Hostname: page-component-cd9895bd7-8ctnn Total loading time: 0 Render date: 2024-12-30T15:51:56.305Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  09 May 2008

L. Degenhardt ,
W. T. Chiu ,
K. Conway ,
L. Dierker ,
M. Glantz ,
A. Kalaydjian ,
K. Merikangas ,
N. Sampson ,
J. Swendsen  and
R. C. Kessler
L. Degenhardt*
Affiliation:
National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW, Australia
W. T. Chiu
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MAUSA
K. Conway
Affiliation:
Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, US National Institutes of Health, Bethesda, MDUSA
L. Dierker
Affiliation:
Department of Psychology, Wesleyan University, Middletown, CT, USA
M. Glantz
Affiliation:
Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse, US National Institutes of Health, Bethesda, MDUSA
A. Kalaydjian
Affiliation:
National Institute of Mental Health, Bethesda, MD, USA
K. Merikangas
Affiliation:
National Institute of Mental Health, Bethesda, MD, USA
N. Sampson
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MAUSA
J. Swendsen
Affiliation:
Psychopathology Research Laboratory, University of Bordeaux, Bordeaux, France
R. C. Kessler
Affiliation:
Department of Health Care Policy, Harvard Medical School, Boston, MAUSA
*
*Address for correspondence: Professor L. Degenhardt, National Drug and Alcohol Research Centre, University of NSW, Sydney NSW 2052, Australia. (Email: l.degenhardt@unsw.edu.au)
Get access Rights & Permissions [Opens in a new window]

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.

Keywords

Alcoholcannabisdependencegatewayillicit drugsNational Comorbidity Survey Replicationtobacco
Type
Original Articles
Information
Psychological Medicine , Volume 39 , Issue 1 , January 2009 , pp. 157 - 167
Copyright
Copyright © 2008 Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Anthony, JC, Warner, L, Kessler, R (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology 2, 244–268.CrossRefGoogle Scholar
Degenhardt, L, Bohnert, KM, Anthony, J (2007 a). Case ascertainment of alcohol dependence in general population surveys: ‘gated’ versus ‘ungated’ approaches. International Journal of Methods in Psychiatric Research 16, 111–123.CrossRefGoogle ScholarPubMed
Degenhardt, L, Bohnert, KM, Anthony, J (2008). Assessment of cocaine and other drug dependence in the general population: ‘hated’ versus ‘ungated’ approaches. Drug and Alcohol Dependence 93, 227–232.CrossRefGoogle Scholar
Degenhardt, L, Cheng, H, Anthony, J (2007 b). Assessing cannabis dependence in community surveys: methodological issues. International Journal of Methods in Psychiatric Research 16, 43–51.CrossRefGoogle ScholarPubMed
Degenhardt, L, Chu, W-T, Sampson, N, Kessler, RC, Anthony, JC (2007 c). Epidemiological patterns of extra-medical drug use in the United States: evidence from the National Comorbidity Survey Replication, 2001–2003. Drug and Alcohol Dependence 90, 210–223.CrossRefGoogle ScholarPubMed
Degenhardt, L, Coffey, C, Moran, P, Carlin, JB, Patton, GC (2007 d). The predictors and consequences of adolescent amphetamine use: findings from the Victorian Adolescent Health Cohort Study. Addiction 102, 1076–1084.CrossRefGoogle Scholar
Degenhardt, L, Lynskey, M, Hall, W (2000). Cohort trends in the age of initiation of drug use in Australia. Australian and New Zealand Journal of Public Health 24, 421–426.CrossRefGoogle ScholarPubMed
Engels, R, Knibbe, R, Drop, M (1997). Inconsistencies in adolescents' self-reports of initiation of alcohol and tobacco use. Addictive Behaviors 22, 613–623.CrossRefGoogle ScholarPubMed
Fergusson, D, Boden, J, Horwood, LJ (2006). Cannabis use and other illicit drug use: testing the cannabis gateway hypothesis. Addiction 101, 556–569.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1996). Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). American Psychiatric Press: Washington, DC.Google Scholar
Ginzler, J, Cochran, B, Domenech-Rodriguez, M, Cauce, A, Whitbeck, L (2003). Sequential progression of substance use among homeless youth: an empirical investigation of the gateway theory. Substance Use and Misuse 38, 725–758.CrossRefGoogle ScholarPubMed
Golub, A, Johnson, BD (1994 a). Cohort differences in drug-use pathways to crack among current crack abusers in New York City. Criminal Justice and Behavior 21, 403–422.CrossRefGoogle Scholar
Golub, A, Johnson, BD (1994 b). The shifting importance of alcohol and marijuana as gateway substances among serious drug abusers. Journal of Studies on Alcohol 55, 607–614.CrossRefGoogle ScholarPubMed
Golub, A, Johnson, BD (2002). The misuse of the ‘Gateway Theory’ in US policy on drug abuse control: a secondary analysis of the muddled deduction. International Journal of Drug Policy 13, 5–19.CrossRefGoogle Scholar
Grau, L, Dasgupta, N, Harvey, A, Irwin, K, Givens, A, Kinzly, M, Heimer, R (2007). Illicit use of opioids: is OxyContin a ‘gateway drug’? American Journal on Addictions 16, 166–173.CrossRefGoogle ScholarPubMed
Hall, W, Degenhardt, L, Lynskey, M (2001). The Health and Psychological Consequences of Cannabis Use. Australian Publishing Service: Canberra.Google Scholar
Hall, W, Lynskey, M (2005). Is cannabis a gateway drug? Testing hypotheses about the relationship between cannabis use and the use of other illicit drugs. Drug and Alcohol Review 24, 39–48.CrossRefGoogle ScholarPubMed
Henry, B, Moffitt, T, Caspi, A, Langley, J, Silva, P (1994). On the ‘remembrance of things past’: a longitudinal evaluation of the retrospective method. Psychological Assessment 6, 92–101.CrossRefGoogle Scholar
Johnston, LD, O'Malley, PM, Bachman, JG (2003). National Survey Results on Drug Use from the Monitoring the Future Study, 1975–2003. National Institute on Drug Abuse: Rockville, MD.Google Scholar
Kandel, D, Davies, M, Karus, D, Yamaguchi, K (1986). The consequences in young adulthood of adolescent drug involvement. Archives of General Psychiatry 43, 746–754.CrossRefGoogle ScholarPubMed
Kandel, D, Faust, R (1975). Sequence and stages in patterns of adolescent drug use. Archives of General Psychiatry 32, 923–932.CrossRefGoogle ScholarPubMed
Kandel, D, Yamaguchi, K (2006). Testing the gateway hypothesis. Addiction 101, 470–472.CrossRefGoogle ScholarPubMed
Kandel, DB (1984). Marijuana users in young adulthood. Archives of General Psychiatry 41, 200–209.CrossRefGoogle ScholarPubMed
Kandel, DB, Yamaguchi, K, Chen, K (1992). Stages of progression in drug involvement from adolescence to adulthood: further evidence for the gateway theory. Journal of Studies on Alcohol 53, 447–457.CrossRefGoogle ScholarPubMed
Kessler, RC, Abelson, J, Demler, O, Escobar, JI, Gibbon, M, Guyer, ME, Howes, MJ, Jin, R, Vega, WA, Walters, EE, Wang, P, Zaslavsky, A, Zheng, H (2004 a). Clinical calibration of DSM-IV diagnoses in the World Mental Health (WMH) version of the World Health Organization (WHO) Composite International Diagnostic Interview (WMHCIDI). International Journal of Methods in Psychiatric Research 13, 122–139.CrossRefGoogle ScholarPubMed
Kessler, RC, Berglund, P, Chiu, WT, Demler, O, Heeringa, S, Hiripi, E, Jin, R, Pennell, BE, Walters, EE, Zaslavsky, A, Zheng, H (2004 b). The US National Comorbidity Survey Replication (NCS-R): design and field procedures. International Journal of Methods in Psychiatric Research 13, 69–92.CrossRefGoogle ScholarPubMed
Kessler, RC, Merikangas, KR (2004). The National Comorbidity Survey Replication (NCS-R): background and aims. International Journal of Methods in Psychiatric Research 13, 60–68.CrossRefGoogle ScholarPubMed
Kessler, RC, Ustun, TB (2004). The World Mental Health (WMH) Survey Initiative Version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). International Journal of Methods in Psychiatric Research 13, 93–121.CrossRefGoogle ScholarPubMed
Labouvie, E, Bates, M, Pandina, R (1997). Age of first use: its reliability and predictive utility. Journal of Studies on Alcohol 58, 638–643.CrossRefGoogle ScholarPubMed
MacCoun, R (2006). Competing accounts of the gateway effect: the field thins, but still no clear winner. Addiction 101, 473–474.CrossRefGoogle ScholarPubMed
Mackesy-Amiti, ME, Fendrich, M, Goldstein, PJ (1997). Sequence of drug use among serious drug users: typical vs atypical progression. Drug and Alcohol Dependence 45, 185–196.CrossRefGoogle ScholarPubMed
Morral, A, McCaffrey, D, Paddock, S (2002). Reassessing the marijuana gateway effect. Addiction 97, 1493–1504.CrossRefGoogle ScholarPubMed
Patel, V, Fisher, AJ, Hetrick, S, McGorry, P (2007). Mental health of young people: a global public-health challenge. Lancet 369, 1302–1313.CrossRefGoogle ScholarPubMed
Patton, G, Coffey, C, Carlin, J, Sawyer, SM, Lynskey, M (2005). Reverse gateways? Frequent cannabis use as a predictor of tobacco initiation and nicotine dependence. Addiction 100, 1518–1525.CrossRefGoogle ScholarPubMed
Reid, L, Elifson, K, Sterk, C (2007). Ecstasy and gateway drugs: initiating the use of ecstasy and other drugs. Annals of Epidemiology 17, 74–80.CrossRefGoogle ScholarPubMed
Shedler, J, Block, J (1990). Adolescent drug use and psychological health: a longitudinal inquiry. American Psychologist 45, 612–630.CrossRefGoogle ScholarPubMed
Toumbourou, J, Stockwell, T, Neighbors, C, Marlatt, G, Sturge, J, Rehm, J (2007). Interventions to reduce harm associated with adolescent substamce use. Lancet 369, 1391–1401.CrossRefGoogle ScholarPubMed
Wu, LT, Korper, S, Marsden, M, Lewis, C, Bray, R (2003). Use of incidence and prevalence in the substance use literature: a review. Substance Abuse and Mental Health Services Administration, Office of Applied Studies: Rockville, MD.Google Scholar