Behrendt S, Wittchen HU, Höfler M, Lieb R, Beesdo K. Transitions from first substance use to substance use disorders in adolescence: is early onset associated with a rapid escalation? Drug Alcohol Depend 99: 68-78

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.

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    • "Similarly, no research to date has explored whether there is overlap between factors associated with earlier opportunity and those associated with the speed of progression to dependence. These include other substance use (Behrendt et al., 2009), some mental health factors (Behrendt et al., 2011) and gender (Ridenour et al., 2006; Wittchen et al., 2008). "
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    ABSTRACT: Background: There is a developing body of research looking at cannabis use opportunity, but little research examining timing of opportunity to use cannabis. Aims: Identify factors associated with 1) earlier opportunity to use cannabis and 2) faster progression from opportunity to cannabis dependence. Method: Cross-sectional study of 3824 Australian twins and siblings, measuring age of onset of cannabis use opportunity and DSM-IV cannabis dependence. Survival analysis identified factors associated with faster progression to opportunity or dependence. Results: Factors associated with both speed of progression to opportunity and dependence were conduct disorder (opportunity HR 5.57, 95%CI 1.52-20.47; dependence HR 2.49, 95%CI 1.91-3.25), parental drug problems (opportunity HR 7.29, 95%CI 1.74-30.62; dependence HR 3.30, 95%CI 1.63-6.69), weekly tobacco use (opportunity HR 8.57, 95%CI 3.93-18.68; dependence HR 2.76, 95% CI 2.10-3.64), and female gender (opportunity HR 0.69, 95%CI 0.64-0.75; dependence HR 0.44, 95%CI 0.34-0.55). Frequent childhood religious attendance (HR 0.74, 95%CI 0.68-0.80), parental conflict (HR 1.09, 95%CI 1.00-1.18), parental alcohol problems (HR 1.19, 95%CI 1.08-1.30) and childhood sexual abuse (HR 1.17, 95%CI 1.01-1.34) were uniquely associated with transition to opportunity. Depressive episode (HR 1.44, 95%CI 1.12-1.85), tobacco dependence (HR 1.36, 95%CI 1.04 – 1.78), alcohol dependence (HR 2.64, 95%CI 1.53-4.58), other drug use (HR 2.10, 95%CI 1.64-2.69) and other drug dependence (HR 2.75, 95%CI 1.70-4.43) were uniquely associated with progression to dependence. Conclusion: The profile of factors associated with opportunity to use cannabis and dependence only partially overlaps, suggesting targeting of interventions may benefit from being tailored to the stages of drug use.
    Full-text · Article · Jan 2016 · Drug and alcohol dependence
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    • "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). "
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    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.
    Full-text · Article · Jan 2015 · Drug and Alcohol Dependence
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    • "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]. "
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    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.
    Full-text · Article · Sep 2014 · Substance Abuse Treatment Prevention and Policy
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