First, stressful life events were only assessed in the 12 months prior to the NESARC Wave 3 interview and do not account for stressful life events outside of this period. Thus, the present investigation cannot address the causal or temporal relationship between stressful life events and SUDs examined in this study. It is possible that having a SUD may also increase the odds of higher life event stress. Prospectively designed studies will be an important next step in determining the directionality of the relationship between stress and SUD diagnoses. Relatedly, the assessment of stressful life events relied on retrospective recall by participants and the NESARC survey did not account for the severity of each stressful life event. It is possible that severity ratings may inform whether severe stressors were more strongly associated with AUD, TUD, CUD, or OUD than mild stressors. Similarly, many types of stressful life events were not addressed in the NESARC survey. Individuals may have been misclassified into having had no stressful life events when it is plausible that they could have experienced a stressor(s) not addressed
