In addition to disentangling the relative contributions of direct and indirect effects of prenatal exposures on offspring outcomes, this study also has potential implications for identifying individuals who are at the highest risk for substance use and abuse. Though offspring of alcoholics are at increased risk for early onset of drinking and development of SUD, not all HR adolescents go on to develop drug or alcohol problems. The current findings indicate that individuals from a high-risk background who are also prenatally exposed to alcohol and/or cigarettes during pregnancy are especially likely to use and abuse substances, and may have the greatest need for identification and intervention.
