Substance Use Among US Adults at Midlife: Risk Factors and Protective Factors Among National and Milwaukee Black American Samples

OBJECTIVES: Pain interference and financial insecurity are risk factors for substance use. This study examined whether possible protective factors-religious service attendance, spirituality, and social connectedness-moderate the associations between risk factors and substance use among national and Milwaukee Black American samples of adults at midlife in the United States. METHODS: Participants were adults from the Midlife in the United States Study (MIDUS) national sample (N=4962) and the Milwaukee Black American sample (N=866). A sequential modeling approach tested main effects and moderation effects, examining whether possible protective factors (religious service attendance, spirituality, and social connectedness) moderated the associations between risk factors (pain interference and financial insecurity) and substance use. RESULTS: Our findings revealed different patterns across samples. In the national sample, pain interference (β = 0.11, 95% CI = 0.08, 0.14) and financial insecurity (β = 0.06, 95% CI = 0.03, 0.09) independently predicted substance use risk. Religious service attendance moderated the pain interference-substance use link (β = -0.03, 95% CI = -0.06, -0.002). In the Milwaukee Black American sample, financial insecurity (β = 0.15, 95% CI = 0.08, 0.22), but not pain interference, independently predicted substance use. Spirituality moderated the pain interference-substance use association (β = -0.12, 95% CI = -0.18, -0.05). Religious service attendance, spirituality, and social connectedness did not moderate the financial insecurity-substance use association in either sample. CONCLUSIONS: Religious service attendance and spirituality seem to serve as protective moderators in the association between pain interference and substance use. Faith-based interventions for those with pain interference or substance use may warrant testing.