Substance use pathways to methamphetamine use among treated users
Introduction
Research on the patterns and sequence of drug initiation is accruing and has the potential to better inform the development of prevention and early intervention strategies. Much of this research has been directed to three broad areas: the adolescent period, which typically encompasses initial onset of drug use, substances used earliest in the sequence, and general populations, most of whom do not progress to serious use of drugs. Some studies have focused on problem populations of serious drug users, with a majority of this limited research focusing on opiate and cocaine use. Little is known about the patterns of drug use development specifically for users of methamphetamine (MA), a drug now labeled a principal drug threat because of epidemic increases in its use during the past decade. While problems associated with MA abuse have been recognized for many years, MA has now become the focus of national strategies for combating its spread and impact (Drug Enforcement Administration, 2005, National Drug Intelligence Center, 2004, Office of National Drug Control Policy, 2000, Office of National Drug Control Policy, 2005, Pennell et al., 1999). Examination of patterns of drug initiation among MA users can better inform these efforts.
Considerable research exists on patterns of onset of substance use among adolescents, with results showing typical progression through initiation of alcohol, tobacco, and marijuana before use of other illicit drugs (e.g. Ellickson et al., 1992, Kandel & Yamaguchi, 1993, Newcomb, 1995, Oetting & Beauvais, 1990, Young et al., 2002, Yu & Williford, 1992). In general populations, earlier age of onset of alcohol use has been found to be predictive of later problem use of alcohol and of use of illicit drugs (e.g. Fergusson, Lynskey et al., 1994, Grant & Dawson, 1998, Gruber et al., 1996, Hawkins et al., 1997, Kandel & Yamaguchi, 1993). While use of marijuana has often been found to be a precursor of other illicit drug use and early marijuana use is associated with increased risks of progression to other illicit drug use and abuse (Fergusson & Horwood, 2000, Lynskey et al., 2003), other studies have found that marijuana use was not a necessary precondition for progression to other illicit drug use (Blaze-Temple & Lo, 1992). By contrast, among native American youth who had used two or more drugs, marijuana was more likely to be initiated before alcohol (Novins, Beals, & Mitchell, 2001).
Patterns of substance use onset are less consistent for specific populations that have progressed to regular use of illicit drugs. For example, in a study of intravenous heroin users, results supported the common pattern of earliest onset of alcohol and tobacco (average age 13.4 and 13.6, respectively) followed by marijuana (age 14.8). In that sample, heroin was initiated at an average age of 18.8 years, a year earlier than MA for the 46% who had used MA (Zinkernagel et al., 2001). However, other studies have found that marijuana was the initial drug used by a large proportion of regular drug users and also that many initiated use of other illicit drugs prior to either alcohol or marijuana (Golub & Johnson, 1994, Mackesy-Amiti et al., 1997).
Describing drug progression and selected personal and contextual conditions that are related to this progression may facilitate the identification of risk factors and critical periods for developing interventions to delay onset or progression. Regrettably, we know little about such patterns of drug use initiation among the increasing numbers of MA users.
This paper describes substance/drug initiation patterns, including age of initiation and sequence of substances used, for methamphetamine (MA) users sampled from admissions to substance abuse treatment programs in Los Angeles County. In addition, we consider the relationships of selected user characteristics to age of MA initiation and to the relative order of MA initiation within the drug initiation sequence.
Section snippets
Participants
Data are from a study of the natural history of MA use and treatment outcomes, for clients admitted to treatment for MA use in publicly funded Los Angeles County treatment programs. A stratified random sample (by gender, ethnicity, and type of treatment [outpatient, residential]) of admission records was selected from the California Alcohol and Drug Data System (CADDS), primarily from 1996. Treatment programs attempted to locate these former clients to invite their participation in the study;
Sample description—background characteristics
The sample of MA users included in these analyses was sociodemographically diverse: 56% male and 44% female, 16% were African–American, 30% Hispanic, 47% non-Hispanic white, and 7% other or mixed ethnicity. Approximately 1/3 had not finished high school, 21% had a high school diploma or GED but not further training or education, and 47% had at least some post-high school education (college or trade/technical school). At the time of interview, the average age was 32.6 years. The sampled
Summary
Study results showing that most of this sample of treated MA users had used alcohol, marijuana, and tobacco were consistent with the predominance of general population studies of drug use onset and with progression theories (e.g. Kandel et al., 1992, Lynskey et al., 2003, Zinkernagel et al., 2001). Average ages of alcohol, marijuana, and tobacco initiation for our treated MA sample, in early adolescence, were similar to those found in a national household study (National Institute on Drug
Acknowledgements
This research was supported by a grant from the National Institutes on Drug Abuse (R01-DA11020). We thank research staff A. O'Brien, MSc, C. von Mayrhauser, PhD, M. Dylan, PhD, L. Rodriguez, A. Hernandez, C. Casey, PhD, and fieldwork staff, C. Gonzalez, M. Dela Cruz, I. Diaz, D. Grieshop, P. Sheaff, L. Guzman, R. Lua, and M. Frias. And we thank cooperating community treatment providers and study participants for their contributions.
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