Marijuana users in young adulthood.

Striking differences appeared among 1,325 young adults aged 24 to 25 years depending on their marijuana use. Differences increased with involvement, although no threshold appeared at any particular level. Marijuana users were characterized by higher use of other substances, membership in networks of marijuana users, lower participation and greater instability in conventional roles of adulthood, history of psychiatric hospitalization and lower psychological well-being, and participation in deviant activities. Involvement with marijuana-using friends and use by spouse or partner, as well as use of other illicit drugs, were important predictors of current marijuana involvement. In young adulthood, as in adolescence, marijuana use is embedded in a social context favorable to its use and is associated with disaffection from social institutions. The social and psychological correlates of marijuana use are similar in young adulthood and adolescence and have remained unchanged over the last decade.

High school students who use crack and other drugs.

BACKGROUND: When it appeared in the 1980s, crack was thought to represent a completely new pathway of entry into drug use. Our objective was to identify the distinguishing characteristics of adolescents who have reached different stages of drug use, in particular the highest state represented by crack. METHODS: Adolescents (N = 7611) representative of students in grades 7 to 12 from 53 New York state schools were classified in the following six mutually exclusive, cumulative categories of drug use: nonusers; alcohol and/or cigarette users only; marijuana users only; users of illicit drugs other than marijuana but neither cocaine nor crack; cocaine but not crack users; and crack users. The groups were compared in level of psychosocial functioning. RESULTS: Students who use illicit drugs show deficits in school performance, quality of family relationships, and health and increased psychological symptoms. Compared with nonusers, they are more delinquent and more actively involved with their peers and live in social environments in which the perceived use of drugs by other adolescents and parents is more extensive. Delinquency and extent of perceived drug use consistently increase with each higher stage of use. Crack users exhibit the lowest level of psychosocial functioning of any drug-using group. CONCLUSIONS: There are stage-specific characteristics and common characteristics (delinquent participation, peer drug use) throughout the developmental sequence of drug use. Despite declines over the last two decades in the prevalence of the use of different drugs, young people who use drugs display characteristics over historical time similar to those of young drug users 20 years ago.

Adult sequelae of adolescent depressive symptoms.

We examined sequelae of depressive mood, experienced at ages 15 to 16 years, nine years later at ages 24 to 25 years in subjects formerly enrolled in New York State public high schools. Feelings of dysphoria in adolescence predict most strongly a similar experience in adulthood. Such feelings also predict psychiatric hospitalization for women but not for men, at least up to the period we investigated. In addition, adolescent depression is associated with heavy cigarette smoking, increased use of minor prescription tranquilizers (among women), more deviant activities and accidents as young adults, and selective effects on interpersonal relationships. The long-term effects of adolescent depression manifest themselves in a reduced ability to establish an intimate relationship with a member of the opposite sex rather than the ability to maintain a circle of male and female friends. The distance from spouse (or partner) repeats within the marital dyad the lack of closeness to parents experienced in adolescence. Dysphoric mood seems to be associated with a deficiency to establish close interpersonal relationships within the family that expresses itself differently at different stages of the life cycle: toward parents in adolescence, and toward spouses and parents in young adulthood.

Epidemiology of depressive mood in adolescents: an empirical study.

The epidemiology and correlates of depressive mood were measured in a representative sample of public high school students in New York State and a subsample matched to their parents. Depressive mood was measured by a self-reported scale validated in a clinical sample. Adolescents with a diagnosis of major depressive disorder scored higher than those with other psychiatric diagnoses. In the general adolescent sample, ex differences in depressive mood paralleled those previously reported for adults, with girls scoring higher than boys. Adolescents reported higher depressive mood than their parents, with the differences greater in daughter-mother than in son-father pairs. If judged by mood differences, adolescence was a stressful period in the life cycle. Lowest levels of adolescent depressive mood correlated with high levels of attachment both to parents and to peers. Sex differences in depressive mood in adolescents may be accounted for by masked depression and increased delinquency among boys as compared with girls.

Cessation of illicit drug use in young adulthood.

The predictors of cessation of marijuana and cocaine use were examined in a longitudinal cohort of young adult men and women (N = 1222). Six domains of predictors were examined: socioeconomic background variables, participation in the social roles of adulthood, degree of drug involvement, social context of drug use, health status, and deviant activities and conventionality of life experiences. Factors that predicted cessation of use in adulthood paralleled those that predicted lack of initiation in adolescence: conventionality in social role performance, social context unfavorable to the use of drugs, and good health. A most important predictor was prior degree of involvement in licit and illicit drugs. In multivariate analyses, degree of prior drug involvement remained the strongest predictor of drug cessation for of marijuana use, while friends' use was the most important for cocaine. Those who use drugs in response to social influences are more likely to stop using them than those who also use drugs for psychological reasons.

The consequences in young adulthood of adolescent drug involvement. An overview.

To examine the consequences of adolescent drug use on the psychosocial and health functioning of young adults, we followed up 1004 young men and women from age 15 or 16 years to age 25 years. The use of four different classes of drugs was examined: cigarettes, alcohol, marijuana, and other illicit drugs. Twenty outcomes were examined, including continuity of participation in work and in family roles, level of education, delinquent activities, self-reported health and psychological symptoms, and use of five drug classes in early adulthood (including prescribed psychoactive medications). The effects of marijuana and of other illicit drugs could not be disentangled, so these drugs were treated as a single class. Controlling for initial individual differences in adolescence, use of the three major drug classes between adolescence and early adulthood affected most of the outcomes examined; most strongly continued use of the same substance. Unique drug effects included those of illicit drugs on increased delinquency, unemployment, divorce, and abortions, and of cigarettes on lowered psychological mood. Illicit drugs predicted drug-related health problems, whereas cigarette use predicted increased breathing difficulties.

Maternal smoking during pregnancy and psychopathology in offspring followed to adulthood.

OBJECTIVE: To extend findings from several independent reports of an association between maternal smoking during pregnancy and attention-deficit hyperactivity disorder, conduct disorder, and substance abuse in the offspring. METHOD: This is a 10-year longitudinal study of offspring assessed at 3 points in time into adulthood. Fifty offspring of mothers who reported smoking at least 10 cigarettes almost daily during pregnancy and 97 offspring of mothers who reported never smoking during pregnancy were studied. Psychiatric diagnosis in offspring was assessed blind to parental diagnosis. RESULTS: There was a greater than 4-fold increased risk of prepubertal-onset conduct disorder in boys and a greater than 5-fold increased risk of adolescent-onset drug dependence in girls whose mothers smoked 10 or more cigarettes almost daily during pregnancy. These findings could not be explained by maternal substance abuse during pregnancy, parental psychiatric diagnosis, family risk factors, prenatal and early developmental history of offspring, postnatal maternal smoking, or smoking in the offspring. CONCLUSIONS: Maternal smoking during pregnancy may have a long-term effect on specific psychopathology in offspring. The underlying pathophysiology of nicotine on the fetus requires study. The findings suggest the importance of programs aimed at smoking prevention and cessation in women during pregnancy.

Psychiatric comorbidity among adolescents with substance use disorders: findings from the MECA Study.

OBJECTIVE: To investigate the extent to which adolescents in the community with current substance use disorders (SUD) experience co-occurring psychiatric disorders. METHOD: Diagnostic data were obtained from probability samples of 401 children and adolescents, aged 14 to 17 years, and their mothers/caretakers, who participated in the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. RESULTS: The rates of mood and disruptive behavior disorders are much higher among adolescents with current SUD than among adolescents without SUD. Comparison with adult samples suggests that the rates of current comorbidity of SUD with psychiatric disorders are the same among adolescents as adults, and lower for lifetime disruptive disorders/antisocial personality disorder among adolescents than adults. CONCLUSIONS: The high rate of coexisting psychiatric disorders among adolescents with SUD in the community needs to be taken into account in prevention and treatment programs.

The NIMH Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study: background and methodology.

OBJECTIVE: A collaborative study was conducted to develop methods for surveys of mental disorder and service utilization in unscreened population-based samples of children and adolescents. METHOD: Probability household samples of youths 9 through 17 years of age were selected at four sites and interviews were conducted with a total of 1,285 pairs of youths and their adult caretakers in their homes. Lay interviewers administered a computer-assisted version of the NIMH Diagnostic Interview Schedule for Children Version 2.3 and structured interviews to assess demographic variables, functional impairment, risk factors, service utilization, and barriers to service utilization. RESULTS: More than 7,500 households were enumerated at four sites, with enumeration response rates above 99%. Across sites, 84% of eligible youth-caretaker pairs were interviewed for about 2 hours each. Ninety-five percent of both youths and caretakers found the interview to be acceptable enough to recommend to a friend. CONCLUSIONS: These findings indicate that large-scale epidemiological surveys of mental disorders and mental health service use involving lengthy interviews in the homes of unscreened population-based samples of youths and their adult caretakers are acceptable to the community and can achieve good response rates. The other reports in this Special Section address the reliability and validity of the various survey instruments and other key findings.

Predictors of cessation of marijuana use: an event history analysis.

Event history analysis was applied to monthly life and drug histories of a representative community sample of 706 marijuana users, followed from ages 15-16 to 34-35, to investigate factors associated with cessation of marijuana use from adolescence to adulthood. In addition to age and gender, the most important determinants of cessation are the phenomenology of marijuana use, social role participation, depressive symptoms and deviance. Frequent users, those who started using early and those who use illicit drugs other than marijuana are more likely to continue their marijuana use. Using marijuana for social reasons accelerates cessation, using to change one's mood reduces cessation. Becoming pregnant and a parent is the most important social role leading to marijuana cessation for women. There is also a very important experimental effect of the interview itself on the reported timing of a cessation. The effect of a social context favorable to marijuana use appears to reflect selection rather than social influence.

Relationships between frequency and quantity of marijuana use and last year proxy dependence among adolescents and adults in the United States.

The association between levels of marijuana use and last year dependence is investigated in a nationally representative sample of adolescents and adults, who used marijuana within the last year (n = 9284). Data are aggregated from three surveys (1991-1993) of the National Household Survey on Drug Abuse. A proxy measure of DSM-IV dependence criteria was developed from self-reported symptoms of dependence and drug-related problems. Both frequency and quantity of marijuana use within the last year are linearly associated with the logit of the probability of being dependent on marijuana. The associations vary significantly by age but not gender. Adolescents are dependent at a lower frequency and quantity of use than adults: the differences diverge as level of use increases. Twice as many adolescents as adults who used marijuana near-daily or daily within the last year were identified as being dependent (35% versus 18%). Frequency and quantity of use each retained a unique effect on dependence, but frequency appeared to be more important than quantity in predicting last year dependence. These results provide insight into the processes underlying the age and sex differentials observed in the prevalence of marijuana dependence. The implications of the findings for the epidemiology of marijuana use and dependence are discussed.

Effects of chronic cocaine use on physical health: a prospective study in a general population sample.

Few studies have examined long-term effects of chronic cocaine use on physical health in the general population. The current study assesses the effects of chronic cocaine use by the late twenties on physical health by the mid thirties in a longitudinal cohort from the general population. Measures of physical health included self-reported health status, cardiovascular, neurological, and somatic symptoms, and number of hospital or sick days within the last year. The casual analyses were restricted to males because few females used cocaine heavily and the relationships between females' cocaine use and physical health were rarely significant. Among males, chronic cocaine use increased physical health problems, controlling for prior health status, current cocaine use, use of other drugs and sociodemographic characteristics. In turn, poor health contributed to continued cocaine use. Variance partitioning based on cocaine use patterns (frequency and chronicity) indicated that chronic users experienced the most adverse consequences on subsequent physical health. Implications for understanding how chronic cocaine use affects a broad spectrum of physical functioning are discussed.

Comorbidity between patterns of substance use dependence and psychiatric syndromes.

BACKGROUND: Comorbidity of dependence on single and multiple drugs with psychiatric syndromes was examined in national samples from the National Household Survey on Drug Abuse (NHSDA). METHODS: Subjects are adults from the l994, l995 and l996 NHSDA surveys. Proxy measures of drug dependence in the last year were constructed from five dependence symptoms that approximated DSM-IV criteria. Measures of patterns of concurrent dependence on cigarettes, alcohol and illicit drugs were constructed. Fallible indicators of a major depressive episode and any anxiety disorder (generalized anxiety disorder, agoraphobia and panic attack) were based on scales measuring symptoms during the last year. Comorbidity was estimated by adjusted odds ratios. RESULTS: Probable drug dependent individuals have higher rates of psychiatric syndromes. Rates of psychiatric syndromes were similar for those uniquely dependent on alcohol, cigarettes or illicit drugs (adjusted odds ratios approximately 2.0). Rates almost doubled for those dependent on both an illicit and a licit drug. CONCLUSIONS: Individuals uniquely dependent on a single drug class experience similar rates of psychiatric morbidity. All those dependent on illicit drugs experience higher rates of psychiatric syndromes. This reflects the additive association of dependence on legal and illegal drugs with psychiatric disorders and the increased rates of dependence on a legal drug among those dependent on an illicit drug. Individuals with multiple dependencies on legal and illegal drugs have the highest need for mental health services.

College on problems of drug dependence meeting, Puerto Rico (June 1996) marijuana use and dependence.

Discoveries concerning an endogenous cannabinoid system and observations of dramatic increases in marijuana use among youth in the United States have fueled a recent increase in basic and clinical research to better understand and treat marijuana dependence. At the annual meeting of the College on Problems of Drug Dependence (Puerto Rico, 1996) a symposium 'Marijuana Use: Basic Mechanisms, Epidemiology, and Clinical Issues' reviewed a number of important areas of ongoing research that address marijuana dependence. Overviews and original research were presented regarding the development of dependence (preclinical and clinical research), motivational effects (laboratory models), the epidemiology of dependence and its development, clinical management of marijuana use among patients seeking treatment for other drugs of abuse, and treatment for adult marijuana dependence. This paper summarizes the symposium presentations and provides discussion of recent scientific developments concerning marijuana use and dependence.

Ethnic differences in correlates of adolescent cigarette smoking.

PURPOSE: To examine the correlates of cigarette smoking among African-American, Hispanic, and white adolescents in a cross-sectional national sample. METHODS: A total of 1795 mother-child dyads from the 1992 National Longitudinal Survey of Youth were selected for analyses. Measures of adolescents cigarette smoking and family, individual, peer, and sociodemographic risk factors were analyzed. RESULTS: White youths reported the highest rates of lifetime, current, and persistent smoking, and initiated smoking at a significantly earlier age than African-Americans and Hispanics. Except for maternal cigarette smoking and substance use, African-Americans and Hispanics experienced a disproportionately larger number of purported risk factors than whites. Multivariate analyses revealed common and ethnic-specific correlates of adolescent lifetime and current smoking, with many more significant associations among whites than minorities. Common correlates included youth's age across all three ethnic groups, problem behaviors and delinquency among whites and African-Americans, and perceived peer pressure to smoke among whites and Hispanics. Ethnic-specific correlates included maternal smoking, maternal cocaine use, low maternal religiosity, and negative scholastic attitudes, which increased smoking for whites; and positive parenting, which reduced smoking for African-Americans. CONCLUSIONS: The lack of effects of maternal smoking and perceived peer pressure to smoke on African-American adolescents compared with whites suggests that role modeling and interpersonal influence may be more important determinants of smoking for white than African-American adolescents. The differential impact of family and peer factors on the smoking of adolescents of different ethnicity warrants further investigation.

Types of marijuana users by longitudinal course.

OBJECTIVE: Taxonomies of alcoholism and antisocial behaviors based on developmental course converge on two-group classifications that emphasize early and late onset. Typologies for users of illicit drugs remain to be developed. This article proposes a developmental taxonomy of marijuana users. METHOD: Cluster analysis was applied to a representative community sample of 708 (364 male, 344 female) marijuana users followed from adolescence to age 34-35. The Ward method, followed by relocation, was used to classify marijuana users into different types based on age of onset, chronicity of heavy use and persistence of use. ANOVA and logit analyses were utilized to describe the cluster solution and examine the correlates of cluster membership. RESULTS: Four marijuana use clusters were identified: early onset-heavy use, early onset-light use, mid onset-heavy use and late onset-light use. The groups differed from each other in degree of involvement in marijuana and other drugs, sociodemographic and lifestyle characteristics. The majority of those with early onset did not become heavily involved in marijuana. Unique factors were associated with membership in each group. Factors differentiating early from mid-onset heavy use included association with marijuana-using peers and having had a mental disorder. Peer delinquency was an additional factor differentiating early initiators who became heavy users from those who did not. CONCLUSIONS: A simple two-type classification fails to take into account the heterogeneity of early and late onset groups. By itself, early onset into marijuana will not lead to problematic use or rapid progression into the use of other drugs. Motivation underlying use and dysfunctional behaviors are associated with the development of problematic drug use and dependence.

The impact of maternal drinking during and after pregnancy on the drinking of adolescent offspring.

OBJECTIVE: The impact of prenatal maternal drinking on alcohol consumption in adolescent offspring was examined among boys and girls separately. METHOD: A prospective longitudinal sample of 185 mother-firstborn child dyads was used to examine the impact of maternal self-reported alcohol consumption during pregnancy on adolescent self-reported lifetime and current drinking, controlling for potential confounding factors. RESULTS: In this representative general population sample, maternal drinking during pregnancy, particularly continuous moderate to heavy consumption, had a significant positive effect on adolescent daughters' current drinking, but a slight negative effect on sons' lifetime drinking. The sex-specific prenatal effect on current drinking persisted with controls for prenatal maternal cigarette smoking, current maternal drinking, child-rearing practices (i.e., maternal-child closeness, monitoring and a rule against drinking) and the adolescent's problem behaviors in childhood. Prenatal maternal smoking was also associated with elevated rates of adolescent drinking, particularly current drinking. Of the child-rearing variables, only a rule against drinking decreased adolescent drinking. CONCLUSIONS: Selected prenatal factors may constitute risks for alcohol consumption among adolescent daughters. The results are discussed in light of animal models that document increased vulnerability among female offspring to the deleterious effects of gestational alcohol exposure. Implications for understanding the risk factors associated with adolescent alcohol use are discussed.

Stages of progression in drug involvement from adolescence to adulthood: further evidence for the gateway theory.

Sequential stages of involvement in alcohol and/or cigarettes, marijuana, other illicit drugs and medically prescribed psychoactive drugs from adolescence to adulthood are investigated in a longitudinal cohort that has been followed from ages 15 to 35. Alternative models of progression are tested for their goodness of fit. Four stages are identified: that of legal drugs, alcohol or cigarettes; marijuana; illicit drugs other than marijuana; and medically prescribed drugs. Whereas progression to illicit drugs among men is dependent upon prior use of alcohol, among women either cigarettes or alcohol is a sufficient condition for progression to marijuana. Age of onset and frequency of use at a lower stage of drug use are strong predictors of further progression.

Reconciling unidimensional and multidimensional models of patterns of drug use.

Guttman-scale analyses and factor analyses seem to produce contradictory results in analyzing patterns of multiple drug use. Guttman-scale analyses usually show that drug use fits a unidimensional and cumulative model of involvement; factor analyses reject the unidimensional model. The two methods, however, can be reconciled. Guttman scaling is appropriate for discerning patterns of drug involvement, factor analysis for operationalizing degree of involvement within a specific pattern of use.

A longitudinal study of onset of drinking among high-school students.

During the course of the school year 30% of high-school abstainers started using distilled spirits. The influence of intra- and interpersonal characteristics on beginning to drink is assessed.