Drug use among youth: National survey data support a common liability of all drug use
Introduction
The medicalization, legalization, and normalization of marijuana use has invigorated a debate on whether this substantial legal and social transformation will significantly modify current patterns of marijuana use and other potentially hazardous substances, especially among youth (D'Amico et al., 2015; Hall et al., 2016). Concurrent with these social and legal changes, scientific evidence is accumulating that initiation of marijuana, alcohol, and cigarette smoking during adolescence heightens susceptibility to addiction and other adverse consequences (Degenhardt et al., 2016; Jordan & Andersen, 2017; Khokhar et al., 2018; Meruelo et al., 2017; Tice, 2013). The heightened vulnerability of youth to addiction, other adverse consequences, and the lamentable rise in opioid use disorders and death (Madras, 2017) provide a compelling rationale to prevent youth substance use nationally as a public health priority. Research has examined many risk and protective factors for initiation and escalation to compulsive use. Effective prevention may be optimized by addressing all substance use rather than focusing on individual substances.
As marijuana availability has risen with increasing legal and social acceptance, it becomes a public health imperative to examine factors that increase marijuana use including the alcohol and tobacco (nicotine) as well as other illegal for youth. More than 40 years ago, Kandel and Faust (Kandel & Faust, 1975) investigated adolescent involvement in drug use based on random and sequential sampling of students in New York State middle and high schools. Of over 8000 students surveyed, they reported that students who smoked cigarettes and drank alcohol rapidly progressed to marijuana use within 5–6 months, but of those who had not initiated use of tobacco or alcohol, fewer than one tenth as many had used marijuana. Progression to using other illicit drugs was much higher among marijuana users than non-marijuana users. A similar conclusion was drawn from the National Longitudinal Study of Adolescent Health report, based on a large comprehensive survey of adolescents in the United States (Moss et al., 2014). This survey examined the U.S. prevalence of various patterns of early adolescent (prior to age 16) use of alcohol, cigarettes, and marijuana. It concluded that early onset of use of alcohol, marijuana and cigarettes combined was more common than initiation of individual substances in early adolescence. A recent study examining prevalence of adolescent marijuana use by groups separated by their use of cigarettes, binge alcohol use and neither substance (Miech et al., 2017) provided additional evidence for the link between use of substances (Chadi & Levy, 2017).
The generalized risk factor for initiation of substance use, based partially on international surveys, has gained traction in recent years (Degenhardt et al., 2009; Fergusson et al., 2006; Huizink et al., 2010; Mackesy-Amiti et al., 1997; Vanyukov et al., 2012). According to this interpretation, early onset of any drug use is attributable to common liabilities, with the sequence of specific drugs used influenced by individual traits, local culture, and availability (Palmer et al., 2012). Regardless of which model is sustained with ongoing epidemiological or biological study, patterns of drug use are influential in shaping prevention strategies targeting youth.
The present study examined recent patterns of substance use among 12–17 year-old adolescents from the nationally representative survey data on substance use. We specifically examined whether among youth, use of one substance is associated with increased risk for using any other substance, and conversely, whether the non-use of one substance is associated with decreased risk for using other substances. Our population-based approach, which examined generalized risk for substance use among the most vulnerable cohort of substance users, youth aged 12–17, can inform current national public health youth prevention efforts.
Section snippets
Data source
We examined data from youth aged 12–17 who participated in the 2014 National Survey on Drug Use and Health (NSDUH), conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). NSDUH provides nationally representative data on substance use among the U.S. civilian, noninstitutionalized population aged 12 or older. The NSDUH data collection protocol was approved by the Institutional Review Board at RTI International. Data are collected by interviewers during in-person
Unadjusted prevalence of past-month and lifetime substance use
Based on the sampled 17,000 youth aged 12–17 years from the 2014 NSDUH data, we estimated that among youth in the U.S., the unadjusted prevalence of past-month use of marijuana, cigarettes, alcohol, or illicit drugs other than marijuana was 7.4%, 4.9%, 11.5%, or 2.6%, respectively. The unadjusted prevalence of lifetime use of marijuana, cigarettes, alcohol, or illicit drugs other than marijuana was 16.4%, 14.2%, 29.6%, or 13.4%, respectively.
Associations between marijuana use and use of other substances
Youth who used marijuana in the past month were much
Discussion
All nonmedical drug use is illegal for youth under age 18 in the United States. Our results suggest that the decision to abstain from any drugs is associated with a lower risk of the use of all other drugs. A steadily growing percentage of American youth are refraining from any alcohol, cigarette, marijuana and other drug use, demonstrating that a youth prevention goal of “no use” is indeed attainable (Levy et al., 1975–2014; Han et al., 2017). Yet use of substances among 12–17 year-olds (
Conclusions
Since the majority of substance use disorders can be traced to initiation during adolescence, focusing on preventing substance use during adolescence is a public health imperative. This study's finding that among youth, use of any one substance significantly increases the prevalence of other substance use supports the inclusion of universal prevention interventions, which increase the percentage of adolescents making the choice to not use any of these addicting substances. This objective is
Funding sources
The Institute for Behavior and Health, Inc. received funding from the Charles Stewart Mott Foundation, grant no. 2013-00630.
Conflict of interest
Drs. DuPont, Han and Ms. Shea have no conflicts to disclose. Dr. Madras has consulted for Guidepoint and RiverMend Health.
Human participation protection
The data collection protocol of the National Survey on Drug Use and Health was approved by the Institutional Review Board at the RTI International.
Acknowledgments
The findings and conclusions of this study are those of the authors and do not necessarily reflect the views of the Substance Abuse and Mental Health Services Administration or the U.S. Department of Health and Human Services. The Institute for Behavior and Health, Inc. received funding from the Charles Stewart Mott Foundation, grant no. 2013-00630. All authors contributed to the preparation of the manuscript. Dr. DuPont and Ms. Shea developed the study concept and helped polish the manuscript,
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2022, Psychiatric Clinics of North AmericaCitation Excerpt :Most who misuse opioids have already used these so-called “gateway substances” during adolescence.21,22 While multiple studies attest to overlapping onset of substance use,23,24 neurobiological gateway mechanisms for nicotine have the most evidence. By increasing midbrain dopamine neurons’ firing rate, nicotine can amplify the reinforcing effects of other substances and nondrug rewards (see later in discussion).22,25