Transitions from first substance use to substance use disorders in adolescence: Is early onset associated with a rapid escalation?

Institute of Clinical Psychology and Psychotherapy, Technische Universitaet Dresden, Chemnitzer Street 46, D-01187 Dresden, Germany.
Drug and alcohol dependence (Impact Factor: 3.42). 10/2008; 99(1-3):68-78. DOI: 10.1016/j.drugalcdep.2008.06.014
Source: PubMed


Early substance use (SU) in adolescence is known to be associated with an elevated risk of developing substance use disorders (SUD); it remains unclear though whether early SU is associated with more rapid transitions to SUD.
To examine the risk and speed of transition from first SU (alcohol, nicotine, cannabis) to SUD as a function of age of first use.
N=3021 community subjects aged 14-24 years at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI.
(1) The conditional probability of substance-specific SU-SUD transition was the greatest for nicotine (36.0%) and the least for cannabis (18.3% for abuse, 6.2% for dependence) with alcohol in between (25.3% for abuse; 11.2% for dependence). (2) In addition to confirming early SU as a risk factor for SUD we find: (3) higher age of onset of any SU to be associated with faster transitions to SUD, except for cannabis dependence. (4) Transitions from first cannabis use (CU) to cannabis use disorders (CUD) occurred faster than for alcohol and nicotine. (5) Use of other substances co-occurred with risk and speed of transitions to specific SUDs.
Type of substance and concurrent use of other drugs are of importance for the association between age of first use and the speed of transitions to substance use disorders. Given that further research will identify moderators and mediators affecting these differential associations, these findings may have important implications for designing early and targeted interventions to prevent disorder progression.

59 Reads
  • Source
    • "Early initiation of alcohol use is associated with higher risk to develop alcohol use disorders (Behrendt et al., 2009; Grant et al., 2005), suggesting that traits may exist that predispose one to substance experimentation or sensitivity to exposure. This population is of particular interest because, although alcohol abuse and dependence is rare in adolescence, the population prevalence of these disorders jumps to 6% by late adolescence (Cohen et al., 1993; Rohde et al., 1996), particularly when they are comorbid with mood, stress-related or behavioral disorders (Aseltine et al., 1998; Clark et al., 1998), which also increase in prevalence during adolescence (Birmaher et al., 1996). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Adolescence is a period of developmental flux when brain systems are vulnerable to influences of early substance use, which in turn relays increased risk for substance use disorders. Our study intent was to assess adolescent regional cerebral blood flow (rCBF) as it relates to current and future alcohol use. The aim was to identify brain-based predictors for initiation of alcohol use and onset of future substance use disorders. Methods: Quantitative rCBF was assessed in 100 adolescents (age 12-15). Prospective behavioral assessments were conducted annually over a three-year follow-up period to characterize onset of alcohol initiation, future drinking patterns and use disorders. Comparisons amongst use groups (i.e., current-, future-, and non-alcohol using adolescents) identified rCBF associated with initiation of alcohol use. Regression by future drinking patterns identified rCBF predictive of heavier drinking. Survival analysis determined whether or not baseline rCBF predicted later development of use disorders. Results: Baseline rCBF was decreased to the parietal cortex and increased to mesolimbic regions in adolescents currently using alcohol as well as those who would use alcohol in the future. Higher baseline rCBF to the left fusiform gyrus and lower rCBF to the right inferior parietal cortex and left cerebellum was associated with future drinking patterns as well as predicted the onset of alcohol and substance use disorders in this cohort. Conclusions: Variations in resting rCBF to regions within reward and default mode or control networks appear to represent trait markers of alcohol use initiation and are predictive of future development of use disorders.
    Drug and Alcohol Dependence 01/2015; 149. DOI:10.1016/j.drugalcdep.2015.01.012 · 3.42 Impact Factor
  • Source
    • "For example, 4.5% of U.S. high school seniors report ever using cocaine one or more times during their life, 2.6% report using in the past 12 months, and 1.1% report using cocaine one or more times during the past 30 days [1]. Drug use in adolescence (especially late adolescence) is associated with increased risk for drug use disorders as well as other health and social problems such as school failure and sexually transmitted infections including HIV [2-4]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: This study examined associations between perceived neighborhood illicit drug selling, peer illicit drug disapproval and illicit drug use among a large nationally representative sample of U.S. high school seniors. Data come from Monitoring the Future (2007–2011), an annual cross-sectional survey of U.S. high school seniors. Students reported neighborhood illicit drug selling, friend drug disapproval towards marijuana and cocaine use, and past 12-month and past 30-day illicit drug use (N = 10,050). Multinomial logistic regression models were fit to explain use of 1) just marijuana, 2) one illicit drug other than marijuana, and 3) more than one illicit drug other than marijuana, compared to “no use”. Report of neighborhood illicit drug selling was associated with lower friend disapproval of marijuana and cocaine; e.g., those who reported seeing neighborhood sales “almost every day” were less likely to report their friends strongly disapproved of marijuana (adjusted odds ratio [AOR] = 0.38, 95% CI: 0.29, 0.49) compared to those who reported never seeing neighborhood drug selling and reported no disapproval. Perception of neighborhood illicit drug selling was also associated with past-year drug use and past-month drug use; e.g., those who reported seeing neighborhood sales “almost every day” were more likely to report 30-day use of more than one illicit drug (AOR = 11.11, 95% CI: 7.47, 16.52) compared to those who reported never seeing neighborhood drug selling and reported no 30-day use of illicit drugs. Perceived neighborhood drug selling was associated with lower peer disapproval and more illicit drug use among a population-based nationally representative sample of U.S. high school seniors. Policy interventions to reduce “open” (visible) neighborhood drug selling (e.g., problem-oriented policing and modifications to the physical environment such as installing and monitoring surveillance cameras) may reduce illicit drug use and peer disapproval of illicit drugs.
    Substance Abuse Treatment Prevention and Policy 09/2014; 9(1):35. DOI:10.1186/1747-597X-9-35 · 1.16 Impact Factor
  • Source
    • "The Climate Schools program was effective in delaying initiation to ecstasy use for the intervention group, compared to the control group. Even though this difference between groups diminished by the five-month follow-up, it is an important result as a substantial body of evidence has shown that early onset of drug use is a risk factor for developing a substance use disorder in later life [45,46]. The Climate Schools program was also related to a plateau in the frequency of ecstasy use in the intervention group, with this difference gradually diminishing over time. "
    [Show abstract] [Hide abstract]
    ABSTRACT: BackgroundPsychostimulants and cannabis are two of the three most commonly used illicit drugs by young Australians. As such, it is important to deliver prevention for these substances to prevent their misuse and to reduce associated harms. The present study aims to evaluate the feasibility and effectiveness of the universal computer-based Climate Schools: Psychostimulant and Cannabis Module.MethodsA cluster randomised controlled trial was conducted with 1734 Year 10 students (mean age = 15.44 years; SD = 0.41) from 21 secondary schools in Australia. Schools were randomised to receive either the six lesson computer-based Climate Schools program or their usual health classes, including drug education, over the year.ResultsThe Climate Schools program was shown to increase knowledge of cannabis and psychostimulants and decrease pro-drug attitudes. In the short-term the program was effective in subduing the uptake and plateauing the frequency of ecstasy use, however there were no changes in meth/amphetamine use. In addition, females who received the program used cannabis significantly less frequently than students who received drug education as usual. Finally, the Climate Schools program was related to decreasing students’ intentions to use meth/amphetamine and ecstasy in the future, however these effects did not last over time.ConclusionsThese findings provide support for the use of a harm-minimisation approach and computer technology as an innovative platform for the delivery of prevention education for illicit drugs in schools. The current study indicated that teachers and students enjoyed the program and that it is feasible to extend the successful Climate Schools model to the prevention of other drugs, namely cannabis and psychostimulants.Trial registrationAustralian and New Zealand Clinical Trials Registry ACTRN12613000492752.
    Substance Abuse Treatment Prevention and Policy 06/2014; 9(1):24. DOI:10.1186/1747-597X-9-24 · 1.16 Impact Factor
Show more


59 Reads
Available from