For better and for worse: Evidence of differential susceptibility to environmental adversity in youth substance use from the cVEDA cohort
Asian Journal of Psychiatry, 124, 105116, doi: 10.1016/j.ajp.2026.105116
Abstract
BACKGROUND: Familial vulnerability and environmental adversity are both associated with adolescent substance-use, yet their joint effects remain insufficiently characterized. This study examined their interaction using a latent gene-environment (GxE) framework in the cVEDA cohort. METHODS: The sample included 3786 adolescents and young adults aged 12-24 years. Familial vulnerability was indexed as the family-history density (FHD) scores derived from the pedigree for medical and psychiatric conditions, adjusted for degree of relatedness. Environmental adversity was captured using measures of childhood adversity, school climate, and parenting experiences. Substance use summarized as a global continuum of risk score from the WHO ASSIST. Weighted latent G×E models were estimated using an alternating optimization approach, adjusting for age and sex. Competing susceptibility patterns were compared, and predictive performance was evaluated using five-fold cross validation. RESULTS: Familial vulnerability and environmental adversity were each associated with greater substance use involvement, with evidence that familial vulnerability amplified environmental effects. The latent familial composite was driven primarily by family history of alcohol dependence (ηp2=0.03) and other psychiatric disorders (ηp2=0.044). The latent environmental composite was dominated by adverse childhood experiences (ηp2=0.042) and unsafe school climate (ηp2=0.029), with smaller contributions from childhood neglect and negative parenting practices (ηp2textless0.01). Model comparisons suggested a weak differential susceptibility pattern. Cross validation showed good discrimination (AUC=0.84). CONCLUSIONS: Youth with greater familial vulnerability appear more environmentally sensitive, consistent with a "for-better-and-for-worse" pattern typical of differential susceptibility model. Integrating family risk screening with interventions targeting school climate, childhood adversity, and parenting may help identify targets for substance use prevention.