Does the 'gateway' matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication.
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| Title: | Does the 'gateway' matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication. |
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| Authors: | Degenhardt L (AUTHOR), Chiu WT (AUTHOR), Conway K (AUTHOR), Dierker L (AUTHOR), Glantz M (AUTHOR), Kalaydjian A (AUTHOR), Merikangas K (AUTHOR), Sampson N (AUTHOR), Swendsen J (AUTHOR), Kessler RC (AUTHOR) |
| Source: | Psychological Medicine. Jan2009, Vol. 39 Issue 1, p157-167. 11p. |
| Abstract: | BACKGROUND: The '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).METHOD: The 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. RESULTS: Gateway 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. CONCLUSIONS: Drug 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. [ABSTRACT FROM AUTHOR] |
| Copyright of Psychological Medicine is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.) | |
| Database: | Psychology and Behavioral Sciences Collection |
| FullText | Text: Availability: 0 |
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| Header | DbId: pbh DbLabel: Psychology and Behavioral Sciences Collection An: 105505188 AccessLevel: 6 PubType: Academic Journal PubTypeId: academicJournal PreciseRelevancyScore: 0 |
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| Items | – Name: Title Label: Title Group: Ti Data: Does the 'gateway' matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication. – Name: Author Label: Authors Group: Au Data: <searchLink fieldCode="AR" term="%22Degenhardt+L%22">Degenhardt L</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Chiu+WT%22">Chiu WT</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Conway+K%22">Conway K</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Dierker+L%22">Dierker L</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Glantz+M%22">Glantz M</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kalaydjian+A%22">Kalaydjian A</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Merikangas+K%22">Merikangas K</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Sampson+N%22">Sampson N</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Swendsen+J%22">Swendsen J</searchLink> (AUTHOR)<br /><searchLink fieldCode="AR" term="%22Kessler+RC%22">Kessler RC</searchLink> (AUTHOR) – Name: TitleSource Label: Source Group: Src Data: <searchLink fieldCode="JN" term="%22Psychological+Medicine%22">Psychological Medicine</searchLink>. Jan2009, Vol. 39 Issue 1, p157-167. 11p. – Name: Abstract Label: Abstract Group: Ab Data: BACKGROUND: The '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).METHOD: The 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. RESULTS: Gateway 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. CONCLUSIONS: Drug 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. [ABSTRACT FROM AUTHOR] – Name: AbstractSuppliedCopyright Label: Group: Ab Data: <i>Copyright of Psychological Medicine is the property of Cambridge University Press and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.) |
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| RecordInfo | BibRecord: BibEntity: Identifiers: – Type: doi Value: 10.1017/S0033291708003425 Languages: – Code: eng Text: English PhysicalDescription: Pagination: PageCount: 11 StartPage: 157 Titles: – TitleFull: Does the 'gateway' matter? Associations between the order of drug use initiation and the development of drug dependence in the National Comorbidity Study Replication. Type: main BibRelationships: HasContributorRelationships: – PersonEntity: Name: NameFull: Degenhardt L – PersonEntity: Name: NameFull: Chiu WT – PersonEntity: Name: NameFull: Conway K – PersonEntity: Name: NameFull: Dierker L – PersonEntity: Name: NameFull: Glantz M – PersonEntity: Name: NameFull: Kalaydjian A – PersonEntity: Name: NameFull: Merikangas K – PersonEntity: Name: NameFull: Sampson N – PersonEntity: Name: NameFull: Swendsen J – PersonEntity: Name: NameFull: Kessler RC IsPartOfRelationships: – BibEntity: Dates: – D: 01 M: 01 Text: Jan2009 Type: published Y: 2009 Identifiers: – Type: issn-print Value: 00332917 Numbering: – Type: volume Value: 39 – Type: issue Value: 1 Titles: – TitleFull: Psychological Medicine Type: main |
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