April 3, 2012 — Most cases of alcohol and drug abuse start in adolescence, new research suggests.
Findings from the Adolescent Supplement of the National Comorbidity
Survey (NCS-A), which examined more than 10,000 US teens, showed that
78.2% of the participants between the ages of 17 and 18 years had
consumed alcohol at least once and that nearly half were regular
users. Of all participants, 15.1% met criteria for lifetime alcohol
abuse.
In addition, more than 42.5% of the oldest cohort report having used illicit drugs, and 16.4% were diagnosed with drug abuse.
The median age for onset of abuse of either alcohol or illicit drugs was 14 years.
"The patterns of alcohol and drug use that emerge during adolescence
are increasingly recognized as important determinants of later
substance use behavior and associated disorders," Joel Swendsen, PhD,
from the National Center for Scientific Research at the University of
Bordeaux, France, and colleagues write.
"Prevention and treatment efforts would benefit from careful attention to [these] correlates and risk factors," they add.
The study is published in the April issue of the Archives of General Psychiatry.
Stages of Use
The NCS-A was conducted between February 2001 and January 2004 using a
modified version of the World Health Organization Composite
International Diagnostic Interview (CIDI). The CIDI was administered
face-to-face to 10,123 US adolescents between the ages of 13 and 18
years.
Four stages of alcohol use (use, regular use, and abuse with or
without dependence) and 4 stages of illicit drug use (opportunity to
use, first drug use, and abuse with or without dependence) were
measured for all participants. Diagnoses of abuse were based on criteria
from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition.
Regular use of alcohol was defined as consuming at least 12 drinks in
a single year. "Opportunity to use" was defined as either having had
someone offer alcohol or illicit drugs to the participant or being
around others when they were using such substances.
Results showed that 59.8% of all participants had consumed alcohol at
some point in their lives. This included 42.5% of those between the
ages of 13 and 14 years and 64.9% of those between the ages of 15 and 16
years.
In addition, 25.2% of all participants reported regular use of
alcohol, including 47.1% of those between the ages of 17 and 18 years.
"The prevalence of alcohol use with or without dependence ranged from
1.3% for the youngest cohort to 15.1% for adolescents 17 to 18 years
old," report the investigators.
Public Health Implications
Of all participants, 60.2% reported having had the opportunity to use
drugs, including 81.4% of those between 17 and 18 years, 67.1% of
those between 15 and 16 years, and 39.2% of those between 13 and 14
years.
A total of 24.4% of all the teens reported having used illicit drugs
at least once. This included 9.6% of those in the youngest cohort,
meaning nearly a quarter of those exposed to drugs went on to use.
"Abuse of illicit drugs was slightly more common than the abuse of
alcohol, ranging from 3.4% of youth in the 13- to 14-year cohort to
16.4% of adolescents aged 17 to 18 years old," write the researchers.
They note that "the public health implications of the current findings are far reaching."
Future prevention strategies should target early adolescence and take
into account various factors concerning the different stages of
substance use, write the investigators.
They add that an additional complication is "the emergence of drug
instrumentalization models" that emphasize a role for psychoactive
substances.
"The critical evaluation of such perspectives and the development of
appropriate national policy...can only be achieved through empirical
data describing the nature of harm or risk posed by alcohol and drugs,"
conclude the study authors.
The study was supported by grants from the
Intramural Research Program of the National Institute of Mental Health.
The study authors have disclosed no relevant financial relationships.
Arch Gen Psychiatry. 2012;69:390-398. Abstract
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