Risk of psychoactive substance dependence among substance users in a trauma inpatient population

One measure of a substance's addictive risk is the proportion of users who become dependent. This study evaluates the lifetime and current risk of substance dependence among lifetime substance users' among trauma inpatients and provides a relative ranking of addictive risk among the substances. Data on use of 8 substance groups (alcohol, opiates, marijuana, cocaine, other stimulants, sedative-hypnotics, hallucinogens, other drugs) were obtained by interview (Structured Clinical Interview for the DSM-III-R) from 1,118 adult trauma inpatients. Prevalence of lifetime dependence among lifetime users ranged from 80.7% for opiates and 70.9% for cocaine to 33.3% for hallucinogens and 26.6% for sedative-hypnotics. The rank order of addictive risk was similar to that found in the general population. Trauma inpatients had a higher absolute addictive risk than the general population, comparable to the risk found in patients in treatment for substance use disorders, suggesting the importance of screening trauma inpatients for substance dependence.     

Getting Higher: Co-Occurring Drug Use Among Marijuana-Using Emerging Adults

The most widely used illicit drug in the United States continues to be marijuana, and its use among emerging adults continues to increase. Marijuana use can result in a range of negative consequences and has been associated with other drug use in adolescents and emerging adults. This study examined the relationship between marijuana use frequency and the use of six other drug classes (opiates, cocaine, stimulants, hallucinogens, inhalants, and sleep medications) among emerging adults. A cross-sectional interview design was used with a community sample of 1,075 emerging adults in the northeastern United States. Using logistic regression analysis controlling for age, ethnicity, gender, and frequency of binge alcohol, daily marijuana use was found to be associated with a significant increase in the expected odds of opiate, cocaine, stimulant, hallucinogen, inhalant, and tobacco use. The findings identify a subgroup of emerging adult marijuana users—those who use daily—that may be vulnerable to additional negative consequences associated with polysubstance use.     

Mostly Smokers: Identifying Subtypes of Emerging Adult Substance Users

Background: The concurrent use of marijuana and other substances among emerging adults (ages 18–25) is a major public health problem. This study examined if there are distinct subtypes of emerging adult marijuana users and if these are associated with demographic and substance use variables. Methods: The design was a cross-sectional interview with a community sample of 1,503 emerging adults in the northeastern U.S. who reported last month marijuana use. We used latent class analysis (LCA) to identify distinct subtypes of emerging adults who used additional substances and examined predictors of the latent classes. Results: We identified three distinct classes of emerging adults who use substances: “mostly smokers” (those who primarily use marijuana and nicotine), “moderate users” (those who primarily use marijuana and/or heavy episodic alcohol), and “polysubstance users.” Polysubstance users had higher probabilities of use of all assessed substances (e.g. cocaine, opiates, sleep medications, stimulants, synthetic marijuana, and inhalants) than the other two groups. Not being currently enrolled in school and male gender were associated with mostly smokers and polysubstance users group status. Conclusions: We identified a distinct group of emerging adult marijuana users who primarily smoke marijuana and cigarettes, suggesting that there could be a shared vulnerability for risk of co-occurrence.     

Exposure opportunity as a mechanism linking youth marijuana use to hallucinogen use

The aim of this study is to shed light upon an observed association between the use of marijuana and hallucinogens (e.g. LSD), with a specific focus on the idea that two separate mechanisms might link marijuana use to hallucinogen use: (1) greater hallucinogen exposure opportunity for marijuana users versus nonusers; (2) increased probability of hallucinogen use for marijuana users versus nonusers, once the opportunity to use hallucinogens has occurred. This work is based on a novel analysis of retrospective, self-report data from more than 40000 young participants in the 1991-1994 National Household Surveys on Drug Abuse (NHSDA), with discrete time survival analysis models. Youths who had used marijuana were substantially more likely than nonusers to have the opportunity to use hallucinogens (estimated unadjusted relative risk, uRR=16.3; 95%. Confidence interval (CI)=14.3-18.6). Once an opportunity to use hallucinogens occurred, marijuana users were more likely than nonusers to initiate hallucinogen use (uRR=12.6; 95% CI=9.0-17.6). This evidence provides a more complete view of interconnections between marijuana use and hallucinogen use, and helps to clarify the pivotal role for drug exposure opportunities. Important next steps will be to understand what accounts for variation in the exposure opportunities experienced by marijuana users, and to understand why some marijuana users do not progress even when they have a chance to do so.     

506例物质依赖者DSM-Ⅳ轴I诊断结果分析

目的:了解506例物质依赖者的物质滥用和精神障碍情况。方法:应用DSM-Ⅳ-TR轴I障碍定式临床检查病人版,调查了506例物质依赖者DSM-Ⅳ轴I诊断情况。结果:阿片类物质使用障碍者、酒精使用障碍者、镇静催眠抗焦虑剂使用障碍者、大麻使用障碍者和多种物质使用障碍者分别达到99.0%、4.5%、9.3%、6.5%和4.2%,其中大麻使用障碍者年龄分组比较有统计学差异;兴奋剂使用障碍者和致幻剂使用障碍者达到20.0%和5.9%,男女分组比较和年龄分组比较均有统计学差异。终生患有其他精神障碍者为16.0%;心境障碍者为8.1%,主要为重度抑郁障碍和物质滥用引起的心境障碍;精神分裂症和其他精神病性障碍者为5.7%,主要为物质滥用引起的精神病性障碍;焦虑障碍者为4.0%。结论:在阿片类物质依赖者诊治过程中,其他物质滥用和多种物质依赖及其相关的精神问题都不容忽视;年轻的,特别是女性群体受兴奋剂、大麻、氯胺酮和多种物质滥用影响更明显,并出现相关精神障碍问题,在物质滥用防治中应予以同样关注。     

Patterns of drug use among young adults

The present study assessed patterns of multiple drug use among a sample of university employees and students who had been identified as having moderately high drug use habits. Use of eleven categories of legal and illegal drugs was tested and subjects reported how much of each drug they currently and habitually used. Factor analysis yielded three factors of drug use. Four of the items in the first factor (hallucinogens, cocaine, marijuana, alcohol) exhibited moderately strong and positive intercorrelations, suggesting that this particular pattern of drug use was the most common and/or reliable among young adult drug users. Sedatives and opiates were the highest loading items on the second factor, suggesting a pattern of drug use motivated by the desire for relaxation and stress avoidance. The third factor identified a pattern of legal stimulant use involving two of the three food-like categories of items employed in the present study (i.e., caffeinated cola beverages and chocolate, but not coffee). The results provided only mixed support for the hypothesis that categories of drugs with similar pharmacological properties define patterns of multiple drug use.     

Extent and patterns of drug use by students at a Spanish university

A drug-use survey of 1,010 randomly chosen students at the University of Oviedo in Spain was carried out in 1986. The survey instrument used was a self-administered questionnaire. During the 12 months before the survey, 91 per cent of the students had used alcohol, 57 per cent tobacco, 17 per cent cannabis, 9 per cent tranquillizers, 5 per cent amphetamines, 2 per cent cocaine, 2 per cent hallucinogens, 1 per cent opiates and 0.6 per cent volatile solvents. At some time in their lives, 96 per cent of the students had used alcohol, 70 per cent tobacco, 31 per cent cannabis, 19 per cent tranquillizers, 15 per cent amphetamines, 5.5 per cent hallucinogens, 5 per cent cocaine, 3 per cent opiates and 3 per cent volatile solvents. Both male and female students had begun using volatile solvents early in life. The age of first cannabis use for the majority of users was between 16 and 18. The users of other illicit drugs covered by the study had not begun using them until they were 18 or older.     

Differential Drug Use Patterns Among Sexually Abused Adolescent Girls in Treatment for Chemical Dependency

A sample of 444 girls admitted to adolescent chemical dependency treatment was divided into four groups based on sexual abuse experiences. Girls who reported intrafamilial abuse, extrafamilial abuse, or both, were compared with nonvictims in terms of alcohol and drug use histories. Prevalence and frequency of alcohol, marijuana, and cocaine did not differ significantly among the groups. However, all sexual abuse victims were significantly more likely to regularly use stimulants, sedatives, tranquilizers, and hallucinogens. Sexual abuse victims also reported earlier onset of alcohol and drug use, more self-medication, and more use to escape family problems.     

High prevalence of substance use disorders among adolescents who use marijuana and inhalants

BACKGROUND: We examined the association between the use of inhalants, marijuana, and other drugs and recent DSM-IV substance use disorders among adolescents aged 12-17 years. METHODS: Data were drawn from 2000 to 2001 National Household Surveys on Drug Abuse. Adolescents aged 12-17 years who reported having ever used an illicit drug in their lifetime were categorized into four mutually exclusive groups: inhalant users (16%), marijuana users (53%), inhalant and marijuana users (16%), and other drug users (15%). Logistic regression models were used to estimate associations with recent substance use diagnoses among lifetime adolescent drug users (N=10,180). RESULTS: We found that 31% of lifetime drug users reported having never used marijuana. One half of these atypical drug users were predominantly nonmedical users of pain relievers. Adolescents who used inhalants or other drugs but not marijuana were least likely to report multidrug use. Adolescents who reported using both inhalants and marijuana were most likely to use three or more classes of drugs (73%) and to receive a diagnosis of past year alcohol (35%) and drug (39%) abuse or dependence. CONCLUSIONS: Our study findings suggest that among lifetime adolescent drug users, those who use both inhalants and marijuana are at very high risk for alcohol and drug use disorders.     

北京三所高校学生使用精神活性药物情况调查

本文采用自填问卷方式对北京地区三所高校在校学生使用精神活性药物情况进行了调查,结果表明,三所学校男女生在有生以来、过去1 a和过去1个月中使用最普遍的是酒,使用的主要原因是消遣和好奇心。在男生中列第二位的是烟,其次是解热镇痛药(去痛片)、镇静安眠药(包括安定类和苯巴比妥类等)、阿片类药物(包括吗啡、度冷丁、可待因、强痛定和氨酚待因片)和中枢兴奋剂(包括苯丙胺、匹莫林和利他林)。而女生中有生以来列第二位的是解热镇痛药,其次是镇静安眠药、烟、阿片类药物和中枢兴奋剂。过去1 a和过去1个月中排首位的是酒精,其次是解热镇痛药、烟、镇静催眠药、阿片类药物和中枢兴奋剂。合法精神药物使用的主要原因是治病,但也有少数非医疗用途使用的现象。有个别学生报告在最近1 a内使用过非法药物(包括大麻、可卡因、致幻剂)。这些学生使用非法药物的原因主要是寻求快乐、解除烦恼,提示个别大学生可能存在着不良的心理因素。     

Non-injection substance use correlates with risky sex among men having sex with men: data from HIVNET

Associations between substance use and sexual behavior were examined among 3220 seronegative men who have sex with men (MSM) in a HIV vaccine preparedness study. Relationships between current and past substance use and current sexual risk were evaluated using crude odds ratios and logistic regression to adjust for confounding variables. Heroin and injection drug use were uncommon (< 2%). Substances most often used were alcohol (89%), marijuana (49%), nitrite inhalants (29%), amphetamines or similarly acting stimulants (21%), cocaine 14% and hallucinogens (14%). Increased adjusted odds for unprotected sex were significantly associated with current heavy alcohol use (OR 1.66; CI 1.18, 2.33), past alcohol problems (OR 1.25; CI 1.05, 1.48), and current drug use (OR 1.26; CI 1.08, 1.48). When associations with specific drugs and nitrite inhalants were examined separately, current use of cocaine and other stimulants (OR 1.25; CI 1.01, 1.55), hallucinogens (OR 1.40; CI 1.10, 1.77), and nitrite inhalants (some (OR 1.61; CI 1.35, 1.92); heavy (OR 2.18; CI 1.48, 3.20)), were independently associated with unprotected sex. Those with past drug use or past heavy alcohol use but not currently using demonstrated no increase in sexual risk, suggesting an important role for substance-focused interventions in risk reduction efforts among MSM.     

A comparison of motives for marijuana and alcohol use among experienced users

Motivational models suggest that individuals use substances to achieve desired effects. Given different pharmacological effects across drug classes, and variations in social context, one would expect that the motives instigating use differ by drug class. However, commonalties in motives across drugs have also been observed. The purpose of this study was to examine similarities and differences across a common set of motives for alcohol and marijuana among experienced users of both drugs. Participants were 46 college students (21 women) who completed a motives assessment twice, once for marijuana and once for alcohol. All had used each drug 60 or more times in their lifetime. Social motives were more highly endorsed for alcohol than marijuana. Expansion motives were more highly endorsed for marijuana. Enhancement motives were more highly endorsed for marijuana than alcohol among women but not men. Endorsement of coping and conformity motives did not differ across drugs. Experienced users of marijuana and alcohol discriminate between their reasons for using the two drugs. These findings are discussed with regard to the differentiation between and commonalties among substances of abuse.     

Prevalence and pattern of substance use among undergraduates in a Nigerian University.

The prevalence and pattern of substance use was investigated among undergraduate students of the University of Ilorin, Kwara State, Nigeria in June 1988. Six hundred and forty-nine students completed a 117-item self-report questionnaire 636 of which were analysed. Mean age and S.D. of respondents was 23 +/- 3.7 years; 69% were males. The most commonly used substances with their 'lifetime' prevalence rates were as follows: salicylate analgesics, 95.2%; alcohol, 77%; stimulants, 69.2%; antibiotics, 63.3%; hypno-sedatives, 49.4% and cigarettes, 37.4%. The corresponding 'current use' rates were relatively lower. Low use was recorded for cannabis, organic solvents, hallucinogens, cocaine and narcotic analgesics. Majority of the 'current users' use the substances on an occasional basis except for cigarettes where more than half reported weekly or daily use. Males were significantly more of 'current' users of cigarettes and alcohol while females tend to use stimulants more. The use of most of the substances started in primary school. The need for a comprehensive demand-reduction programme in Nigeria based on this and other local findings was advocated. Continuous monitoring, particularly of hard drug use, appears imperative.     

Reinforcements from the first drug experience can predict later drug habits and/or addiction: Results with coffee,cigarettes, alcohol,barbiturates, minor and major tranquilizers,stimulants, marijuana,hallucinogens, heroin,opiates and cocaine

The relationship between the reinforcing quality of the first drug experiences and eventual habits for a variety of drugs was studied in 42 male drug abusers who were predominantly opiate addicts. These subjects volunteered for drug studies carried out by the Addiction Research Center. The degree of reinforcement they derived from their first drug experience was related to their subsequent habit. This was true for alcohol, barbiturates, minor tranquilizers, cocaine, stimulants, marijuana, glue or solvents, hallucinogens, opiates other than heroin and heroin. Positive but non-significant correlations were found for coffee and major tranquilizers. The correlation for cigarettes was contrary to expectations. Of the components to the index of reinforcement, degree of liking of a drug on the first occasion was most related to the subsequent habit. The greatest initial reinforcement scores were found for heroin, cocaine and opiates other than heroin. Drugs which were not well liked on the first occasion included major tranquilizers, cigarettes, coffee, and glue.     

Early onset of drug and polysubstance use as predictors of injection drug use among adult drug users

Early onset of alcohol, marijuana, and cigarette use is an indicator of later substance use problems in adulthood such as alcohol or other drug dependence. This paper seeks to address the association between early onset alcohol, marijuana, cigarette, and polysubstance use with injection drug use among recent illicit drug users. The current study used baseline data from the Baltimore site of the NEURO-HIV Epidemiologic Study, an investigation of neuropsychological and social-behavioral risk factors of HIV, hepatitis A, hepatitis B, and Hepatitis C among both injection and non-injection drug users in Baltimore, Maryland. The present study used a subset (N=651) of the larger parent study that identified as White or Black, and reported any drug use in the past 6 months. In the full sample slightly more than half (52.5%) of study participants were IDUs. IDUs differed from non-IDUs on age of initiation for cigarettes, marijuana, and alcohol, with IDUs initiating the use of all three substances significantly earlier than non-IDUs. IDUs also had significantly greater proportions of early onset of alcohol (χ(2)=19.71, p<.01), cigarette (χ(2)=11.05, p<.01), marijuana (χ(2)=10.83, p<.01), and polysubstance use (χ(2)=23.48, p<.01) than non-IDUs. After adjusting for age, gender, and race/ethnicity, only participants identified as early onset alcohol users (AOR=1.47, 95% CI: 1.00-2.18) and early onset polysubstance users (AOR=1.62, 95% CI: 1.10-2.38) were more likely to have IDU status than those who reported initiating substance use later. IDU status was then stratified by race/ethnicity. After controlling for age and gender, only early polysubstance use was a significant predictor of IDU status for Whites (AOR=2.06, 95% CI: 1.07-3.93). Consistent with literature on early substance initiation and later illicit substance use, early onset of alcohol and polysubstance use is an important risk factor for IDU in adulthood.     

Self-reported drug use among secondary school students in the Nigerian state of Ogun

A survey of drug use, based on a sample of 990 students in their fourth and final year of secondary school in the Abeokuta local government area of the State of Ogun in Nigeria was conducted by means of a self-report drug-use questionnaire in September 1986. There were 534 male and 377 female respondents. Their mean age was 16.4 and the majority (89 per cent) of them were from the lower or middle socio-economic levels. The most commonly used drugs were salicylate analgesics, mild stimulants, alcohol, antibiotics and diazepam. Low use was recorded for barbiturates, cannabis, organic solvents and cocaine, and there was no reported use of narcotic analgesics or hallucinogens. Females used diazepam significantly more than males. Most users had their first contact with drugs in primary school. The author stressed the need to develop a viable drug-abuse preventive programme and a comprehensive data base in Ogun.     

Substance use problems reported by historically Black college students: combined marijuana and alcohol use versus alcohol alone

Using secondary data analysis,this study compares alcohol and other drug (AOD) problems experienced by African-American students attending a historically Black university who use alcohol only versus those who use alcohol plus marijuana. Results indicate that students who used marijuana plus alcohol experienced more AOD problems than their counterparts who used alcohol only. The current findings are similar to previous research with a majority White college student population.     

Daily marijuana users with past alcohol problems increase alcohol consumption during marijuana abstinence

Drug abuse treatment programs typically recommend complete abstinence because of a fear that clients who stop use of one drug will substitute another. A within-subjects study investigated whether consumption of alcohol and other substances changes during marijuana abstinence. Twenty-eight daily marijuana users who were not trying to stop or reduce their marijuana consumption completed an 8-day baseline period in which they used marijuana and other drugs as usual, a 13-day marijuana abstinence period, and a 7-day return-to-baseline period. Participants provided self-report of substance use daily and submitted urine samples twice weekly to verify marijuana abstinence. A diagnosis of past alcohol abuse or dependence significantly moderated the alcohol increase from baseline to marijuana abstinence (p < 0.01), such that individuals with this diagnosis significantly increased alcohol use (52% increase) but those without this history did not (3% increase). Increases in marijuana withdrawal discomfort scores and alcohol craving scores from baseline to marijuana abstinence significantly and positively correlated with increases in alcohol use. Increases in cigarettes, caffeine, and non-marijuana illicit drugs did not occur. This study provides empirical validation of drug substitution in a subgroup of daily marijuana users, but results need to be replicated in individuals who seek treatment for marijuana problems.