearing, and opioid use: educational attainment, employment status, age, race/ethnicity, and metropolitan status. A lack of social ties, such as those provided through marriage and children, can lead to social isolation and put young adults at greater risk of opioid misuse than adults with strong family and community ties. The presence of children in the household might be particularly important for otherwise disconnected young adults, because children may provide meaning, social bonds, links to institutions, and constraints on time use that are associated with lower probability of opioid misuse.
Social Connections as a Solution
The share of married adults with children has fallen in the U.S., and these trends are projected to continue. Changes in family structure have occurred simultaneously with widespread economic restructuring and the dismantling of the U.S. social safety net. These shifts have contributed to increases in economic insecurity among recent cohorts entering the traditional ages of family formation. Economic insecurity contributes to family conflict and breakdown, undermining important supports against substance misuse. There is no quick fix to restoring social safety nets or reversing family structure trends. Decades of failed policy interventions have tried to enforce or coax family formation through punitive approaches that deny support to those without such connections. Our findings suggest that new policy efforts, like expanded Child Tax Credits, that enable people to achieve the families they wish to have in the contemporary environment, may have long-run benefits in preventing substance misuse. In the nearer term, we see our findings as reflecting the importance of fostering social connections within communities.
Family is only one source of social connection. Many other institutions play important roles in promoting social connections and providing support. Meaningful employment, friendships, and participation in faith-based and other community organizations also provide support, purpose, and meaning. Policymakers, educators, faith leaders, and community leaders can intervene by enacting strategies and advocating for policies that help young adults build social connections within their communities. If we want to keep people from misusing drugs, we must provide opportunities for everyone to engage in activities that bring meaning and purpose.
Data and Methods
We used data on 401,404 U.S. adults aged 18-34 from the 2002-2018 waves of the National Survey on Drug Use and Health (NSDUH), which is representative of the U.S. civilian population with fixed addresses. We tested the relationships between marital status and presence of children in the household with past-year prescription opioid misuse and heroin use. The full peer-reviewed paper also reports findings for injection needle use. See additional methodological details and full findings here: https://www.sciencedirect.com/science/article/abs/pii/S0376871621001630.
- Dydyk, A. M., Jain, N. K., & Gupta, M. (2020). Opioid Use Disorder. In StatPearls. StatPearls Publishing. http://www.ncbi.nlm.nih.gov/books/NBK553166/
- Verdery, A. M., England, K., Chapman, A., Luo, L., McLean, K., & Monnat, S. (2020). Visualizing Age, Period, and Cohort Patterns of Substance Use in the US Opioid Crisis. Socius, 6, 2378023120906944.