Cumulative Vulnerabilities: Substance Use in Adolescence and in Recovery

Substance use and substance use disorders (SUDs) pose a significant health and economic concern in the United States. Conditions and comorbidities exist that are associated with substance use onset, continuation, and outcomes. In the theory of Reinforcer Pathology, we can categorize these conditions into vulnerabilities, or factors that may be associated with susceptibility to substance use onset and poorer outcomes in substance use recovery. The theory of vulnerabilities and reinforcer pathology is tested through three investigations. The first investigation sought to establish the relationship between cumulative vulnerabilities and adolescent substance use in a cross-sectional analysis. The second investigation evaluates the temporal relationship of cumulative vulnerabilities and substance use among adolescents. The final investigation establishes the relationship of cumulative vulnerabilities and substance use among individuals in recovery from Opioid Use Disorder. Collectively, these reports suggest that the intersection and cumulation of vulnerabilities to substance use and substance use disorders are directly related to substance use outcomes. Future research and reports in the substance use domain should consider these constructs, their accumulation, and their co-occurrence patterns.