of parental substance misuse in estimates of substance use outcomes,9,13 or have treated parental substance misuse as a direct form of adversity.3,7,10 Parental substance misuse could confound the association between childhood PTEs and adolescent drug use because of its association with exposure to a dysfunctional home environment, family violence, and other forms of trauma,31,32 as well as its influence on adolescent drug use through biological predisposition, access to drugs in the home, modeling behavior, low parental involvement, and social acceptability.3,6,33-38 Furthermore, parental substance misuse could also moderate the association between PTEs and drug use, because adolescents with a parent who misuses substances could be at higher risk for drug use due to predisposition, access, and modeling.
