Consistency of patterns of drug use

Prior cigarette smoking initiation predicting current alcohol use: evidence for a gateway drug effect among California adolescents from eleven ethnic groups

Gateway drug theory provides a useful framework for understanding drug use among adolescent populations. Studies have reported a gateway effect of cigarette smoking on alcohol use among adolescents; but there is a lack of knowledge regarding ethnic differences in this effect. Using data from a cross-sectional survey in California, 11,239 subjects (46.3% male) from 31 high schools with at least 25% of total enrollment of Asian and at least 200 students with Asian ancestry entered the analysis. Among them, 6016 were ninth graders (mean age=14.3, S.D.=0.49) and 5223 were twelfth graders (mean age=17.3, S.D.=0.54). After controlling for seven variables, the risk ratio of last 30-day alcohol use among prior smoking initiators vs. noninitiators was 5.82 for non-Hispanic Whites, 4.25 for Blacks, 8.37 for Asian Indians, 3.99 for Chinese, 3.45 for Filipinos, 3.48 for Japanese, 5.41 for Koreans, 7.57 for Vietnamese, 4.02 for Mexicans, 2.64 for South/Central Americans, and 5.95 for adolescents with multiethnic background. Comparison of the 11 ethnic groups indicated that adolescents from different ethnic groups but with similar cultural background had a similar risk level; such pattern existed after controlling for acculturation, parents' monitoring, and school performance. The risk ratio did not differ by gender and grade. There is an association between prior cigarette smoking initiation and current alcohol use among adolescents from different ethnic backgrounds, including those of multiethnicity, which supports the generalizability of gateway drug effect of cigarette smoking on alcohol use. Studies should be conducted to investigate factors attributable to the ethnic variations of this association.

Assessment of drug involvement: applications to a sample of physicians in training

The investigators examined survey data of lifetime and recent drug use in national samples of 2036 senior medical students and 1772 resident physicians to test whether patterns of lifetime drug use could be characterized adequately by a single underlying dimension of 'drug involvement'. The data analysis was based on a two parameter normal item response theory (IRT) model using the marginal maximum likelihood estimation method. The results showed that a single latent dimension of 'drug involvement' characterized individual drug use differences on the following measures: substances ever used, substances used in the previous year or previous month, and the sequential order of first use for each substance. The dimension was equivalent for students and resident physicians, and for both genders. Those who professed 'no religion' tended to be more drug involved. Physicians-in-training with a higher drug involvement score based on lifetime use were more likely: (a) to have used higher-ranking drugs (such as LSD and prescription opiates) in the past year; and (b) to have used a greater number of different drugs during the past month. Subjects first began to use each of the substances in a relatively invariant sequence corresponding to that predicted by the model. The implications of this model for evaluating the drug use histories of physicians-in-training, for identifying subgroups at greater risk for continued drug involvement after the beginning of medical training, and for further psychological, biological, and sociocultural research on the nature of 'drug involvement' are discussed.

Model for quantifying the drug involvement of medical students

We have applied a two-parameter normal item-response model to analyze data on "drugs ever used" by freshman medical students, then used the result to predict their subsequent drug use patterns over the first 18 months of medical school. Our results provide strong evidence for the existence of a single latent dimension of "drug involvement," and they demonstrate that a student's initial position on this dimension predicts subsequent drug use well. The model applies to male and female students equally well, suggesting the dimension is not sex specific. Students' drug use is cumulative in the sense that an individual tends to add new drugs to all previous drugs, rather than "graduating" from a previous to a new drug, as he/she becomes more "drug involved." Greater "drug involvement" is also associated with more frequent use of most drug categories.

Patterns of drug use from adolescence to young adulthood: II. Sequences of progression

Major pathways of progression among legal, illegal, and medically prescribed psychoactive drugs from adolescence to young adulthood are described. The data are based on a follow-up cohort of former adolescents representative of high school students in grades 10 and 11 in New York State who were reinterviewed nine years later at ages 24-25. Various models of progression are tested for their goodness of fit. The patterns formerly observed in adolescence involving progression from one class of legal drug (either alcohol or cigarettes) to marijuana to the use of other illicit drugs appear in the transitional period into young adult, with an additional stage, that of prescribed psychoactive drugs. Some differences appear between men and women, with cigarettes more important for women than for men in the total progression.

Problem drinking and the dimension of involvement with drugs: a Guttman scalogram analysis of adolescent drug use

Analyses of data from two nationwide surveys of high school students, one carried out in 1974 and the other in 1978, suggest that problem drinking may be seen as yet another step along an underlying dimension of involvement with both licit and illicit drugs. The dimension of involvement with drugs consists of the following levels: nonuse of alcohol or illicit drugs; nonproblem use of alcohol; marijuana use; problem drinking; use of pills (amphetamines, barbiturates, hallucinogenic drugs); and the use of "hard drugs" such as cocaine or heroin. The dimension possesses excellent Guttman-scale properties in both national samples as well as in subsamples differing in gender and ethnic background. The ordering of the levels of involvement was confirmed by the ordering of the alcohol-drug involvement groups based on their mean scores on measures of psychosocial proneness for involvement in problem behavior. The excessive use of a licit drug, i.e., problem drinking, appears to indicate greater involvement in drug use than does the use of an illicit drug, marijuana. This finding points to the importance of distinguishing between use and problem use of drugs in efforts to understand adolescent drug involvement.

Sequential use of drugs and alcohol: a reexamination of the stepping-stone hypothesis

This study examines sequential use of various drugs and alcohol among 1544 subjects being treated for substance abuse in 10 treatment centers. Several models were developed to examine drug usage with respect to specific lags dealing with the number of years between periods of beginning use of different types of drugs. The models also assessed the relationships between the lags from first to regular use of specific drugs. Length of use and amount of the drug used first in a sequence are associated with the lag from regular use of that drug to regular use of another drug--especially when the initial drug is marijuana. Contrary to expectation, shorter lags from first to regular alcohol use point toward longer lags from regular alcohol use to use of other drugs. However, the lag from first to regular alcohol use is positively related to the lag from first to regular marijuana use.

Concurrent and sequential use of drugs and alcohol: patterns, characteristics of users, and implications for treatment and prevention

A treatment population of 1,544 drug/alcohol abusers at 10 combined treatment centers was studied to determine the various patterns of sequential use and their corresponding policy implications. Most of the persons who began their substance abuse with alcohol continued to use only alcohol. Alcoholics who did use another substance, either sequentially or concurrently, tended to select a drug other than opiates or marijuana. Although a majority of opiate users eventually became concurrent or sequential users of another substance, a sizable number remained mono-users. A miniscule number of the opiate users moved on to alcohol or marijuana. Most of the users initiated into regular use with marijuana eventually began to use a nonopiate, nonalcoholic substance. A majority of the users who started with a nonalcohol, nonopiate, nonmarijuana substance eventually used marijuana. Sequential and concurrent users in general were more similar to each other than to mono-users. The implications of the development of drug use typologies for direct treatment are discussed. Having identified target groups, the author then suggests policies for controlling substance abuse indirectly, such as those dealing with employment.

Temporal patterns of the use of non-prescribed drugs

Licit and illicit non-prescribed drugs, regardless of their classification, are used in a common temporal pattern with the possible exceptions of caffeine and cocaine. The temporal patterns of drug use are highly correlated with the nationwide temporal pattern of TV watching, suggesting a pleasure-oriented, recreational use. The peak times for substance use and abuse may have implications for the delivery of professional or paraprofessional services.

Adolescent drug use: an analysis

In a survey of self-reports to a 60-item questionnaire from 3,348 students in Grades 8 to 12, an increase with age was found in the use of alcohol, tobacco, marijuana, and the hallucinogens. Interestingly, the female Ss reported greater use of tobacco from Grades 8 to 11 than males. Alcohol still headed the list of favorite drugs, with 73% of the seniors reporting its use. Adequacy of family communication was negatively associated with drug usage, with peer advice and help being sought more frequently when youth were involved with drugs. Fear of harmful physiological effects was an important deterrent to the use of these substances; fear of arrest was not. Of the different hypotheses for drug use, strongest support was shown for differential association. Peer use of illegal drugs was an important correlate of the adolescents' use of these substances

Methods of administration of street drugs: stereotypes, actuality, and perceived dangers

Youthful multiple drug users and abusers were interviewed to ascertain their methods of self-administration of street drugs. Stereotypes associating a particular drug with a particular method of self-administration are of dubious value. They do not reflect the diversity of methods commonly employed by users. Both drug substance and method of administration have a marked influence on users' judgments of the danger of various drug experiences.

Some social and personality correlates of heroin use

Two groups of Ss, one heroin knowledgeable and one heroin naive, were administered tests of personality and degree of contact with the drug culture. It was predicted that: (1) drug use is related to association with other users, (2) personality measures would distinguish heroin from non-heroin users, and (3) heroin-knowledgeable Ss would be more impulsive in their judgments than heroin-naive Ss.