Preadult polytoxicomania—strong environmental underpinnings and first genetic hints

Considering the immense societal and personal costs and suffering associated with multiple drug use or “polytoxicomania”, better understanding of environmental and genetic causes is crucial. While previous studies focused on single risk factors and selected drugs, effects of early-accumulated environmental risks on polytoxicomania were never addressed. Similarly, evidence of genetic susceptibility to particular drugs is abundant, while genetic predisposition to polytoxicomania is unexplored. We exploited the GRAS data collection, comprising information on N~2000 deep-phenotyped schizophrenia patients, to investigate effects of early-life environmental risk accumulation on polytoxicomania and additionally provide first genetic insight. Preadult accumulation of environmental risks (physical or sexual abuse, urbanicity, migration, cannabis, alcohol) was strongly associated with lifetime polytoxicomania (p = 1.5 × 10−45; OR = 31.4), preadult polytoxicomania with OR = 226.6 (p = 1.0 × 10−33) and adult polytoxicomania with OR = 17.5 (p = 3.4 × 10−24). Parallel accessibility of genetic data from GRAS patients and N~2100 controls for genome-wide association (GWAS) and phenotype-based genetic association studies (PGAS) permitted the creation of a novel multiple GWAS–PGAS approach. This approach yielded 41 intuitively interesting SNPs, potentially conferring liability to preadult polytoxicomania, which await replication upon availability of suitable deep-phenotyped cohorts anywhere world-wide. Concisely, juvenile environmental risk accumulation, including cannabis and alcohol as starter/gateway drugs, strongly predicts polytoxicomania during adolescence and adulthood. This pivotal message should launch more effective sociopolitical measures to prevent this deleterious psychiatric condition.

Age of Inhalant First Time Use and its Association to the Use of other Drugs

Inhalants are the 4th most commonly abused drugs after alcohol, tobacco, and marijuana. Although inhalants are often referred as Gateway Drugs this hypothesis is less examined. Using the 2003 National Survey on Drug Use and Health data, age of first time inhalant use was compared with the age of onset of other drugs among 6466 inhalant users who also used at least one of 14 other drugs. Findings indicated that only 4.2% multiple drug users who used inhalants prior to other drugs, especially alcohol, tobacco, and marijuana. Thus, the theory that inhalants are gateway drugs was not supported.

The Role of Gateway Drugs and Psychosocial Factors in Substance Dependence in Eastern India

Objective: Western studies have identified the gateway patterns of substance use which lead the way from the so called “Soft Drugs” (like nicotine, etc.) to the “Hard Drugs” (like Opioids) [the Gateway hypothesis]. Nicotine and alcohol have been implicated as the most common initiating drugs in studies from different places, however, studies are lacking from this region. This study was designed to find the drugs of initiation and to understand the factors for initiation, maintenance, and relapse of these substances in persons dependent on them in Eastern India. Method: Seventy subjects with ICD 10 DCR diagnosis of substance dependence admitted consecutively in Center for Addiction Psychiatry, Central Institute of Psychiatry (CIP), Ranchi, were taken up for the study after taking written informed consent. A semi-structured questionnaire including the substance use part of Mini International Neuropsychiatric Inventory (MINI) was administered. Results: Alcohol and opioids were the most common drugs of dependence but nicotine and alcohol were found to be the most common initiating drugs in both alcohol and opioid groups. Persons dependent on opioids presented earlier for treatment, with earlier development of withdrawal symptoms and having completed lesser years of formal education, and had higher monthly incomes as compared to those dependent on alcohol. The most common psychosocial factors determining initiation and maintenance were peer pressure or curiosity. Conclusions: If adolescents and youth can be motivated to stay away even from the “gateway drugs” by targeting common initiation factors, it may lead to delay in dependence or possibly avoidance of development of dependence.

Home Alone: Is it a Risk Factor for Middle School Youth and Drug Use?

This study examined the relationship between middle school/junior high student latchkey status and early experimentation and use of alcohol, tobacco, and other drugs. Students were queried about the frequency (number of times per week) and quantity (number of hours per day) of unsupervised after school days in an average week. Questions were also asked regarding their experiences with “gateway” drugs, inhalants, and steroids. Chi square analysis was used to test the strength of association. The results of this study indicated that latchkey youth (LKY) who were home alone two or more days per week were four times more likely to have gotten drunk in the past month than those youth who had parental supervision five or more times a week. Also, significant differences were observed for LKY with respect to cigarette smoking, inhalants, and marijuana use. Other findings and demographic variables were discussed as they pertain to LKY as well as suggested strategies for healthy self-care alternatives.

Cohort Differences in Drug-Use Pathways to Crack among Current Crack Abusers in New York City

Much prior literature has focused on substance use progression through alcohol, tobacco, and marijuana leading from a time of no drug use as a youth to the possibility of serious drug abuse. This article extends this literature by empirically examining retrospectively the sequence of hard drugs used as reported retrospectively by 994 hard drug abusers from New York City. The sequence was strongly mediated by birth year. Nearly all (81%) current crack abusers born prior to 1953 had previously injected heroin. At the other extreme, prior heroin injection was rare (10%) among crack abusers born since 1967. Many (37%) of these younger crack abusers initiated use of crack just after having used gateway drugs. Theoretical and policy implications of these findings are discussed.