Likelihood of developing an alcohol and cannabis use disorder during youth: Association with recent use and age

Abstract

Aim

We extend the literature on the association of early onset of drug use and estimated risk for developing a substance use disorder (SUD) by investigating the risk that recent onset of alcohol and cannabis use confers for developing a substance use disorder at each chronological age of adolescence and young adulthood (12–21-years-old).

Design

Using 2003 data from the National Survey on Drug Use and Health [Substance Abuse Mental Health Service Administration (SAMHSA), 2004. Overview of Findings from the 2003 National Survey on Drug Use and Health. Office of Applied Studies, NSDUH Series H-24, DHHS Publication No. SMA-04-3963, Rockville, MD], we computed separate risk indices for developing an alcohol and cannabis use disorder for recent (prior 2 years) alcohol and cannabis users, respectively, at each age from 12 to 21 years of age, and compared estimated risk to recent onsets users among respondents aged 22–26.

Findings

The results indicated that the teenage years were strongly linked to an elevated risk status. The odds ratio (OR) of having a prior year alcohol use disorder (AUD) among recent onset alcohol users was significantly elevated for youth at ages 14, 16, 17 and 18 (range of ORs = 2.0–2.1) compared to the estimated risk for AUD among recent onset users aged 22–26. For cannabis, we obtained significantly elevated ORs for a cannabis use disorder (CUD) at each of teenage years (ages 12–18; range of ORs = 3.9–7.2), when compared to older recent onset users (aged 22–26).

Conclusions

These data provide further epidemiological support that adolescence is a particularly vulnerable period for developing a SUD.

Introduction

Several population- and clinical-based studies have documented that drug use during youth contributes to an elevated risk for developing a substance use disorder (SUD), starting with the publication by Robins and Przybeck (1985), and followed by several more recent analyses of survey data (DeWit et al., 2000, Grant and Dawson, 1997, Grant et al., 2001, Hingson et al., 2006, Nelson and Wittchen, 1998; Substance Abuse and Mental Health Administration, SAMHSA, 2005), and several prospective studies have also highlighted the reliable association of early onset of use and later drug use problems, including a substance use disorder (e.g., Brook et al., 2002, Lynskey et al., 2003, McGue et al., 2001).

The observed link between early onset of drug taking and increased risk of a SUD is important to the drug abuse literature for several reasons (Chen et al., 2005): the association between early onset and estimated SUD risk held up for over two decades of research and across diverse demographic groups (e.g., Grant and Dawson, 1997) and in other countries (e.g., Nelson and Wittchen, 1998, SAMHSA, 2005); the onset of use variable is relatively easy to measure, especially in the context of other more complex risk factors that represent the wide range of individual, peer, family and community risk factors reported in a vast literature (Hawkins et al., 1992); and this risk factor readily accommodates prevention programs that need to target their efforts toward a reliable and relatively universal factor (Winters et al., 2007).

The link between early onset use and estimated risk for SUDs may surely be influenced by the fact that early onset users accumulate more exposure to the drug and thus are at higher risk to develop a drug problem, compared to late onset users who have less exposure to drug involvement. But mechanisms other than duration of drug use are emerging as also important to consider. Two reports by Anthony and colleagues have analyzed national survey data to show that the risk afforded to early onset use is not just an artifact of exposure time (Anthony and Petronis, 1995, Chen et al., 2005). The recent report is particularly relevant to the present paper. They examined findings from the National Household Survey on Drug Abuse conducted during 2000–2001 of a representative sample of U.S. residents aged 12 and older (SAMHSA, 2001, SAMHSA, 2002). The analysis estimated the risk of becoming cannabis dependent among those whose first use of cannabis occurred within 24 months prior to taking the survey. Excess risk of cannabis dependence was the highest in the early to late adolescent age groups (age 12–18-years-old), with the highest rate at around the 14–15-year-old range. In addition, family incomes less than US$ 20,000 and those that used three or more drugs before the first use of cannabis was also associated with elevated risk.

The extant literature provides a basis to view both chronological age and age of onset as vital risk factors. Despite the fact that the association of early onset of drug use, age and progression to abuse or dependence has been studied in some detail, there is room to extend this work. To date, this body of work provides only a general picture of how chronological age and early onset use contribute to risk for SUD. Our research question is this: To what extent is there an elevated risk of developing alcohol and cannabis use disorders at each chronological age of youth among those who are recent onset users? There are no published reports that have examined this research question at each chronological age. Specifically, we explored the likelihood among recent (within the prior 2 years) onset users of alcohol and recent onset users of cannabis of having a current (prior year) DSM-IV-defined (APA, 1994) substance use disorder as a function of age of the respondent, based on responses to the 2003 NSDUH (SAMHSA, 2004). It is our expectation that the younger years will continue to reveal a strong link to drug use vulnerability when chronological age is more closely examined. A better understanding of the association of recent use, chronological age and estimated risk for developing drug problems will help further clarify the risk pathways toward SUDs for young people.