Adolescent Drug Use Gateway to Addiction in Adulthood

Man walking and thinking about Adolescent Drug Use

Dr. Mark Gold’s Research You Can Use

A recent study, assessing the national survey data, unearthed a common liability of all drug use initiated earlier in youth: substance abuse initiated during adolescence was indicative of a greater prevalence of substance use disorder among adults. Even though surprising, this makes sense as all drugs of abuse share common neurobiological mechanisms to cause euphoria.

Alcohol, tobacco and marijuana gateway to illicit drug use

The recent rising trends of medicalizing, legalizing and standardizing marijuana has galvanized raging debates regarding how this legal and social modification will influence the current patterns of marijuana use and other questionable substances, especially regarding the youth. This confusing argument often conflates cancer patient use or even adult use with young adolescent use. Simultaneously, scientific evidence has consistently maintained that the initiation of drug use, whether marijuana, alcohol and tobacco use during adolescence considerably increases the vulnerability to life-long addiction and other harmful consequences.

Especially in the face of the present epidemic of opioid use disorders and overdose fatalities, an irrefutable rationale to prevent adolescent substance use as a public health priority has gained much momentum. With the increasing popularity of marijuana, it has become even more imperative to assess the factors encouraging adolescent use of marijuana, alcohol, and nicotine, alongside other illicit substances.

Several studies in the past have established correlations between adolescent marijuana use to a greater progression to other illicit drug use. Columbia University’s Kandel and Faust explored adolescent drug use in 1975 through random and sequential sampling of students in middle and high schools.

adolescents and substance abuse - Girl drinking alcoholEight thousand students were surveyed, and results showed that students consuming tobacco and alcohol progressed significantly quicker to marijuana use within a matter of 5 to 6 months than compared to those who had not initiated the use of tobacco and alcohol. Out of the latter, fewer than one-tenth had used marijuana. Succession to other illicit drugs was also much higher among marijuana users as compared to non-marijuana users.

Similar results were reached from the National Longitudinal Study of Adolescent Health report, involving a broad, comprehensive survey of adolescents in the U.S. Conclusions drawn indicated that the early onset combined use of tobacco, alcohol, and marijuana was more common among young adolescents.

Over recent years, this hypothesis has only gained more traction as evidence keeps increasing as to how early initiation of any drug use is related to common liabilities, influenced by individual traits, culture, family background, and availability. It is undeniable that understanding patterns of drug use is imperative as their influence extends to shaping relevant and effective prevention strategies.

The present study

Founding NIDA Director, Robert L. DuPont and colleagues aimed to assess the relationship between using one substance by adolescents and a greater risk for using any other substance, regardless of any use sequences. The team examined data collected from 17,000 youth, aged 12 to 17 years, who participated in the 2014 National Survey on Drug Use and Health and revised this sample of nationally representative data in 2017. The 2014 NSDUH collected data on current (past-month) and lifetime consumption of tobacco, alcohol, marijuana and other illicit drugs for all participants through in-person interviews.

Descriptive analyses and multivariable logistic regression models were utilized for the study in order to estimate the prevalence and other factors such as age, sex, and ethnicity. Marijuana, alcohol, and tobacco were all established as gateway drugs for teens. Adolescent use of any one gateway drug was associated with the use of the other two. Teen use of any one gateway drug was linked to the use of other illicit drugs.

Based on the sample population, the unadjusted prevalence of current use of marijuana, cigarettes, alcohol or other illicit drugs was 7.4 percent, 4.9 percent, 11.5 percent or 2.6 percent respectively. The unadjusted prevalence of lifetime use of marijuana, cigarettes, alcohol or other illicit drugs was recorded as 16.4 percent, 14.2 percent, 29.6 percent or 13.4 percent respectively.

Marijuana use and the use of other substances

Woman smokingYoung adolescents who currently used marijuana were more likely to use cigarettes and drink heavily or binge drink and use other illicit drugs.

Past-month marijuana users were 8.9 times more likely to report past-month cigarette use, 5.6 times more likely to use alcohol, 7.9 times more likely to binge drink and 9.9 times more likely to use other illicit drugs.

Alcohol use and the use of other substances

Youth involved in the current use of alcohol were much more likely to use cigarettes, marijuana, and other illicit drugs. In fact, the severity of alcohol was found to be directly proportional to the prevalence of tobacco, marijuana, and illicit drug use.

Youth with past-month alcohol use, without binge drinking or heavy use, were 5.8 times more likely to report past-month marijuana use, 4.8 times more likely to report past-month illicit drug use and 3.8 times more likely consume cigarettes.

Comparatively, youth with past-month binge alcohol use only were 9.9 times more likely to use marijuana, 7.6 times more likely to report past-month illicit drug use and 8.1 times more likely to report cigarette consumption.

Moreover, youth with current heavy alcohol use were 15.7 times more likely to report marijuana use, 16.8 times more likely to report illicit drug use and 13.4 times more likely to report cigarette consumption.

Tobacco use and the use of other substances

Past-month cigarette smokers were seven times more likely to report marijuana to report marijuana use, 7.7 times more likely to indulge in illicit drug use and 4.2 times more likely to consume alcohol. Adjusted lifetime marijuana, other illicit drugs, and alcohol use were all greater among youth who report lifetime cigarette use.

Why is this significant?

Given recent data estimates and evidence acquired, it is relatively obvious that in order to improve teen health and reduce addiction, it is imperative, to begin with reducing teen drug use. Abstaining from any drug use is linked to a lower risk of using all other drugs. Many existing youth prevention programs/messages target individual substances, certain risks of substance abuse associated with particular amounts.

Couple talkingIt is now time to target substance abuse in a wider context that encompasses discouraging all other drug use by young adolescents.

By prioritizing abstinence of all drug use in youth, there might be better chances of reducing not just adolescent drug use but substance use disorders into adulthood as well. Prevention should focus on approaches that reduce the use of all substances simultaneously.

Rather than disparaging the “Gateway Hypothesis,” it is crucial to consider any drug use during the human brain’s formative years as gateway events. Teenage cigarette initiation means a greater likelihood of life-long smoking, similar to how underage drinking indicates more chances of binge drinking and heavy drinking in the future. Marijuana use is no different in this case.

It is important to realize that first drug use is associated with significant precursors and present factors, as has been explored for decades. Targeting such factors may play a vital role in preventing, or at least delaying, initiation of drug use in early adolescence. The nationally representative findings from this study hold significant importance for future prevention, public health policies, and programs, especially considering the current opioid crisis.



About the Author:

Mark GoldMark S. Gold, M.D.  served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014. Dr. Gold was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Learn more about Mark S. Gold, MD

About the Transcript Editor:

Sana Ahmed photoA journalist and social media savvy content writer with extensive research, print and on-air interview skills, Sana Ahmed has previously worked as staff writer for a renowned rehabilitation institute, a content writer for a marketing agency, an editor for a business magazine and been an on-air news broadcaster.

Sana graduated with a Bachelors in Economics and Management from London School of Economics and began a career of research and writing right after. Her recent work has largely been focused upon mental health and addiction recovery.

The opinions and views of our guest contributors are shared to provide a broad perspective of addictions. These are not necessarily the views of Addiction Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Addiction Hope understand that addictions result from multiple physical, emotional, environmental and genetic factors. If you or a loved one are suffering from an addiction, please know that there is hope for you, and seek immediate professional help.

Published on December 26, 2018
Reviewed by Jacquelyn Ekern, MS, LPC on December 26, 2018
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