Results from the present investigation provide strong support for the relationship between past year stress and transitions in past year SUD diagnoses, across all major classes of substances. In a nationally representative sample of adults in the United States, we demonstrate that adults with two or more stressful life events were 2 to 5 times more likely to have a new onset alcohol, tobacco, cannabis, or opioid use disorder compared to those with zero or one stressful life event. Similarly, adults with two or more stressful life events were 2 to 3 times less likely to have a remitted alcohol, tobacco, or cannabis use disorder compared to those with zero or one stressful life event. These epidemiological findings identify that stress, experienced as life event stress, is a critical factor associated with substance abuse onset and persistence.12,14,15,41 Notably, stress played an important role in SUD transitions similarly for both men and women, with the exception of AUD. Men with two or more stressful life events were 2.5 times more likely to have a new AUD compared to men with zero
