Short communicationEarly-onset drug use and risk for drug dependence problems
Introduction
There is substantial evidence that drug problems surface more quickly when use starts before adulthood, even when length or duration biases are taken into account (Anthony and Petronis, 1995, Grant and Dawson, 1998, Janson, 1999, Chen et al., 2005). Some observers even express a view that preventing or delaying onset of drug use (until adulthood) might be sufficient to prevent occurrence of drug dependence syndromes. King and Chassin (2007) take a more sobering perspective; their evidence supports the idea that early-onset alcohol use is simply a marker and not a cause of later alcohol problems.
Our literature review indicates that no more than a handful of human studies have investigated early-onset issues with respect to drugs other than alcohol, tobacco and cannabis (Anthony, Chen, & Storr, 2005). In addition, most studies in this area are based upon self-reports made during cumulative (“lifetime history”) assessments, and do not control for the confounding influence of a statistical problem known as a “length” or “duration” bias, as discussed by Anthony & Petronis (1995) in a re-examination of evidence from the Epidemiologic Catchment Area Program. Here, with a broad view across multiple psychoactive drug compounds and with control over length biases, this research project seeks new evidence on whether adolescent-onset users have excess risk for all measured clinical features of the drug dependence syndromes. The analyses clarify specific problems that emerge most rapidly within a 24 month interval after onset of use among adolescent-onset and adult-onset users.
Section snippets
Subjects and measures
This project's data are from public use datasets released after the 2000 to 2002 United States National Surveys on Drug Use and Health (US, NSDUH), which were designed to produce estimates for prevalence and correlates of drug use in annual federal reports (Substance Abuse and Mental Health Services Administration [SAMHSA], 2003). These public use datasets are made available so that investigators can design and complete their own novel analyses with respect to research questions not planned in
Results
According to ‘common slope’ models without covariates (Table 1), adolescent-onset cannabis users were an estimated 2–4 times more likely to experience clinical features within 24 months after first use as compared to their adult-onset counterparts (estimated crude relative risk, RR = 3.0, p < 0.001). An association of similar magnitude was observed for recent-onset users of inhalant drugs (RR = 3.2, p < 0.001). With the ‘hallucinogens’ group as the sole exception, all corresponding unadjusted RR
Discussion
In summary, based upon these US data about experiences of a nationally representative sample of recent-onset drug users during 2000–2, we confirm an excess risk of developing clinical features associated with drug dependence when extra-medical drug use starts before age 18 versus during adulthood, for all drug groups under study except for hallucinogens. We observed statistically robust excess risk of clinical features of drug dependence (and associated problems) among adolescent recent onset
Acknowledgements
The work was supported by NHRI MD-097-PP-04 (CYC), NIDA R01DA09897, R01DA016323 (CLS), and a NIDA KO5 Senior Scientist award (K05DA015799) to the senior author (JCA). Data reported herein come from national survey data collected under the auspices of the Office of Applied Studies, Substance Abuse and Mental Health Services Administration.
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