A survey of pre-arrest drug use in sentenced prisoners

The paper presents the results of a retrospective, self-report survey of pre-arrest drug use in a representative sample of 1751 men serving a prison sentence. Reported drugs used were cannabis (34%), opiates (9%), amphetamine (9%) and cocaine (5%), including 1%‘crack’ users. Pre-arrest injecting was reported by 11% of inmates, including 68% of all opiate users and 57% of amphetamine users. Drug dependence was reported by 11%, including 7% dependent on opiates, 2% on amphetamines and l% on cocaine. Relative to other drugs, the figure for cocaine is higher than is suggested by a previous clinic survey. Pre-arrest cannabis use was reported by 54% of black prisoners and 34% of white. White prisoners are more likely to report use of ‘hard’ drugs, drug dependence and injecting, but this masks a higher rate of cocaine use by black prisoners. Opiate use varied between health regions, from 3% of prisoners in the West Midlands to 25% of those from the Mersey region. These findings have implications for service provision and for an understanding of cultural influences on illicit drug use.     

Temporal progression of cocaine dependence symptoms in the US National Comorbidity Survey

Objective Cocaine dependence first appeared as a diagnostic category in 1987 with the publication of DSM‐III‐R. While the temporal sequencing of alcohol symptoms has a long history, little such attention has been focused on cocaine dependence. This paper examines the retrospective recall of DSM‐III‐R cocaine dependence symptom progression among a large sample of cocaine users and the relationship of these symptoms to psychiatric comorbidity. Methods Using data from the US National Comorbidity Survey, DSM‐III‐R criterion ‘A’ cocaine dependence symptoms were sequenced temporally based on age of symptom onset. Each of these numerical symptom strings was examined to determine its prevalence and association to comorbid psychiatric disorders. Results Cocaine users represented 16% of the sample. Although hundreds of symptom sequence permutations are possible, only a few are highly prevalent. Subjects whose early onset symptoms are neuroadaptive (e.g. tolerance and withdrawal) are more likely to develop cocaine dependence than subjects whose early symptoms are characterized by psychosocial consequences. Furthermore, certain temporal patterns were found to increase or decrease the presence or absence of cocaine dependence and psychiatric comorbidity. Finally, psychiatric comorbidity preceded rather than followed cocaine use onset disproportionately. Conclusions Like alcohol users, cocaine users follow a limited array of symptom sequence pathways from first use to dependence. By better understanding and examining the temporal progression of drug use symptoms, clinicians might improve screening and assessment activities and determine more effectively the extent of risks associated with continued premorbid drug use and enhance treatment‐matching. We encourage clinicians to develop evaluation instruments that specifically ask patients to sequence their cocaine use‐related symptoms temporally.     

Severity of dependence and route of administration of heroin, cocaine and amphetamines

This study investigates severity of dependence upon heroin, cocaine and amphetamines in a group of 200 heroin users, 75% of whom were not in contact with any treatment agency. For drug takers who were current users of more than one drug, heroin produced more severe dependence than either cocaine or amphetamine and many users of these stimulant drugs reported having experienced no problems of dependence. Severity of dependence was influenced by route of administration as welt as type of drug. Heroin taken by injection was associated with more severe dependence than smoked heroin. For cocaine, injection and smoking were associated with equivalent dependence ratings, and both of these routes were associated with more severe dependence than cocaine used intranasally. For amphetamine, there were no differences in severity of dependence ratings for injection, intranasal or oral use. Severity of dependence was correlated with dose and duration of drug use; it was also associated with previous attendance at a drug treatment agency, though dependence problems were also common among heroin users who had never received treatment. Implications of these findings are discussed.     

Is there a progression from abuse disorders to dependence disorders?

Background Recent studies suggest that a progression occurs from alcohol abuse to alcohol dependence. Although DSM‐IV criteria for all substance use‐related diagnoses are based largely on the alcohol dependence syndrome, progression from abuse to dependence might not generalize to other substances. Aims This study tested whether a progression from DSM‐IV abuse to dependence occurs related to the use of cannabis, cocaine and opiates. Design Retrospective data from the DSM‐IV Substance Use Disorders Work Group (n = 1226) were reanalysed using McNemar's χ², configural frequency analyses and survival analyses. Participants were men and women who were primarily African‐Americans or Caucasians. Settings Participants were recruited from community and clinical settings. The measure was the Composite International Diagnostic Interview–Substance Abuse Module. Findings For all substances, life‐time dependence in the absence of life‐time abuse was rare. Results were consistent with a progression occurring for alcohol and cannabis, but not for cocaine and opiates. Abuse and dependence occurred in the same year for 66% of the cocaine users who experienced both disorders (57% of users with any cocaine disorder) and 65% of the opiate users who experienced both disorders (46% of users with any opiate disorder). Because cocaine and opiate dependence in the absence of abuse were rare, it is possible that progressions in cocaine and opiate disorders occur more rapidly than cannabis and alcohol. Conclusions Research is needed to clarify the mechanisms that influence progressions of substance use disorders. Potential factors leading to between‐drug variation in rate of progression of disorders are discussed.     

Dual dependence: assessment of dependence upon alcohol and illicit drugs, and the relationship of alcohol dependence among drug misusers to patterns of drinking, illicit drug use and health problems

Aims The study investigates severity of alcohol dependence among drug misusers. Specifically, it investigates the inter‐relationship of alcohol and drug dependence and associations with alcohol consumption, drug consumption and substance‐related problems. Design, setting, participants The sample comprised 735 people seeking treatment for drug misuse problems, who were current (last 90 days) drinkers. Measurements Data were collected by structured face‐to‐face interviews. Dependence upon illicit drugs and upon alcohol was measured by the Severity of Dependence Scale (SDS). Findings Three groups of drinkers were identified: non‐alcohol‐dependent drug misusers (63%); low‐dependence (19%); and high‐dependence (18%). Many drug misusers were drinking excessively and alcohol dependence was related to patterns of alcohol and drug consumption. High‐dependence drinkers were more likely to drink extra‐strength beer; they were less frequent users of heroin and crack cocaine but more frequent users of benzodiazepines, amphetamines and cocaine powder; they reported more psychological and physical health problems. The SDS was found to have good reliability and validity as a measure of alcohol dependence. SDS scores for alcohol and drug dependence were unrelated. Conclusions Alcohol use is an important and under‐rated problem in the treatment of drug misusers. A comprehensive assessment of alcohol use among drug misusers should include separate assessments of alcohol consumption, alcohol‐related problems and severity of alcohol dependence.     

Cannabis dependence in young adults: an Australian population study

Objectives The symptomatology of cannabis dependence remains ill‐defined and its importance controversial. Compared with alcohol dependence, the symptom profile of cannabis dependence has received little attention. We aimed to (a) report cannabis use in a representative population of young adults, (b) examine cannabis dependence symptoms according to frequency in the dependence syndrome and (c) contrast the symptomatology of cannabis and alcohol syndromes. Methods 1601 young adults (mean age 20.7 years) from an Australian longitudinal cohort study (N = 2032) were surveyed in 1998. Regular substance users were assessed for DSM‐IV cannabis and alcohol dependence. Prevalence estimates allowed for sampling variation and attrition. Results Fifty‐nine per cent reported life‐time use of cannabis, 17% used at least weekly and 7% (11% males, 4% females) met criteria for cannabis dependence. Symptom prevalence in dependent cannabis users was: persistent desire 91%; unintentional use 84%; withdrawal 74%; excessive time obtaining/using 74%; continued use despite health problems 63%; tolerance 21%; and social consequences 18%. The combination of withdrawal, persistent desire and unintentional use was reported by 57%. Dependent cannabis users reported compulsive and out‐of‐control use more frequently than dependent alcohol users, withdrawal similarly and tolerance considerably less often. Conclusions Cannabis use appears to be normative behaviour in young Australians. Progression beyond weekly use of cannabis carries a significant risk of dependence that should be considered in the public health response. The differing profiles of cannabis and alcohol dependence, particularly with regard to craving, draws attention to the need for further study of cannabis dependence as an important and distinct disorder in young adults.     

Probability and predictors of remission from life-time nicotine, alcohol, cannabis or cocaine dependence: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Aim To estimate the general and racial/ethnic specific cumulative probability of remission from nicotine alcohol cannabis or cocaine dependence, and to identify predictors of remission across substances. Design Data were collected from structured diagnostic interviews using the Alcohol Use Disorder and Associated Disabilities Interview Schedule—DSM‐IV version. Setting The 2001–2002 National Epidemiological Survey of Alcohol and Related Conditions (NESARC) surveyed a nationally representative sample from US adults (n = 43 093) selected in a three‐stage sampling design. Participants The subsamples of individuals with life‐time DSM‐IV diagnosis of dependence on nicotine (n = 6937), alcohol (n = 4781), cannabis (n = 530) and cocaine (n = 408). Measurements Cumulative probability estimates of dependence remission for the general population and across racial/ethnic groups. Hazard ratios for remission from dependence. Findings Life‐time cumulative probability estimates of dependence remission were 83.7% for nicotine, 90.6% for alcohol, 97.2% for cannabis and 99.2% for cocaine. Half of the cases of nicotine, alcohol, cannabis and cocaine dependence remitted approximately 26, 14, 6 and 5 years after dependence onset, respectively. Males, Blacks and individuals with diagnosis of personality disorders and history of substance use comorbidity exhibited lower hazards of remission for at least two substances. Conclusions A significant proportion of individuals with dependence on nicotine, alcohol, cannabis or cocaine achieve remission at some point in their life‐time, although the probability and time to remission varies by substance and racial/ethnic group. Several predictors of remission are shared by at least two substances, suggesting that the processes of remission overlap. The lower rates of remission of individuals with comorbid personality or substance use disorders highlight the need for providing coordinated psychiatric and substance abuse interventions.     

Persistence of drug use during imprisonment: relationship of drug type, recency of use and severity of dependence to use of heroin, cocaine and amphetamine in prison

AIM: To investigate the persistence of use of heroin, cocaine and amphetamine drugs during imprisonment, and to identify factors associated with increased levels of persistence. DESIGN: The use of heroin, cocaine and amphetamine by current prison inmates has been examined and, in particular, the relationship between drug use within prison and the type of drug used prior to imprisonment, recency of use and severity of dependence. SETTING AND PARTICIPANTS: A randomly selected sample of 1009 adult male prisoners in 13 prisons in England and Wales during 1994/95; structured confidential interviews conducted by independent research staff. Enquiry about prior use of heroin, cocaine or amphetamine focused on three time-periods (ever, last year and last month pre-prison) and the use of these drugs during the first month of imprisonment. FINDINGS: A total of 557 (55%) of the 1009 prisoners had used previously one of the three drugs selected for study: 58% had used heroin, 69% cocaine and 75% amphetamine. More than half (59%; 327/557) had used these drugs in the month before the current imprisonment. Drug use in prisons was most likely to occur among those who had used in the month prior to imprisonment. The persistence of heroin use in prison occurred more frequently (70%) than use of cocaine (20%) or amphetamine (15%). Of those using heroin pre-imprisonment, 67% considered they were dependent, compared to 15% and 22%, respectively, for cocaine and amphetamine users. CONCLUSIONS: Changes in the drug-taking behaviour of drug users after imprisonment vary according to the type of drug being taken. Prisoners were much more likely to continue to use heroin than either cocaine or amphetamines while in prison. Heroin was most likely to be used by those who had been using heroin during the immediate pre-imprisonment period, and particularly by the two-thirds of heroin users who considered themselves dependent. In view of the high prevalence of prior use of these drugs by individuals currently imprisoned, continuing attention is required to study of their behaviour and of the impact of interventions that may be introduced during or following their incarceration.     

A comparison of ‘visible’ and ‘invisible’ users of amphetamine,cocaine and heroin: two distinct populations?

Aim. To compare the characteristics of heroin, cocaine and amphetamine users having no history of contact with services with those of a group in contact. Method. Multiple agency sampling and field work which included ‘snowballing’ using ‘privileged access interviewers’. Each subject underwent a structured interview which included the Severity of Dependency Scale (SDS), and completed a confidential, self-report questionnaire. Setting. Three contrasting provincial urban locations. Participants. Five hundred and eighty-one regular users of the target drugs. Of these, 380 (65%) denied any contact with police or helping agencies in connection with drug use. Findings. Most zero-contact users (79%) expressed little or no concern about their drug use, and no wish for help or advice. They were much more likely to use stimulants only; less likely ever to inject any drug or, for those that did, to share equipment; less likely to use opioids, amphetamine or cocaine powder on a daily basis; more likely to use Ecstasy; and yielded significantly lower SDS scores for all target drugs save crack. Prevalence of crack use was lower, but the proportion of daily users was the same as in the contact group. Most (69%) contact users remained concerned about their drug use, but 58% expressed little or no confidence that local services could meet their needs. In both groups, SDS scores for cocaine powder were comparable to those for cannabis, LSD and Ecstasy. Of the 495 cannabis smokers identified (85% of the sample), 72% reported daily consumption. Conclusions. The findings are consistent with the hypothesis that ‘visible’ and ‘invisible’ drug users are distinct populations in terms of behavioural characteristics, vulnerability to compulsive use, and prevalence of drug-related problems or concern. Purchasers and providers with limited resources should concentrate on improving the range and quality of services for users already in contact rather than attempting to uncover invisible populations. On the basis of SDS scores, cocaine HCI seems to have a relatively modest addictive potential.     

Cocaine-using patients with a normal or nondiagnostic electrocardiogram: single-photon emission computed tomography myocardial perfusion imaging and outcome

Background:

Few trials have examined the outcomes of patients who use cocaine with chest pain and who have a normal or nondiagnostic electrocardiogram (ECG) and the use of single‐photon emission computed tomography (SPECT) myocardial perfusion imaging (MPI).

Hypothesis:

We sought to compare the characteristics and overall outcomes in cocaine users vs non‐cocaine users presenting to the emergency department with a normal/nondiagnostic ECG and to assess the value of rest MPI in both of these populations.

Methods:

Patients with symptoms compatible with myocardial ischemia, suspected acute coronary syndrome (ACS), and a normal/nondiagnostic ECG were enrolled in the Emergency Room Assessment of Sestamibi for Evaluation of Chest Pain (ERASE Chest Pain) trial, a randomized controlled trial designed to evaluate the impact of rest MPI on triage decisions. Cocaine users (n = 294) were compared to non‐cocaine users (n = 2180). Cocaine users were younger than non‐cocaine users, and 72% were male.

Results:

Among the cocaine users, 2.4% had a myocardial infarction, 1.4% required percutaneous coronary intervention, and none of the patients underwent coronary artery bypass graft surgery. Among cocaine users with a final diagnosis of not ACS, randomization of patients to rest SPECT MPI resulted in an appropriate reduction in hospital admissions in both the cocaine users (P = 0.011) and the non‐cocaine users (P < 0.001), suggesting improved triage when MPI was used.

Conclusions:

Cocaine users with a normal/nondiagnostic ECG are at low risk of cardiac events. Even though cocaine users are at low risk of cardiac events, SPECT MPI remains effective in the risk stratification and improves triage management decisions resulting in lower admission rates and more discharges to home. Clin. Cardiol. 2011 DOI: 10.1002/clc.21977 This work was supported by grant number RO1‐HS09110 from the Agency for Healthcare Research and Quality, and in part by the General Clinical Research Centers at Tufts Medical Center (MO1‐RR00054), Northwestern Memorial Hospital (MO1‐RR00048), and Boston Medical Center (MO1‐RR00533), funded by the NIH National Center for Research Resources. The authors have no other funding, financial relationships, or conflicts of interest to disclose.     

Adolescent inhalant use, abuse and dependence

Aims To compare adolescent inhalant users without DSM‐IV inhalant use disorders (IUDs) to youth with IUDs (i.e. abuse or dependence) across demographic, psychosocial and clinical measures. Design Cross‐sectional survey with structured psychiatric interviews. Setting Facilities (n = 32) comprising the Missouri Division of Youth Services (MDYS) residential treatment system for juvenile offenders. Participants Current MDYS residents (n = 723); 97.7% of residents participated. Most youth were male (87%) and in mid‐adolescence (mean = 15.5 years, standard deviation = 1.2, range = 11–20); more than one‐third (38.6%, n = 279) reported life‐time inhalant use. Measurements Antisocial behavior, temperament, trauma‐exposure, suicidality, psychiatric symptoms and substance‐related problems. Findings Among life‐time inhalant users, 46.9% met criteria for a life‐time DSM‐IV IUD (inhalant abuse = 18.6%, inhalant dependence = 28.3%). Bivariate analyses showed that, in comparison to non‐users, inhalant users with and without an IUD were more likely to be Caucasian, live in rural or small towns, have higher levels of anxiety and depressive symptoms, evidence more impulsive and fearless temperaments and report more past‐year antisocial behavior and life‐time suicidality, traumatic experiences and global substance use problems. A monotonic relationship between inhalant use, abuse and dependence and adverse outcomes was observed, with comparatively high rates of dysfunction observed among inhalant‐dependent youth. Multivariate regression analyses showed that inhalant users with and without an IUD had greater levels of suicidal ideation and substance use problems than non‐users. Conclusions Youth with IUDs have personal histories characterized by high levels of trauma, suicidality, psychiatric distress, antisocial behavior and substance‐related problems. A monotonic relationship between inhalant use, abuse and dependence and serious adverse outcomes was observed.     

Pilot randomized double blind placebo-controlled study of dexamphetamine for cocaine dependence

Aims To establish the feasibility of conducting a placebo‐controlled clinical trial of dexamphetamine replacement therapy for cocaine dependence and to obtain preliminary data. Design Double‐blind randomized placebo‐controlled trial. Participants Thirty cocaine‐dependent injecting drug users. Intervention Subjects were assigned randomly to receive 60 mg/day dexamphetamine (n = 16) or placebo (n = 14) for 14 weeks. Measurements Immunoassay and mass spectrometric techniques were used to identify cocaine metabolites in urine. Subjects were screened using the Composite International Diagnostic Interview and DSM‐IV. The Opiate Treatment Index, Brief Symptom Inventory, Severity of Dependence Scale and visual analogue craving scales were used to collect pre‐ and post‐self‐report data. Findings Treatment retention was equivalent between groups; however, outcomes favoured the treatment group with no improvements observed in the placebo control group. The proportion of cocaine‐positive urine samples detected in the treatment group declined from 94% to 56% compared to no change in the placebo group (79% positive). While the improvements were not significant between groups, within‐group analysis revealed that the treatment group reduced self‐reported cocaine use (P = 0.02), reduced criminal activity (P = 0.04), reduced cravings (P < 0.01) and reduced severity of cocaine dependence (P < 0.01) with no within‐group improvements found in the placebo group. Conclusions A definitive evaluation of the utility of dexamphetamine in the management of cocaine dependence is feasible and warranted.     

Test–re-test reliability of DSM-IV adopted criteria for 3,4-methylenedioxymethamphetamine (MDMA) abuse and dependence: a cross-national study

Aims This study evaluated the prevalence and reliability of DSM‐IV adopted criteria for 3,4‐methylenedioxymethamphetamine (MDMA) abuse and dependence with a purpose to determine whether it is best conceptualized within the category of hallucinogens, amphetamines or its own category. Design Test–re‐test study. Participants MDMA users (life‐time use >5 times) were recruited in St Louis, Miami and Sydney (n = 593). The median life‐time MDMA consumption was 50 pills at the baseline. Measurements The computerized Substance Abuse Module for Club Drug (CD‐SAM) was used to assess MDMA abuse and dependence. The Discrepancy Interview Protocol (DIP) was used to determine the reasons for the discrepant responses between the two interviews. Reliability of diagnoses, individual diagnostic criteria and withdrawal symptoms was examined using the kappa coefficient (κ). Findings For baseline data, 15% and 59% met MDMA abuse and dependence, respectively. Substantial test–re‐test reliability of the diagnoses was observed consistently across cities (κ = 0.69). ‘Continued use despite knowledge of physical/psychological problems’ (87%) and ‘withdrawal’ (68%) were the two most prevalent dependence criteria. ‘Physically hazardous use’ was the most prevalent abuse criterion. Six dependence criteria and all abuse criteria were reported reliably across cities (κ: 0.53–0.77). Seventeen of 19 withdrawal symptoms showed consistency in the reliability across cities. The most commonly reported reason for discrepant responses was ‘interpretation of question changed’. Only a small proportion of the total discrepancies were attributed to lying or social desirability. Conclusion The adopted DSM‐IV diagnostic classification for MDMA abuse and dependence was moderately reliable across cities. Findings on MDMA withdrawal support the argument that MDMA should be separated from other hallucinogens in DSM.     

Co-occurrence of obsessive-compulsive disorder and substance use disorder in the general population

Aim Very little is known about the relationship between obsessive–compulsive disorder (OCD) and substance use disorder (SUD). The aim of this study is to compare the co‐occurrence of OCD with SUD to the co‐occurrence of SUD with other psychiatric disorders in a representative community sample. Design In order to examine the association of SUD and OCD, logistic regression analyses were used generating odds ratios and 95% confidence intervals for life‐time prevalence and 12‐month prevalence. Setting and participants Cross‐sectional data were derived from the Netherlands Mental Health Survey and Incidence Study (NEMESIS), a large representative sample of the Dutch population (n = 7076). Measurements The Composite International Diagnostic Interview (CIDI) 1.1 was used to assess Diagnostic and Statistical Manual of Mental Disorders Axis I criteria for psychiatric disorders. Findings The life‐time and 12‐month odds of being diagnosed with SUD in subjects with OCD are significantly higher than the odds of SUD for people without a psychiatric disorder. In men, the co‐occurrence of substance dependence and OCD is significantly higher than the co‐occurrence of substance dependence and other psychiatric disorders, whereas in women this co‐occurrence does not differ significantly. Conclusions The co‐occurrence of substance dependence in obsessive–compulsive disorder is higher than the co‐occurrence of substance dependence in other non‐obsessive–compulsive disorder DSM disorders, especially in men.     

Who are the new amphetamine users? A 10‐year prospective study of young Australians

AIMS: Despite good evidence of increased availability and use of amphetamines world-wide, relatively little is known about the epidemiology of young adult amphetamine use; relationships with social functioning, other drug use and mental health at this age; nor of the adolescent predictors of such use. We examined these issues using a representative cohort of young people followed-up in Victoria, Australia. METHODS: A stratified, random sample of 1943 adolescents was recruited from secondary schools across Victoria at age 14-15 years. This cohort was interviewed on eight occasions until the age of 24-25 years (78% follow-up at that age). Cross-sectional and predictive associations were assessed using logistic regression. RESULTS: At age 24 years, 12% of the sample had used amphetamines in the past year, with 1-2% using at least weekly. Young adult amphetamine use was predicted strongly by adolescent drug use and was associated robustly with other drug use and dependence in young adulthood. Associations were stronger for more frequent users. Among young adults who had not been using amphetamines at age 20 years, the strongest predictor of use at age 24 years was the use of other drugs, particularly cannabis, at 20 years. Psychological distress did not predict independently an increased likelihood of amphetamine use in this cohort. CONCLUSION: Young people in Australia using amphetamine at age 24 years are highly likely to be significant polydrug users. The risks for both initiation of young adult amphetamine use, and maintenance of such use, pertain to the heavy use of other drugs. Interventions for heavy amphetamine users at this age are likely to require attention to multiple drug problems.     

Determining a diagnostic cut-off on the Severity of Dependence Scale (SDS) for cocaine dependence

Aim The study aimed to assess the efficacy of the Severity of Dependence Scale (SDS) as a diagnostic measure of cocaine dependence and determine the cut‐off score that best discriminates between the presence and absence of a DSM‐IV diagnosis of cocaine dependence. Design Cross‐sectional survey. Setting Sydney, Australia. Participants One hundred and forty‐two cocaine users. Measurements The diagnostic performance of the SDS was measured via ROC analysis against DSM‐IV diagnoses of cocaine dependence, as measured by the Composite International Diagnostic Interview (CIDI). Findings ROC analysis revealed the SDS to be a test of high diagnostic utility for the measurement of cocaine dependence. The cut‐off point on the SDS at which there is optimal discrimination between the presence and absence of a DSM‐IV diagnosis of cocaine dependence was found to be 3 (i.e. a score of 3 or more). Conclusions The study statistically validated the utility of the SDS as a diagnostic measure of cocaine dependence and has determined an appropriate cut‐off point. The SDS is recommended as a brief screening instrument for cocaine dependence that can be used in addition to more comprehensive measures, such as the CIDI.     

The validity of DSM-IV cannabis abuse and dependence criteria in adolescents and the value of additional cannabis use indicators

Aims This study assessed the validity of DSM‐IV cannabis abuse and dependence criteria in an adolescent general population sample and evaluated the usefulness of additional cannabis use indicators. Design and setting Data came from the 2008 Survey on Health and Consumption during the Day of Defense Preparation (ESCAPAD), a cross‐sectional self‐administered survey conducted in France. Participants The analytical sample comprised 3641 adolescents aged 17–19 years who reported cannabis use in the past 12 months. Measurements To assess DSM‐IV criteria of cannabis abuse and dependence, the Munich Composite International Diagnostic Interview (M‐CIDI) was used. As additional cannabis use indicators, daily use, use when alone and use before midday were assessed. Confirmatory factor analyses and two‐parameter logistic item response theory (IRT) models were run. Differential item functioning was assessed using the IRT log‐likelihood ratio approach. Results A one‐factor model comprising both abuse and dependence criteria showed the best fit to the data. Abuse item legal problems showed the greatest severity, whereas dependence items larger/longer and tolerance were found least severe. Discriminatory power was lowest for impaired control and legal problems. Additional cannabis use indicators increased the precision of the overall DSM‐IV criterion set. Gender‐based differential item functioning was observed for items tolerance, withdrawal and use before midday. Conclusion The current DSM conceptualization with two distinct and graded diagnostic classes has limited validity among adolescents. In forthcoming revisions of the classification system, several existing criteria should be revised or dropped, new indicators of substance use disorders should be included and gender should be considered.     

Patterns of drug use in Castille and Leon (Spain)

A total of 2500 individuals, aged 14–70years and living in Castille and Leon (Spain), were surveyed in the spring of 1989 with regard to their drug consumption and patterns of use. ‘Lifetime’ drug users' rates were 30.0% for cannabis, 5.4% for cocaine, 5.2% for amphetamines, 2.4% for psychedelic drugs, 1.5% for opiates, 1.1% for tranquillizers, and 0.4% for inhalants. ‘Regular’ drug users were more common among cannabis,–2.8% of the surveyed,–and less frequent among cocaine, opiates and amphetamine users–0.3% of everyone of the substances mentioned above. ‘Lifetime’ drug users were more common among males than among females, among singles than among married, in those younger (18–29 years of age) and with work problems. The starting age of drug consumption ranged between the average of 15.6 years of age for those who consumed inhalants and 19.5 for those who consumed cocaine. The results allow a better understanding of the pattern of drug use in Castille and Leon (Spain), as well as the ‘high’ prevalence of drug use in our region.