title: Associations of alcohol, nicotine, cannabis, and drug use/dependence with educational attainment: evidence from cotwin-control analyses.
abstract: BACKGROUND
  Although substance use is associated with reduced educational attainment, this association may be owing to common risk factors such as socioeconomic disadvantage. We tested whether alcohol, nicotine, and illicit drug use and dependence were associated with lifetime educational attainment after controlling for familial background characteristics.
  
  
  METHODS
  Data were from a 1987 questionnaire and a 1992 telephone diagnostic interview of 6,242 male twins (n = 3,121 pairs; mean age = 41.9 years in 1992) who served in the U.S. military during the Vietnam era and therefore, were eligible for educational benefits after military service. Reduced educational attainment (<16 years) was examined in twin pairs discordant for substance use history. Substance use and dependence risk factors assessed were early alcohol and cannabis use, daily nicotine use, lifetime cannabis use, and alcohol, nicotine, cannabis, and any illicit drug dependence.
  
  
  RESULTS
  Three significant differences were observed between at-risk twins and their cotwins: Compared to their low-risk cotwins, likelihood of completing <16 years of education was significantly increased for the following: (i) twins who used alcohol before age 18 (adjusted OR = 1.44; 95% CI: 1.02 to 2.05), (ii) twins with a lifetime alcohol dependence diagnosis (adjusted OR = 1.76; 95% CI: 1.27 to 2.44), and (iii) twins who had used nicotine daily for 30 or more days (adjusted OR = 2.54, 95% CI: 1.55 to 4.17). However, no differences in education were observed among twin pairs discordant for cannabis initiation, early cannabis use, or cannabis, nicotine, or any illicit drug dependence.
  
  
  CONCLUSIONS
  Even in a veteran population with access to military educational benefits, early alcohol use, alcohol dependence, and daily nicotine use remained significantly associated with years of education after controlling for shared familial contributions to educational attainment. The association between other substances and educational attainment was explained by familial factors common to these substance use phenotypes and adult educational attainment.
authors.affiliation: Midwest Alcoholism Research Center at Washington University, Washington University School of Medicine, St. Louis, Missouri, USA. grantj@psychiatry.wustl.edu
authors.forename: Julia D
authors.initials: JD
authors.lastname: Grant
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Scherrer
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lynskey
authors.forename: Arpana
authors.initials: A
authors.lastname: Agrawal
authors.forename: Alexis E
authors.initials: AE
authors.lastname: Duncan
authors.forename: Jon Randolph
authors.initials: JR
authors.lastname: Haber
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Heath
authors.forename: Kathleen K
authors.initials: KK
authors.lastname: Bucholz
mesh_terms: D000328:Adult; D017668:Age of Onset; D000428:Alcohol Drinking / Q000453:epidemiology*; D015331:Cohort Studies; D003627:Data Interpretation, Statistical; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004522:Educational Status; D005006:Ethnicity; D006801:Humans; D016015:Logistic Models; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology*; D008875:Middle Aged; D012307:Risk Factors; D012959:Socioeconomic Factors; D013332:Student Dropouts; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014029:Tobacco Use Disorder / Q000453:epidemiology*; D014429:Twins, Dizygotic; D014430:Twins, Monozygotic; D014728:Veterans; D047829:Vietnam Conflict