scholarly journals Does the ‘gateway’ matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication

2008 ◽  
Vol 39 (1) ◽  
pp. 157-167 ◽  
Author(s):  
L. Degenhardt ◽  
W. T. Chiu ◽  
K. Conway ◽  
L. Dierker ◽  
M. Glantz ◽  
...  
Keyword(s):  
Drug Use ◽  
Drug Dependence ◽  
Illicit Drugs ◽  
Mental Health Problems ◽  
Age Of Onset ◽  
Household Survey ◽  
Composite International Diagnostic Interview ◽  
Externalizing Disorders ◽  
World Health ◽  
Drug Use Initiation

BackgroundThe ‘gateway’ pattern of drug initiation describes a normative sequence, beginning with alcohol and tobacco use, followed by cannabis, then other illicit drugs. Previous work has suggested that ‘violations’ of this sequence may be predictors of later problems but other determinants were not considered. We have examined the role of pre-existing mental disorders and sociodemographics in explaining the predictive effects of violations using data from the US National Comorbidity Survey Replication (NCS-R).MethodThe NCS-R is a nationally representative face-to-face household survey of 9282 English-speaking respondents aged 18 years and older that used the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) to assess DSM-IV mental and substance disorders. Drug initiation was estimated using retrospective age-of-onset reports and ‘violations’ defined as inconsistent with the normative initiation order. Predictors of violations were examined using multivariable logistic regressions. Discrete-time survival analysis was used to see whether violations predicted progression to dependence.ResultsGateway violations were largely unrelated to later dependence risk, with the exception of small increases in risk of alcohol and other illicit drug dependence for those who initiated use of other illicit drugs before cannabis. Early-onset internalizing disorders were predictors of gateway violations, and both internalizing and externalizing disorders increased the risks of dependence among users of all drugs.ConclusionsDrug use initiation follows a strong normative pattern, deviations from which are not strongly predictive of later problems. By contrast, adolescents who have already developed mental health problems are at risk for deviations from the normative sequence of drug initiation and for the development of dependence.

scholarly journals An Australian Twin Study of Cannabis and Other Illicit Drug Use and Misuse, and Other Psychopathology

2012 ◽  
Vol 15 (5) ◽  
pp. 631-641 ◽  
Author(s):  
Michael T. Lynskey ◽  
Arpana Agrawal ◽  
Anjali Henders ◽  
Elliot C. Nelson ◽  
Pamela A. F. Madden ◽  
...  
Keyword(s):  
Drug Use ◽  
Large Scale ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Age Of Onset ◽  
Cannabis Use ◽  
Drug Use Disorders ◽  
Illicit Drug Abuse ◽  
Highly Correlated ◽  
Adult Twins

Cannabis is the most widely used illicit drug throughout the developed world and there is consistent evidence of heritable influences on multiple stages of cannabis involvement including initiation of use and abuse/dependence. In this paper, we describe the methodology and preliminary results of a large-scale interview study of 3,824 young adult twins (born 1972–1979) and their siblings. Cannabis use was common with 75.2% of males and 64.7% of females reporting some lifetime use of cannabis while 24.5% of males and 11.8% of females reported meeting criteria for DSM-IV cannabis abuse or dependence. Rates of other drug use disorders and common psychiatric conditions were highly correlated with extent of cannabis involvement and there was consistent evidence of heritable influences across a range of cannabis phenotypes including early (≤15 years) opportunity to use (h2 = 72%), early (≤16 years) onset use (h2 = 80%), using cannabis 11+ times lifetime (h2 = 76%), and DSM abuse/dependence (h2 = 72%). Early age of onset of cannabis use was strongly associated with increased rates of subsequent use of other illicit drugs and with illicit drug abuse/dependence; further analyses indicating that some component of this association may have been mediated by increasing exposure to and opportunity to use other illicit drugs.

Illicit Drug use and Dependence in a New Zealand Birth Cohort

2006 ◽  
Vol 40 (2) ◽  
pp. 156-163 ◽  
Author(s):  
Joseph M. Boden ◽  
David M. Fergusson ◽  
L. John Horwood
Keyword(s):  
Risk Factors ◽  
New Zealand ◽  
Drug Use ◽  
Birth Cohort ◽  
Drug Dependence ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Urban Region ◽  
Adolescent Risk

Objective: To describe the patterns of illicit drug use in a birth cohort studied to the age of 25 years. Method: The data were gathered during the Christchurch Health and Development Study. In this study a cohort of 1265 children born in the Christchurch, New Zealand urban region in mid-1977 have been studied to the age of 25 years. Information was gathered on patterns of illicit drug use and dependence during the period 15–25 years. Results: By age 25 years, 76.7% of the cohort had used cannabis, while 43.5% had used other illicit drugs on at least one occasion. In addition, 12.5% of the cohort met DSM-IV criteria for dependence on cannabis, and 3.6% of the cohortmet criteria for dependence on other illicit drugs at some time by age 25. There was also evidence of substantial poly-drug use among the cohort, with hallucinogens and amphetamines being the most commonly used illicit drugs (excluding cannabis). Illicit drug use and dependence was higher in males, in Māori, and in those leaving school without qualifications. Key risk factors for illicit drug use and dependence included adolescent risk-taking behaviours including cigarette smoking and alcohol consumption, affiliation with substance-using peers, novelty-seeking, and conduct problems in adolescence. Other key risk factors included parental history of illicit drug use and childhood sexual abuse. Conclusions: Levels of cumulative illicit drug use in this cohort were relatively high, with the majority of respondents having tried illicit drugs by age 25. For the majority of illicit drug users, drug use did not lead to problems of dependence. Nonetheless, nearly 15% of the cohort showed symptoms of illicit drug dependence by the age of 25 years, with cannabis dependence accounting for the majority of illicit drug dependence.

scholarly journals Mental disorders as risk factors for later substance dependence: estimates of optimal prevention and treatment benefits

2008 ◽  
Vol 39 (8) ◽  
pp. 1365-1377 ◽  
Author(s):  
M. D. Glantz ◽  
J. C. Anthony ◽  
P. A. Berglund ◽  
L. Degenhardt ◽  
L. Dierker ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Large Scale ◽  
Substance Dependence ◽  
Age Of Onset ◽  
Single Case ◽  
Household Survey ◽  
Cost Effective ◽  
Externalizing Disorders ◽  
Secondary Outcome ◽  
Substance Disorders

BackgroundAlthough mental disorders have been shown to predict subsequent substance disorders, it is not known whether substance disorders could be cost-effectively prevented by large-scale interventions aimed at prior mental disorders. Although experimental intervention is the only way to resolve this uncertainty, a logically prior question is whether the associations of mental disorders with subsequent substance disorders are strong enough to justify mounting such an intervention. We investigated this question in this study using simulations to estimate the number of substance disorders that might be prevented under several hypothetical intervention scenarios focused on mental disorders.MethodData came from the National Comorbidity Survey Replication (NCS-R), a nationally representative US household survey that retrospectively assessed lifetime history and age of onset of DSM-IV mental and substance disorders. Survival analysis using retrospective age-of-onset reports was used to estimate associations of mental disorders with subsequent substance dependence. Simulations based on the models estimated effect sizes in several hypothetical intervention scenarios.ResultsAlthough successful intervention aimed at mental disorders might prevent some proportion of substance dependence, the number of cases of mental disorder that would have to be treated to prevent a single case of substance dependence is estimated to be so high that this would not be a cost-effective way to prevent substance dependence (in the range 76–177 for anxiety-mood disorders and 40–47 for externalizing disorders).ConclusionsTreatment of prior mental disorders would not be a cost-effective way to prevent substance dependence. However, prevention of substance dependence might be considered an important secondary outcome of interventions for early-onset mental disorders.

The Response of Out-Patient Opiate Addicts to the Provision of a Temporary Increase in their Prescribed Drugs

1982 ◽  
Vol 141 (4) ◽  
pp. 338-343 ◽  
Author(s):  
Michael Gossop ◽  
John Strang ◽  
P. H. Connell
Keyword(s):  
Drug Use ◽  
Social Functioning ◽  
Drug Dependence ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Temporary Increase ◽  
Management Problem ◽  
Treatment Team ◽  
Careful Monitoring ◽  
Opiate Addicts

SummaryAddicts who use illicit drugs despite receiving a maintenance prescription present a difficult management problem for drug dependence clinics. This study looks at a small group of such addicts and at their response to the provision of a temporary increase in their prescribed opiates. The results indicate that this increase led to a reduction in illicit drug use and to improvements in social functioning. These and other findings are discussed. It is suggested that clinics should be more prepared to consider such temporary increases, but the need for careful monitoring and for the involvement of more than one member of the treatment team is stressed.

Illicit Drugs

2014 ◽  
Author(s):  
Louisa Degenhardt ◽  
Wayne Hall ◽  
Chiara Bucello
Keyword(s):  
Risk Factors ◽  
Drug Use ◽  
Drug Dependence ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Illicit Drug Use ◽  
Developed Countries ◽  
Future Research ◽  
Problem Drug Use ◽  
Problem Drug

Although illicit drug use has been documented across the world, the quality of these estimates is best in the developed countries of Europe, North America, and Australasia. Regular use, “problem drug use,” and drug dependence are less frequently measured but are important to quantify in order to identify disease burden. This paper reviews European, North American, and Australasian estimates of illicit drug use, problem drug use, and drug dependence and presents risk factors of illicit drug use. These risk factors include health risks related to cannabis and mortality associated with problem drug use and injecting drug use. Drug-related morbidity is reviewed, including nonfatal overdose, HIV/AIDS, and hepatitis B and C. Future research needs to focus on obtaining better estimates of mortality and morbidity to better understand the harms associated with illicit drug dependence.

scholarly journals Social fears and social phobia in the USA: results from the National Comorbidity Survey Replication

2007 ◽  
Vol 38 (1) ◽  
pp. 15-28 ◽  
Author(s):  
A. M. Ruscio ◽  
T. A. Brown ◽  
W. T. Chiu ◽  
J. Sareen ◽  
M. B. Stein ◽  
...  
Keyword(s):  
Social Phobia ◽  
Functional Impairment ◽  
Household Survey ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
World Health ◽  
Treatment Seeking ◽  
National Comorbidity Survey Replication ◽  
National Comorbidity Survey ◽  
Co Morbidity

BackgroundDespite heightened awareness of the clinical significance of social phobia, information is still lacking about putative subtypes, functional impairment, and treatment-seeking. New epidemiologic data on these topics are presented from the National Comorbidity Survey Replication (NCS-R).MethodThe NCS-R is a nationally representative household survey fielded in 2001–2003. The World Health Organization (WHO) Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) was used to assess 14 performance and interactional fears and DSM-IV social phobia.ResultsThe estimated lifetime and 12-month prevalence of social phobia are 12.1% and 7.1% respectively. Performance and interactional fears load onto a single latent factor, and there is little evidence for distinct subtypes based either on the content or the number of fears. Social phobia is associated with significant psychiatric co-morbidity, role impairment, and treatment-seeking, all of which have a dose–response relationship with number of social fears. However, social phobia is the focus of clinical attention in only about half of cases where treatment is obtained. Among non-co-morbid cases, those with the most fears were least likely to receive social phobia treatment.ConclusionsSocial phobia is a common, under-treated disorder that leads to significant functional impairment. Increasing numbers of social fears are associated with increasingly severe manifestations of the disorder.

Mental health in Dutch adolescents: a TRAILS report on prevalence, severity, age of onset, continuity and co-morbidity of DSM disorders

2014 ◽  
Vol 45 (2) ◽  
pp. 345-360 ◽  
Author(s):  
J. Ormel ◽  
D. Raven ◽  
F. van Oort ◽  
C. A. Hartman ◽  
S. A. Reijneveld ◽  
...  
Keyword(s):  
Mental Health ◽  
Anxiety Disorders ◽  
Child Behavior Checklist ◽  
Maternal Education ◽  
Age Of Onset ◽  
Externalizing Disorders ◽  
Self Report ◽  
World Health ◽  
Co Morbidity ◽  
Heterotypic Continuity

BackgroundWith psychopathology rising during adolescence and evidence suggesting that adult mental health burden is often due to disorders beginning in youth, it is important to investigate the epidemiology of adolescent mental disorders.MethodWe analysed data gathered at ages 11 (baseline) and 19 years from the population-based Dutch TRacking Adolescents' Individual Lives Survey (TRAILS) study. At baseline we administered the Achenbach measures (Child Behavior Checklist, Youth Self-Report) and at age 19 years the World Health Organization's Composite International Diagnostic Interview version 3.0 (CIDI 3.0) to 1584 youths.ResultsLifetime, 12-month and 30-day prevalences of any CIDI-DSM-IV disorder were 45, 31 and 15%, respectively. Half were severe. Anxiety disorders were the most common but the least severe whereas mood and behaviour disorders were less prevalent but more severe. Disorders persisted, mostly by recurrence in mood disorders and chronicity in anxiety disorders. Median onset age varied substantially across disorders. Having one disorder increased subjects' risk of developing another disorder. We found substantial homotypic and heterotypic continuity. Baseline problems predicted the development of diagnosable disorders in adolescence. Non-intact families and low maternal education predicted externalizing disorders. Most morbidity concentrated in 5–10% of the sample, experiencing 34–55% of all severe lifetime disorders.ConclusionsAt late adolescence, 22% of youths have experienced a severe episode and 23% only mild episodes. This psychopathology is rather persistent, mostly due to recurrence, showing both monotypic and heterotypic continuity, with family context affecting particularly externalizing disorders. High problem levels at age 11 years are modest precursors of incident adolescent disorders. The burden of mental illness concentrates in 5–10% of the adolescent population.

scholarly journals Alcohol and illicit drug dependence among parents: associations with offspring externalizing disorders

2008 ◽  
Vol 39 (1) ◽  
pp. 149-155 ◽  
Author(s):  
N. R. Marmorstein ◽  
W. G. Iacono ◽  
M. McGue
Keyword(s):  
Drug Dependence ◽  
Illicit Drugs ◽  
Illicit Drug ◽  
Externalizing Disorders ◽  
Late Adolescent ◽  
Externalizing Psychopathology ◽  
Adolescent Offspring ◽  
Oppositional Defiant ◽  
Increased Risk ◽  
Parental Alcohol

BackgroundPrevious research indicates that alcohol and drug dependence constitute aspects of a general vulnerability to externalizing disorders that accounts for much of the parent-offspring resemblance for these and related disorders. This study examined how adolescent offspring risk for externalizing psychopathology varies with respect to parental alcoholism and illicit drug dependence.MethodData from the Minnesota Twin Family Study, a community-based investigation of adolescents (age 17 years, n=1252) and their parents, were used. Lifetime diagnoses of alcohol and drug dependence (among both parents and offspring) and offspring attention deficit hyperactivity disorder, oppositional defiant disorder, conduct disorder, adult antisocial behavior, and nicotine dependence were assessed via structured interviews.ResultsParental alcohol dependence and parental drug dependence were similarly associated with increased risk for nearly all offspring disorders, with offspring of alcohol and drug-dependent parents having approximately 2–3 times the odds for developing a disorder by late adolescence compared to low-risk offspring. Compared to parental dependence on other illicit drugs, parental cannabis dependence was associated with weaker increased risk for offspring externalizing disorders.ConclusionsBoth parental alcohol and drug dependence are independently associated with an increased risk for a broad range of externalizing psychopathology among late-adolescent offspring.

scholarly journals Prevalence and predictors of psychotropic medication use: results from the Northern Ireland Study of Health and Stress

2014 ◽  
Vol 24 (6) ◽  
pp. 542-552 ◽  
Author(s):  
T. Benson ◽  
S. O'Neill ◽  
S. Murphy ◽  
F. Ferry ◽  
B. Bunting
Keyword(s):  
Mental Health ◽  
Northern Ireland ◽  
General Population ◽  
Psychotropic Medication ◽  
Medication Use ◽  
Household Survey ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Policy Implications ◽  
World Health

Background.To identify the predictors of psychotropic medication use and to determine rates and patterns of use in Northern Ireland (NI) among the general population and various subgroups.Method.Analysis of data from the NI Study of Health and Stress, a representative household survey undertaken between 2004 and 2008 with 4340 individuals. Respondents were asked about prescribed psychotropic medication use in the previous 12 months along with a series of demographic questions and items regarding experience of traumatic life events. Mental health disorders were assessed using the World Health Organization's Composite International Diagnostic Interview.Results.Females, individuals aged 50–64 years old, those who were previously married, and those who had experienced a traumatic lifetime event were more likely to have taken any psychotropic medication. Use of any psychotropic medication in the population in the previous 12 months was 14.9%. Use among individuals who met the criteria for a 12-month mental health disorder was 38.5%. Almost one in ten individuals (9.4%) had taken an antidepressant.Conclusions.Compared with other countries, NI has high proportions of individuals using psychotropic medication in both the general population and those who met the criteria for a 12-month mental disorder. However, these results still suggest possible under treatment of mental disorders in the country. In addition, rates of use in those with no disorder are relatively high. The predictors of medication use are similar to findings in other countries. Possible research and policy implications are discussed.

Drug use in global perspective

2018 ◽  
Author(s):  
Thomas F. Babor ◽  
Jonathan Caulkins ◽  
Benedikt Fischer ◽  
David Foxcroft ◽  
Keith Humphreys ◽  
...  
Keyword(s):  
Drug Use ◽  
Drug Users ◽  
Illicit Drugs ◽  
Substance Dependence ◽  
Mental Health Problems ◽  
Global Perspective ◽  
Drug Related Problems ◽  
Overwhelming Evidence ◽  
History Of ◽  
Political Economic

The use of illicit psychoactive substances is commonplace in many parts of the world, with significant variations in the extent of drug use and problem use. This reflects differences in drug markets, drug availability, and legislation, as well as political, economic, and social conditions. Cultural and historical conditions can also play an important role. Overwhelming evidence from epidemiological research conducted over the past 50 years shows that adolescence is the period of greatest risk for the initiation of drug use. Most of those who have tried illicit drugs do not go on to develop drug dependence or drug-related problems. Problem drug users are more often males and are likely to have a family history of substance dependence, delinquent behaviour, and mental health problems. Strategies to prevent drug use or drug related harms need to address the complexity of drug-related problems.

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