Alcohol as a Gateway Drug: a study of US 12th graders

BACKGROUND: The Gateway Drug Theory suggests that licit drugs, such as tobacco and alcohol, serve as a “gateway” toward the use of other, illicit drugs. However, there remains some discrepancy regarding which drug—alcohol, tobacco, or even marijuana—serves as the initial “gateway” drug subsequently leading to the use of illicit drugs such as cocaine and heroin. The purpose of this investigation was to determine which drug (alcohol, tobacco, or marijuana) was the actual “gateway” drug leading to additional substance use among a nationally representative sample of high school seniors. METHODS: This investigation conducted a secondary analysis of the 2008 Monitoring the Future 12th‐grade data. Initiation into alcohol, tobacco, and other drug use was analyzed using a Guttman scale. Coefficients of reliability and scalability were calculated to evaluate scale fit. Subsequent cross tabulations and chi‐square test for independence were conducted to better understand the relationship between the identified gateway drug and other substances' use. RESULTS: Results from the Guttman scale indicated that alcohol represented the “gateway” drug, leading to the use of tobacco, marijuana, and other illicit substances. Moreover, students who used alcohol exhibited a significantly greater likelihood of using both licit and illicit drugs. CONCLUSION: The findings from this investigation support that alcohol should receive primary attention in school‐based substance abuse prevention programming, as the use of other substances could be impacted by delaying or preventing alcohol use. Therefore, it seems prudent for school and public health officials to focus prevention efforts, policies, and monies, on addressing adolescent alcohol use.     

Changes in drug behavior from the middle to the late twenties: initiation, persistence, and cessation of use

Patterns of initiation, persistence, and cessation of use of licit, illicit, and prescribed drugs are presented for a longitudinal cohort from their middle to the late twenties. The cohort is representative of adolescents formerly enrolled in public secondary high schools in New York State. No additional initiation of cigarettes, alcohol, and illicit drugs occurred in the four-year follow-up interval, except for cocaine and pills. The largest proportional increase of new users occurred for prescribed psychoactive drugs. Alcohol showed the most persistence of use, followed by cigarettes and marijuana. As the cohort ages, those who continue to use illicit drugs actively do so at lower levels of intensity than at younger ages. For each drug class, the persistence of use is strongly related to earlier intensity of involvement. By age 29, men have accumulated almost twice as many months of use of illicit drugs as women.     

Patterns of drug use from adolescence to young adulthood: III. Predictors of progression.

Possible linkages of influence among classes of drugs in the observed sequential progression from adolescence to young adulthood are investigated through event history analyses. Three stages are examined: initiation to marijuana, to the use of other illicit drugs, and to prescribed psychoactive drugs. The data are based on a follow-up cohort of former adolescents representative of high school students in grade 10 and 11 in New York State who were reinterviewed nine years later at ages 24-25. The sequential order between alcohol and/or cigarettes and marijuana reflects not only the effect of the use of legal drugs on marijuana initiation, but also age effects on onset of these drugs, controlling for individual characteristics measured in adolescence; marijuana use by one''s friends in adolescence is an additional important predictor of marijuana initiation. Prior use of marijuana is necessary for progression to other illicit drugs. Multiple factors are involved in the progression to prescribed drugs, with adolescent depressive symptomatology and use of other illicit drugs important for both sexes, and maternal use of psychoactive drugs, dropping out of school, and prior use of marijuana of additional importance for women. Although licit drugs influence initiation into marijuana independently of age effects, it is especially for the progression from marijuana to other illicit drugs that the earlier drug is associated with the progression to a higher stage drug.     

From beer to crack: developmental patterns of drug involvement.

OBJECTIVES. Prior research has identified developmental stages in drug use in adolescence, from substances that are legal for adults to illicit drugs. The position of crack in patterns of drug involvement remains to be established. METHODS. The analyses are based on a sample (n = 1108) representative of 12th graders attending New York State public and private schools. From reported ages of first use of five classes of drugs (alcoholic beverages, cigarettes, marijuana, cocaine but not crack, crack), alternate models of progression were tested for their goodness of fit through log-linear models. RESULTS. The sequence involves at the earliest stage the use of at least one licit drug, alcohol or cigarettes. Subsequent stages involve marijuana and cocaine; crack is the last drug in the sequence. The results confirm the more important role of alcohol among males and cigarettes among females in the progression into various drug classes. Age of first drug use at a lower stage is a strong predictor of further progression. CONCLUSIONS. The developmental pattern of drug involvement identified in the early 1970s still characterizes adolescent pathways of drug involvement in the late 1980s.     

The prevalence and demographic predictors of illicit and licit drug use among lesbians and gay men.

Studies on illicit and licit drug use among homosexuals of both sexes have focused primarily on gay men, used limited drug measures, and been conducted in cities known for large homosexual populations. This paper examines (1) the prevalence of 12 illicit and licit drugs by sex and age group and (2) the demographic predictors of past-year frequency of marijuana, alcohol, and cigarette use. Organizational mailing lists were used to collect self-report data on 455 homosexuals living in a southern state. Differences were found between gay men and lesbians in the use of specific substances and in the demographic predictors of drug use.     

Progression on drug use and its intervening factors among crack users

OBJECTIVE: To establish a progression on drug use and its intervening factors among crack users. METHODS: A qualitative methodology was applied for an in-depth investigation, taking into consideration the interviewees' viewpoint of the problem. Long interviews using a semi-structured questionnaire were conducted. A purposeful sampling was outlined to create a criterion sampling. For theoretical saturation, 31 crack users and former users were interviewed. RESULTS: Two distinct phases of drug use were identified. In the first phase there predominate licit drugs, mostly alcohol and tobacco, encouraged by the parents and friends and the users' need of self-assurance. An early age start and heavy use of one or both drugs are determinant for the progression to illicit drugs. Marijuana is the first drug used in the second phase, characterized by an active attitude towards drugs which are regarded as a source of satisfaction. DISCUSSION: The progression on drug use seems to be more associated to external decisions (e.g. peer pressure, drug dealers' encouragement, etc.) than to users' preference. Two different kinds of progression were identified: in younger users (<30 years old): tobacco and/or alcohol, marijuana, snorted cocaine, and crack; in older users (>30 years old): tobacco and/or alcohol, marijuana, intravenous medication, snorted cocaine, intravenous cocaine, and crack.     

Factors related to the potential risk of trying an illicit drug among high school students in Paris

To identify risk factors of trying an illicit drug among adolescents exposed to an environment strongly using licit drugs, attitude toward illicit drugs, and use of tobacco, alcohol and tranquilizers were explored in a high school in Paris, April 1990. After a semi-directive interview and a pilot test, 233 students of one class chosen at random out of three at each high school level, completed an anonymous questionnaire. Logistic regression was used to detect risk factors of trying an illicit drug. Three kinds of risk factors were identified: (a) licit drugs: alcoholic drunkenness and abstaining from tranquilizers if personal discomfort is present, (b) peer modeling: presence of a fellow using marijuana, and (c) risk notion: weak risk notion on hashish use and belief that hard and soft drug use are not related. One student in 3 appeared at potential risk of trying an illicit drug. The risk factors suggested by this study may be used to set a policy of illicit drug primary prevention among adolescent specified populations. The importance of environmental factors is underlined.     

Alcohol and Other Drug Use and Automobile Safety: A Survey of Boston-Area Teen-agers

To provide educators with information regarding students' behaviors and beliefs about drinking, drug use and driving, the authors surveyed a stratified random sample of approximately 2,000 seventh and 10th graders in the Boston area in the spring of 1982. The focus of the present paper is on those students who might be most at risk for operating a motor vehicle under the influence of alcohol or marijuana. Therefore, the analysis presented here is limited to 623 students who were 16 years of age or older at the time of the survey.
About half of the students in this age group used alcohol (63%) or marijuana (44%) and as many as 18% had used other illicit drugs during the 1982 school year. While most current drinkers (72%) drank not more than three times a month, nearly half (46%) of the current marijuana users smoked at least once a week.
A substantial proportion of students combined drug and/or alcohol use with driving. Between 43% and 50% had been a passenger with a driver who was under the influence of alcohol or marijuana at least once since the beginning of the school year. Many students did not appear to be aware of the dangers involved in driving under the influence of alcohol or marijuana and about one out of four believed they could use alcohol and other drugs responsibly.
Both students' behaviors and beliefs regarding drinking, drug use and driving were significantly related to the extent of their involvement with alcohol and other drugs. Frequent marijuana users, heavier drinkers and students who used drugs other than alcohol or marijuana were more likely than other students to combine drug use and driving and believe that these activities could be combined safely. The data suggest that the entire constellation of risk-taking and drug-using behaviors should be addressed in educational programs and that information on the effects of other drugs (both alone and in combination with alcohol) on driving ability should be emphasized.     

Patterns of drug use from adolescence to young adulthood: I. Periods of risk for initiation, continued use, and discontinuation

Patterns of initiation, continued use, and decline in drug use are described on the basis of detailed drug histories in a longitudinal cohort representative of former New York State adolescents. In this cohort, the period of major risk for initiation to cigarettes, alcohol, and marijuana, is completed for the most part by age 20, and to illicit drugs other than cocaine by age 21. Those who have not experimented with any of these substances by that age are unlikely to do so thereafter. Initiation into prescribed psychoactive drugs occurs at a later age than for the licit and illicit drugs and continues through the age period covered by the survey. A potential maturational trend in marijuana use in this cohort is apparent with a decline beginning approximately at age 22.5 for most usage patterns. The periods of highest marijuana and alcohol usage decline beginning at ages 20-21 and contrast sharply with cigarettes which exhibit climbing rates of highest use through the end of the surveillance period (age 25). Overall patterns are similar for men and women, with men initiating all drugs at higher rates than women, except for prescribed psychoactives .     

Consumption of licit and illicit drugs in Chile: results of the 1998 study and comparison with the 1994 and 1996 studies]

The principal results are presented here from the Third National Study of the Consumption of Drugs, which was carried out in Chile by the National Board for Narcotics Control between 1 September 1998 and 15 January 1999. The 1998 study used the same methodological design as the first and second studies, which were done in 1994 and 1996. The 1998 study expanded the sample to 31,665 individuals, who were representative of a population of 6,940,727 people from 12 to 64 years old, both sexes, and five socioeconomic levels and who were residents of urban areas in 62 commune administrative divisions of the 13 regions of the country. Results from the 1998 study are compared with those from 1996 and 1994. The 1998 study shows that 17.5% of Chileans have at some time in their life used one of the three illicit drugs most popular in the country: marijuana (16.8%), coca paste (2.3%), and cocaine hydrochloride (4.0%). The prevalence of use of any of the three drugs, mainly marijuana, during the preceding year was 5.3% and during the preceding month 2.2%. With respect to licit drugs, 28.4% of Chileans have at some time in their lives used antianxiety drugs, 84.4% of them have consumed alcohol, and 71.9% have used tobacco. Most of the people who once used illegal drugs have stopped doing so: 71.6% in the case of marijuana, 64.1% with coca paste, and 66.8% with cocaine hydrochloride. For legal drugs, the percentages were lower: 55.5% for anxiolytics, 16.0% for alcohol, and 34.5% for tobacco. The consumption of licit and illicit drugs was several times greater among men than among women, except for anxiolytics, whose use was three times greater among women. Drug use was more frequent among persons between 19 and 25 years old. Consumption of illegal drugs was more frequent at higher socioeconomic levels, and use of licit drugs was more common in the lower socioeconomic levels. The 50th percentile of the age of initiating drug use was 17 years for alcohol, 15 for tobacco, 30 for antianxiety agents, 17 for marijuana, 20 for coca paste, and 21 for cocaine hydrochloride. Comparing the results of the three studies shows that, after an increase in the use of licit drugs between 1994 and 1996, there was a stabilization in 1998. With illegal drugs there was a modest increase in consumption between 1996 and 1998, following a small reduction between 1994 and 1996.     

Racial/Ethnic differences in smoking, drinking, and illicit drug use among American high school seniors, 1976-89.

BACKGROUND. This paper reports racial/ethnic differences in the use of licit and illicit drugs by high school seniors in the United States. METHODS. The study uses questionnaire data from annual, nationally representative surveys of seniors from 1976 through 1989. Combined sample sizes were 57,620 for 1976-79; 75,772 for 1980-84; and 73,527 for 1985-89. RESULTS. Native American had the highest prevalence rates for cigarettes, alcohol, and most illicit drugs; White students had the next highest rates for most drugs. Asian Americans had the lowest prevalence rates, and Black students had levels nearly as low except for marijuana. Prevalence rates for the Hispanic groups were mostly in the intermediate ranges except for relatively high cocaine use among the males. Trend patterns for most forms of drug use were similar across subgroups, although cigarette use declined more sharply for Black than White seniors, resulting in greater Black-White differences in recent years. CONCLUSIONS. This study, other school-based studies, and general population surveys all show relatively low levels of drug use by most non-White youth, especially Black Americans and Asian Americans. Multivariate analyses indicate that such subgroup differences in high school seniors' drug use are not primarily attributable to family composition, parents' education, region, or urban-rural distinctions.     

Driving After Drug or Alcohol Use by US High School Seniors, 2001–2011

Objectives. We examined prevalence, trends, and correlates of driving or riding after use of drugs or alcohol among US high school seniors from 2001 to 2011.Methods. Data come from Monitoring the Future, an annual survey of nationally representative samples of high school seniors. We used logistic regressions with data from more than 22 000 respondents to examine multivariate associations with demographic and lifestyle factors.Results. Large numbers of US high school seniors put themselves and others at great risk of harm by driving after using marijuana or other illicit drugs or drinking alcohol or by riding in a vehicle whose driver had used marijuana, other illicit drugs, or alcohol. Driving after drinking has declined in recent years, but driving after use of marijuana has increased. A higher percentage of students reported driving after using marijuana than after having 5 or more alcoholic drinks. Risky driving and riding behaviors differed little between demographic subgroups but considerably according to lifestyle factors.Conclusions. Stronger efforts are needed to combat adolescent driving under the influence of illicit drugs.Motor vehicle crashes are a leading cause of mortality and morbidity among American youths.1 Alcohol is often a factor in these crashes, and alcohol-impaired driving has long been a focus of attention. In recent years, rates of driving under the influence of alcohol among American youths have declined, but are still unacceptably high.2 Impaired driving caused by use of substances other than alcohol has become an issue of increased concern. The National Institute on Drug Abuse commissioned a white paper on drugged-driving research,3 and a recent National Drug Control Strategy includes a goal of reducing drugged driving in the United States by 10% by the year 2015.4 Specifically, the Office of National Drug Control Policy aims to make preventing drugged driving a national priority on par with preventing drunk driving.5The issue of drugs and driving has been of interest to the federal government for some time. The National Highway Traffic Safety Administration commissioned Drug Use and Highway Safety, a 101-page report published in 1971.6 In 1977, the National Institute on Drug Abuse issued its 11th research monograph, Drugs and Driving.7 The institute addressed the role of marijuana in driving in a 1980 research monograph.8The National Highway Traffic Safety Administration conducted national roadside surveys of alcohol use by drivers in 1973, 1986, 1996, and 2007, but the 2007 survey was the first to include assessment of drug use.9 The 2007 survey found a dramatic decline in the percentage of nighttime drivers with blood alcohol concentrations above the legal limit of 0.08% to 2.2%, down from 7.5% in 1973.10 Among nighttime drivers, 16.3% tested positive for drugs, most often marijuana (8.6%). In another study by the traffic safety agency, data from the Fatal Accident Reporting System showed a rise in drug involvement in motor vehicle crashes.11 A recent systematic review and meta-analysis of the role of a comprehensive list of illicit or prescribed drugs in motor vehicle crashes found that most of the drugs were associated with increased risk.12 Other studies have reported on the role of marijuana in crashes.13,14 A recent systematic review of the association between marijuana use and risk of motor vehicle collision concluded that “acute cannabis consumption is associated with an increased risk of a motor vehicle crash, especially for fatal collisions.”^15(p1)Young drivers are particularly likely to be involved in motor vehicle crashes, so it is important to monitor their drug, drinking, and driving behaviors. We previously studied prevalence and trends in these behaviors among American high school seniors from 2001 to 2006 and concluded that impaired driving by youths remained a problem needing serious attention despite some modest progress in recent years.16We analyzed data from 2001 through 2011 to answer the following questions about high school seniors:

• What changes are taking place in the percentage who drive after using marijuana, using other illicit drugs, drinking any alcohol, or having 5 or more drinks?
• What changes are taking place in the percentage who ride in a vehicle whose driver has used marijuana, used other illicit drugs, drunk any alcohol, or had 5 or more drinks?
• What demographic and psychosocial characteristics are associated with these behaviors?
• What percentage of individuals who report driving after using marijuana also report driving after heavy drinking?
• What percentage of individuals who report driving after using marijuana are involved in accidents?

     

Predictors of Disapproval toward “Hard Drug” Use among High School Seniors in the US

Attitudes toward drug use strongly determine whether an individual initiates use. Personal disapproval toward the use of a particular drug is strongly protective against use; however, little is known regarding how the use of one drug affects attitudes toward the use of other drugs. Since marijuana use is on the rise in the US and disapproval toward use is decreasing, research is needed to determine whether the use of marijuana or other licit or illicit drugs reduces disapproval toward the use of “harder,” more potentially dangerous drugs. The Monitoring the Future study assesses a national representative sample of high school seniors in the US each year. This study investigated predictors of disapproval toward the use of powder cocaine, crack, lysergic acid diethylamide (LSD), heroin, amphetamine, and ecstasy (“Molly”) in a weighted sample of 29,054 students from five cohorts (2007–2011). Results suggest that lifetime use of cigarettes and use of more than one hard drug consistently lowered odds of disapproval. In multivariable models, lifetime alcohol use did not affect odds of disapproval and lifetime marijuana use (without the use of any “harder” drugs) lowered odds of disapproval of LSD, amphetamine, and ecstasy, but not cocaine, crack, or heroin. In conclusion, marijuana use within itself is not a consistent risk factor for lower disapproval toward the use of harder drugs. Cigarette and hard drug use, however, are more consistent risk factors. As marijuana prevalence increases and policy becomes more lenient toward recreational and medicinal use, public health and policy experts need to ensure that attitudinal-related risk does not increase for the use of other drugs.     

Prevalences and perceptions of licit and illicit drugs among New South Wales secondary school students, 1989

Abstract: This paper presents findings on drug prevalences for licit and illicit drugs among New South Wales secondary school students (n = 3753) in late 1989. It also considers the accuracy of students' perceptions of the drug causing the most and fewest drug-related deaths. Data were analysed by age and gender, using logistic regression for the prevalence data. Findings indicate that licit drugs (tobacco, alcohol and analgesics) were the most frequently and widely used. Rates for illicit drugs were low, although there was some degree of experimental use of cannabis which increased amongst older males. Perceptions were found to be inaccurate in emphasising the dangers of the illicit drug heroin over those of the licit drugs tobacco and alcohol. Reasons for these findings are discussed, and more in-depth research recommended into the relationship between drug prevalences and perceptions for different age groups, and its relevance for planning drug prevention initiatives.     

DRUG USE AMONG SYDNEY TEENAGERS IN 1985 AND 1986

To investigate adolescent drug use behaviour, a random community sample of Sydney teenagers aged 14 to 19 years was interviewed at home in 1985 (N=996) and again in 1986 (N=756). Respondents were asked about current use of alcohol, tobacco, marijuana, other illicit drugs, medications and inhalants. Drug use was common: 16 per cent of respondents were heavy drinkers, 28 per cent smoked tobacco, 10 per cent used marijuana and 4 per cent used drugs other than alcohol, tobacco or marijuana. Seventeen per cent were multiple drug users. Drug use was more common among boys than girls, except for tobacco smoking, and increased with age: older males had particularly high prevalences of heavy drinking, tobacco and marijuana use. The prevalence of heavy drinking, tobacco and marijuana use increased by 2–3 percent over the one year follow-up period. About half of the heavy drinkers and marijuana users, and 80 per cent of tobacco smokers had not changed one year later, which indicates the stability of these behaviours. One-third of eligible teenagers contacted at the first interview declined to participate: it is likely that this study underestimates the prevalence of drug use in the community. Heavy drinking, tobacco smoking and marijuana use remain important target behaviours for adolescent drug use prevention programs.     

Prevalence and related risk factors of licit and illicit substances use by adolescent students in Southern Taiwan

Deleterious health sequelae caused by licit and illicit substance use is a serious problem in our society. Adolescent students and particularly those who are prone to substance use are of special concern in the prevention of drug abuse. The purpose of this study was to investigate the prevalence of alcohol consumption, tobacco smoking and illicit drug use and to identify the risk factors related to these habits among adolescent students. A total of 1358 adolescent students aged 16–18 y old were recruited into this study via stratified random sampling from a vocational school in Kaohsiung city. Students were asked to complete a structured questionnaire anonymously and a 96.7% response rate was achieved. Prevalence of substances use was estimated as follows: alcohol drinking, 70.7% (boys 75.1%, girls 51.4%); tobacco smoking, 56% (boys 61.8%, girls 30.2%); illicit drug use 6.4% (boys 6.6%, girls 5.6%). Significant risk factors that emerged as common correlates with substances use were behaviour problems, non-negative attitude toward parent's substance use, and peer influence. A dose–response relationship was found between the prevalence of drinking, smoking, illicit drug use and the number of risk factors adolescents were exposed to. Prevention of adolescent substance abuse should be attempted and risk factors should be reduced. An educational approach is essential not only to gain/impart knowledge of substance abuse, but also to develop an effective program for health and social development.     

Substance abuse by adolescents in Israel and France: a cross-cultural perspective

Household surveys of urban youths 14-18 years of age were conducted in 1979 with 609 Israeli adolescents and in 1977 with 499 French adolescents. The overall order in the prevalence of use of legal and illegal drugs was identical in both countries. Cigarettes and alcohol were used by a larger proportion of young people than the illegal drugs; marijuana was used much more frequently than any other illicit drug. The same cumulative sequence of drug use appeared in the survey data for French and Israeli adolescents as in comparative data for adolescents in the United States--cigarette and alcohol use preceded the use of illicit drugs. Striking cross-cultural differences appeared in the overall lifetime and current prevalences of use of all drugs, in the frequency of use, and in the age- and sex-specific rates for adolescents in Israel and in France. French youths uniformly reported greater lifetime and current use of all alcoholic beverages, cigarettes, and illegal drugs, more extensive involvement, and smaller sex differences than the Israeli youths. Prevalence of the use of drugs in a culture appears to be associated with four social processes: higher number of times each drug has been used; greater persistence of involvement, as reflected by the proportions of current users among those who ever tried a particular drug; earlier age of first use; and a spread of the phenomenon throughout all groups in society that attenuates group differences in drug experiences. These cross-cultural results suggest a relatively conservative position with regard to accessibility and availability of substances: reducing availability may be one way to reduce individual consumption by impinging not on individual persons directly but on society.     

Health behaviours in a Canadian community college sample: prevalence of drug use and interrelationships among behaviours.

This study investigated the prevalence of drug use among a Canadian college sample and the covariation of drug taking and other health-related behaviours. A representative sample of students at a community college in Alberta were interviewed using telephone surveys, mail-in questionnaires and face-to-face interviews. Data was collected on drug, alcohol and caffeine use, cigarette smoking, eating habits, sleep habits and exercise. While use of illicit drugs did not appear to be widespread, alcohol appeared to be a primary substance abuse problem for a minority of subjects. Factor analysis indicated that the various health habits did not form one dimension of health-related behaviours. Four separate factors emerged: abusive drinking, eating habits, a drug use factor (caffeine intake, smoking, cannabis and hallucinogen use), and exercise levels. Findings are discussed in terms of their implications for future research, treatment and intervention.