Transitions from first substance use to substance use disorders in adolescence: Is early onset associated with a rapid escalation?

• Published in: Drug and alcohol dependence 2009-01, Vol.99 (1), p.68-78
• Main Authors: Behrendt, S, Wittchen, H.-U, Höfler, M, Lieb, R, Beesdo, K
• Format: Article
• Language: English
• Subjects: Addictive behaviors; Adolescence; Adolescent; Adult and adolescent clinical studies; Age; Age of Onset; Alcohol Drinking - epidemiology; Biological and medical sciences; Cannabis; Disease Progression; Drug addiction; Early onset; Epidemiology; General aspects; Germany - epidemiology; Humans; Initiation; Longitudinal Studies; Marijuana Smoking - epidemiology; Marijuana Smoking - psychology; Medical sciences; Miscellaneous; Prospective Studies; Psychiatric Status Rating Scales; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Public health. Hygiene; Public health. Hygiene-occupational medicine; Regression Analysis; Risk; Smoking - epidemiology; Street Drugs; Substance abuse; Substance abuse disorders; Substance use disorder; Substance-Related Disorders - diagnosis; Substance-Related Disorders - epidemiology; Survival Analysis; Transition
• ISSN: 0376-8716; 1879-0046
• DOI: 10.1016/j.drugalcdep.2008.06.014

Abstract Background Early substance use (SU) in adolescence is known to be associated with an elevated risk of developing substance use disorders (SUD); it remains unclear though whether early SU is associated with more rapid transitions to SUD. Objective To examine the risk and speed of transition from first SU (alcohol, nicotine, cannabis) to SUD as a function of age of first use. Methods N = 3021 community subjects aged 14–24 years at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI. Results (1) The conditional probability of substance-specific SU-SUD transition was the greatest for nicotine (36.0%) and the least for cannabis (18.3% for abuse, 6.2% for dependence) with alcohol in between (25.3% for abuse; 11.2% for dependence). (2) In addition to confirming early SU as a risk factor for SUD we find: (3) higher age of onset of any SU to be associated with faster transitions to SUD, except for cannabis dependence. (4) Transitions from first cannabis use (CU) to cannabis use disorders (CUD) occurred faster than for alcohol and nicotine. (5) Use of other substances co-occurred with risk and speed of transitions to specific SUDs. Conclusion Type of substance and concurrent use of other drugs are of importance for the association between age of first use and the speed of transitions to substance use disorders. Given that further research will identify moderators and mediators affecting these differential associations, these findings may have important implications for designing early and targeted interventions to prevent disorder progression.