The developmental antecedents of illicit drug use: Evidence from a 25-year longitudinal study

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Abstract

Background

The present study examined the developmental antecedents of illicit drug use and abuse/dependence.

Methods

A 25-year prospective longitudinal study of the health, development, and adjustment of a birth cohort of 1265 New Zealand children. Measures included assessments of adolescent and young adult illicit drug use and abuse/dependence; cannabis use to age 25; measures of parental adjustment; measures of exposure to childhood sexual abuse, physical abuse, and interparental violence; novelty-seeking; childhood and early adolescent adjustment and substance use; and affiliation with substance-using peers.

Results

Illicit drug use and abuse/dependence from ages 16 to 25 were significantly associated (all p values < .05) with a range of parental adjustment measures; exposure to abuse in childhood; individual factors; and measures of childhood and early adolescent adjustment. Analyses using repeated measures logistic regression models suggested that parental illicit drug use, gender, novelty-seeking, and childhood conduct disorder predicted later illicit drug use and abuse/dependence. Further analyses revealed that these pathways to illicit drug use and abuse/dependence were mediated via cannabis use, affiliation with substance-using peers, and alcohol use during ages 16–25.

Conclusions

The current study suggested that the illicit drug use and abuse/dependence were associated with a range of early life circumstances and processes that put individuals at greater risk of illicit drug use and abuse/dependence. However, the use of cannabis in late adolescence and early adulthood emerged as the strongest risk factor for later involvement in other illicit drugs.

Introduction

In recent decades, many developed societies have grappled with issues concerning the use and abuse of a range of illicit drugs, including hallucinogens (LSD, ecstasy, PCP), opiates (heroin, morphine), stimulants (methamphetamine), cocaine, barbiturates, solvents, prescription medications, and plant extracts such as mushrooms (Substance Use and Mental Health Services Administration, 2007; World Health Organization, 2000). The use of such drugs has raised issues about the risk factors and life processes that lead young people to experiment with, use and abuse these drugs. This topic has been the subject of a growing literature (for reviews see: Anderson, 2006, Bloor, 2006, Compton et al., 2005, Galea et al., 2004, Hawkins et al., 1992, Mayes and Suchman, 2006, Rehm et al., 2006, Ripple and Luther, 1996) that has identified a range of factors associated with the increased usage of illicit drugs, including: family background factors, family support, and parental supervision; exposure to abuse during childhood and adolescence; individual factors such as temperament and gender; adjustment problems in childhood and early adolescence; and affiliation with substance-using peers. The purpose of the present investigation is to examine the extent to which both: (a) childhood factors and (b) adolescent adjustment and substance use; may be related to later illicit drug use. A review of representative findings in this area is given below.

Research suggests that parental adjustment problems, including substance use and criminality, may be related to adjustment problems in children, via genetic influences, social learning, or exposure to an unstable home environment (e.g. Bahr et al., 2005, Keyes et al., 2007, Pears et al., 2007, Stallings et al., 1997, van der Zwaluw et al., 2008). It could therefore be argued that parental adjustment factors may play a key role in the development of substance use in offspring.

A wide range of studies have examined family background factors and their relationship to risk of illicit drug use and abuse/dependence in adolescence and early adulthood. A number of studies have found that parental substance use may be related to substance use and abuse in adolescents (Johnson and Leff, 1999). For example, Kilpatrick and colleagues (Kilpatrick et al., 2000), using data from a national household survey, found that exposure to illicit drug abuse by parents increased the risk of substance abuse and dependence amongst adolescents. Similarly, Merikangas et al. (1998) found that individuals who had first-degree relatives who were diagnosed with substance use disorders were at an eight-fold risk of also being diagnosed with a substance use disorder. Pears et al. (2007), using prospective data, found evidence to suggest that patterns of substance use and abuse were transmitted across three generations.

Other factors such as lower levels of parental interest and monitoring, and higher levels of parental criminality may be related to higher levels of substance use and abuse/dependence. For example, Chilcoat and Anthony (1996) found that rates of illicit drug use were higher amongst adolescents who perceived lower levels of parental concern and involvement. Similarly, Duncan et al. (1998) reported that inept parental monitoring was related to increased levels of substance use in adolescents. Hayatbakhsh et al. (2007), using data from a prospective birth cohort, found that maternal partner criminality predicted cannabis use by age 21. Similarly, Felitti et al. (1998) found that parental criminality was associated with an increased risk of drug abuse amongst a large (n > 10,000) cross-sectional sample. In general, the evidence suggests that family dysfunction and parental adjustment problems may be associated with increased risk of illicit drug use.

A second set of factors that has been linked to the risk of involvement with illicit drugs is exposure to abuse during childhood. It could be argued that exposure to abuse in childhood may lead to increased risk of substance use in adulthood, at least in part due to concomitant increases in risk of mental illness (e.g. Mulder, 2002). However, it should be noted that longitudinal data are critical to demonstrate links between childhood abuse and later outcomes (Putnam and Trickett, 1993).

A number of longitudinal studies have found that exposure to sexual abuse in childhood (CSA), exposure to physical abuse, and witnessing interparental violence may be linked to increased risk of substance use and abuse/dependence in adolescence and adulthood (Miller et al., 1997, Simpson and Miller, 2002). For example, Widom et al. (2006), using data from a prospective cohort study, found that those exposed to sexual and/or physical abuse in childhood were 1.5 times more likely to report using illicit drugs at age 40. Similarly, Kilpatrick et al. (2000) found that adolescents who reported having been sexually or physically abused, or who witnessed interparental violence, were at increased risk for substance abuse/dependence. Also, Wilsnack et al. (1997) found that women who reported exposure to CSA were more likely to report using a range of illicit drugs than women who reported no CSA exposure. Felitti et al. (1998) found that one of the key risk factors for later substance abuse/dependence was exposure to interparental violence. Christoffersen and Soothill (2003), using data from over 80,000 children born in Denmark in 1966, found that violence between parents, stemming from alcohol abuse, increased risks of drug addiction in children aged 15–27. In addition, Dube et al. (2002), using a case–control design, found that exposure to interparental violence during childhood was associated with increased likelihood of illicit drug use, including intravenous drug use. The findings of these studies suggest that exposure to abuse during childhood increases the risk of illicit drug use and abuse/dependence in adulthood.

Research suggests that there are a range of individual factors that may predict illicit drug use and dependence. However, two of the strongest predictors of involvement in illicit drugs are gender and novelty-seeking. A range of studies has shown that males are more likely than females to report the illicit drug use and abuse/dependence (Bloor, 2006), and that those reporting higher levels of novelty-seeking (Acton, 2003, Staiger et al., 2007) demonstrate higher levels of illicit drug use and abuse/dependence. For example, Duncan et al. (1998), using growth curve modelling techniques, found that gender predicted adolescent substance use, with males more likely than females to report substance use. Also, Rodham et al. (2005), in a sample of English 15- and 16-year old adolescents, found that males were more likely to report illicit drug use. Similar findings were reported for an Australian secondary school sample (n > 20,000) by Lynskey et al. (1999). In terms of novelty-seeking, Evren et al. (2007) found that novelty-seeking predicted illicit drug dependence in a sample of Turkish adolescents. Also, Adams et al. (2003), using a case–control sample of adolescent substance users, found that those who were high in novelty-seeking reported using a wider range of substances than those low in novelty-seeking. Khan et al. (2005) reported that novelty-seeking had a modest positive association with externalizing disorders, including substance dependence. These findings suggest that males and those higher in novelty-seeking are at a greater risk of illicit drug use and abuse/dependence.

An additional set of factors that may be linked to risks of illicit drug involvement are conduct and attention problems in childhood. A number of studies have suggested that individuals who display conduct and attention problems are at greater risk of illicit drug use and abuse/dependence (Deas and Brown, 2006). For example, Khan et al. (2005), using twin-registry data, found associations between conduct problems and substance abuse problems. Also, Molina and Pelham (2003) found that conduct and attention disorder in early adolescence predicted later use and abuse of a range of substances in later adolescence in a prospective study. Flory et al. (2003) found an interactive relationship between conduct and attention problems and later substance use and dependence, such that individuals with high levels of both conduct and attention problems were at greatest risk of later illicit drug use and dependence. In addition, Fergusson et al. (2007) found that the associations between attention problems in childhood and later illicit drug use were mediated via conduct problems. The findings of these studies suggest that conduct and attention problems in childhood may be related to increased risks of later illicit drug involvement.

A further set of factors that may be linked to increasing risks of illicit drug involvement are substance use and social processes in adolescence. A large number of studies have found evidence for “gateway” effects for cannabis use in illicit drug use and abuse/dependence, in which the use of cannabis may increase the risk of use of other illicit drugs (Kandel, 2003, MacCoun, 1998), while others have suggested that other drugs such as alcohol and tobacco may also be involved in the gateway to illicit drug involvement (Botvin et al., 2002, Center on Addiction and Substance Abuse, 1994). The nature of these “gateway” effects is a matter of some debate (Fergusson et al., 2006, Kandel et al., 2006, MacCoun, 1998, MacCoun, 2006, Morral et al., 2002), and there may be evidence of “reverse gateway” effects (Viveros et al., 2006) in which the use of cannabis may increase the risk of tobacco use. However, a range of studies has clearly shown that the use of cannabis is associated with increasing risks of other illicit drug use and abuse/dependence (Kandel, 2003, MacCoun, 1998). Furthermore, peer influence, and in particular affiliation with substance-using peers, may be associated with increased risks of illicit drug use and abuse/dependence (Bloor, 2006).

The gateway effects of cannabis and other substances have been examined in a number of studies. For example, Lynskey et al. (2003) using a discordant twin design, found that those who had used cannabis were 2.1–5.2 times more likely to use other illicit drugs. Also, Kandel et al. (1992) found that 80%–90% of individuals who reported using both cannabis and other illicit drugs used cannabis prior to using other illicit drugs. Further, Fergusson et al. (2006), using a prospective cohort design, found that frequency of cannabis use predicted risks of other illicit drug use, such that those who used cannabis more frequently were more likely to use other illicit drugs. Kandel and Yamaguchi (2002) found that both tobacco use and alcohol use tended to precede the use of cannabis and other illicit drugs in a large national data set.

Peer influence has also been examined in a number of studies. For example, Duncan et al. (1998) found that peer deviance predicted substance use trajectories during adolescence. Jenkins (1996), using a large cross-sectional data set, found that peer drug use was the strongest predictor of illicit drug use during adolescence. Also, Wills et al. (1998) found that peer influence mediated the associations between early risk factors and later substance use.

Collectively, the findings of these studies suggest that involvement with substance use in early adolescence, and affiliation with substance-using peers, increase the risk of illicit drug involvement in adolescence and early adulthood.

While there has been growing evidence on the risk and protective factors for illicit drug use, there have been relatively few studies that have reported longitudinal data on the role of a wide range of risk factors assessed over the period from childhood to adulthood. In this paper we report on the results of a longitudinal study of use and abuse of illicit drugs in a birth cohort of New Zealand young people studied from birth to the age of 25 years. The analyses reported examine a range of issues in the development of illicit drug use and abuse. These issues include:

  • 1.

    The role of childhood and parental factors in predisposing young people to use illicit drugs:

  • 2.

    The role of peer affiliation and substance (tobacco, alcohol, and cannabis) use in the development of illicit drug use and abuse.

The hypothesized relationships between childhood and parental factors, adolescent peer affiliation and substance use factors, and illicit drug use and abuse/dependence are presented in Fig. 1.

More generally, the aims of the paper are to develop a multivariate account of the ways in which a wide range of social, family, and individual factors combine over the life course to influence the use and abuse of illicit drugs.

Section snippets

Method

The data were gathered as part of the Christchurch Health and Development Study (CHDS). The CHDS is a longitudinal study of a birth cohort of 1265 children (635 males, 630 females) born in the Christchurch (New Zealand) urban region in mid-1977. The cohort has been studied at birth, 4 months, 1 year and at annual intervals to age 16 years, and again at ages 18, 21, and 25. The study has collected information from a variety of sources including: parental interviews, teacher reports,

Rates of illicit drug use and illicit drug abuse/dependence

Over the period from ages 16–25 years, 42.9% (n = 458) of the sample reported using illicit drugs other than cannabis on at least one occasion, and 10.8% (n = 115) met DSM-IV criteria for abuse/dependence (see Section 2). Amongst the cohort, 35% reported having used hallucinogens (ecstasy, LSD); 26% reported having used stimulants (including methamphetamine), barbiturates, or other (illicitly obtained) prescription medicines; 17% reported having used substances such as mushrooms and datura; 5%

Discussion

One of the important findings to emerge from these analyses was the relatively high rate of non-cannabis illicit drug use, with over 40% of the cohort using these drugs on at least one occasion, and over 10% meeting DSM-IV criteria for abuse or dependence. Most of the illicit drug use involved so-called “party drugs” including ecstasy, amphetamines, and LSD. The use of harder drugs, including cocaine and heroin, was uncommon, reported by less than 9% of the cohort. These findings are generally

Conflicts of interest

The authors declare no conflicts of interest.

Acknowledgements

This research was funded by grants from the Health Research Council of New Zealand, the National Child Health Research Foundation, the Canterbury Medical Research Foundation and the New Zealand Lottery Grants Board.

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