Skip to main content
NCBI home page
International Journal of Methods in Psychiatric Research logoLink to International Journal of Methods in Psychiatric Research
. 2008 Jun 10;17(Suppl 1):S16–S29. doi: 10.1002/mpr.254

What are the high risk periods for incident substance use and transitions to abuse and dependence? Implications for early intervention and prevention

H‐U Wittchen 1,6, S Behrendt 1,6,✉, M Höfler 1, A Perkonigg 1, R Lieb 2,3, G Bühringer 4,5, K Beesdo 1
PMCID: PMC6879091  PMID: 18543359

Abstract

Background: For a better understanding of the evolution of addictive disorders and the timely initiation of early intervention and prevention, we have to learn when and how quickly the critical transitions from first substance use (SU) to regular use and from first SU and regular SU to abuse and dependence occur. Little data are currently available on the transitions to substance use disorders (SUDs) across the spectrum of legal and illegal drugs taking into account gender differences. It is the aim of this paper to describe the high density incidence and transition periods of SU and SUD for alcohol, nicotine, cannabis and other illicit drugs for young males and females.

Methods: A sample of (n = 3021) community subjects aged 14–24 at baseline were followed‐up prospectively over 10‐years. SU and SUD were assessed using the DSM‐IV/M‐CIDI. Results: Ages 10–16 are the high risk period for first alcohol and nicotine use (up to 38% of subjects start before age 14). Onset of illegal SU occurs later. Substantial proportions of transitions to regular SU and SUD occur in the first three years after SU onset. Only few gender differences were found for time patterns of SU/SUD incidence and transition.

Conclusion: Except for alcohol the time windows for targeted intervention to prevent progression to malignant patterns in adolescence are critically small, leaving little time for targeted intervention to prevent transition. The fast transitions to abuse and dependence in adolescence may be indicative for the increased vulnerability to substance effects in this time period. Basic research on the determinants of transitions should thus target this period in adolescence. Copyright © 2008 John Wiley & Sons, Ltd.

Keywords: substance use, age, onset, epidemiology

Full Text

The Full Text of this article is available as a PDF (537.5 KB).

REFERENCES

  1. Armstrong TD, Costello EJ. Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity. J Consult Clin Psychol 2002; 70: 1224–39. [DOI] [PubMed] [Google Scholar]
  2. Boden JM, Fergusson DM, Horwood LJ. Illicit drug use and dependence in a New Zealand birth cohort. Aust NZ J Psychiatry 2006; 40: 156–63. [DOI] [PubMed] [Google Scholar]
  3. Bonomo YA, Bowes G, Coffey C, Carlin JB, Patton GC. Teenage drinking and the onset of alcohol dependence: a cohort study over seven years. Addiction 2004; 99: 1520–8. [DOI] [PubMed] [Google Scholar]
  4. Breslau N, Fenn N, Peterson E. Early smoking initiation and nicotine dependence in a cohort of young adults. Drug and Alcohol Depend 1993; 33: 129–37. [DOI] [PubMed] [Google Scholar]
  5. Bühringer G. Allocating treatment options to patient profiles: clinical art or science? Addiction 2006; 101 646–52. [DOI] [PubMed] [Google Scholar]
  6. Bühringer G, Wittchen H‐U, Gottlebe K, Kufeld C, Goschke T. Why do people change? The role of cognitive control processes in onset and cessation of substance abuse disorders. Int J Meth Psychiatr Res 2008; 17: S4–S15. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Chen C‐Y, Anthony J. Possible age‐associated bias in reporting of clinical features of drug dependence: epidemiological evidence on adolescent‐onset marijuana use. Addiction 2003; 98: 71–82. [DOI] [PubMed] [Google Scholar]
  8. Chen C‐Y, O'Brien MS, Anthony JC. Who becomes cannabis dependent soon after the onset of use? Epidemiological evidence from the United States: 2000–2001. Drug and Alcohol Depend 2005; 79: 11–22. [DOI] [PubMed] [Google Scholar]
  9. Compton WM, Grant BF, Colliver JD, Glantz MD, Stinson FD. Prevalence of marihuana use disorders in the United States, 1991–1992 and 2001–2002. J Am Med Assoc 2004; 291: 2114–21. [DOI] [PubMed] [Google Scholar]
  10. Costello EJ, Erkanli A. Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex. J Clin Child Psychol 1999; 28: 298–311. [DOI] [PubMed] [Google Scholar]
  11. Everett SA, Warren CW, Sharp D, Kann L, Husten CG, Crosett LS. Initiation of cigarette smoking and subsequent smoking behavior among U.S. high school students. Preventive Medicine 1999; 29: 327–33. [DOI] [PubMed] [Google Scholar]
  12. Feuerlein W. ed. Alkoholismus – Missbrauch und Abhängigkeit. Stuttgart: Thieme, 1989. [Google Scholar]
  13. Harford T, Grant B, Yi H‐y, Chen C. Patterns of DSM‐IV alcohol abuse and dependence criteria among adolescents and adults: results from the 2001 National Household Survey on drug abuse. Alcoholism: Clin Exp Res 2005; 29: 810–28. [DOI] [PubMed] [Google Scholar]
  14. Lachner G, Wittchen H‐U, Perkonigg A, Holly A, Schuster P, Wunderlich U, Türk D, Garczynski E, Pfister H. Structure, content and reliability of the Munich Composite International Diagnostic Interview (M‐CIDI). Substance use sections. Eur Addict Res 1998; 4: 28–41. [DOI] [PubMed] [Google Scholar]
  15. Lieb R, Schuster P, Pfister H, Fuetsch M, Höfler M, Isensee B, Müller N, Sonntag H, Wittchen H‐U‐. Epidemiologie des Konsums, Mißbrauchs und der Abhängigkeit von legalenund illegalen Drogen bei Jugendlichen und jungen Erwachsenen: Die prospektiv.longitudinale Verlaufsstudie EDSP. Sucht 2000; 46: 18–31. [Google Scholar]
  16. Lubman DI, Hides L, Yücel M, Toumbourou JW. Intervening early to reduce developmentally harmful substance use among youth populations. Med J Aust 2007; 187: 22–5. [DOI] [PubMed] [Google Scholar]
  17. Marlatt GA, Baer JS, Kivlahan DR, Dimeff LA, Larimer ME, Quigley LA, Somers JM, Williams E. Screening and brief intervention for high‐risk college student drinkers: results from a 2‐year follow‐up assessment. J Consult Clin Psychol 1998; 66: 604–15. [DOI] [PubMed] [Google Scholar]
  18. Mcbride N, Farringdon F, Midford R, Meuleners L, Phillips M. Early unsupervised drinking – reducing the risks. The School Health and Alcohol Harm Reduction Project. Drug and Alcohol Rev 2003; 22: 263–76. [DOI] [PubMed] [Google Scholar]
  19. Monshouwer K, Smit F, de Graaf R, van Os J, Vollebergh W. First cannabis use: does onset shift to younger ages? Findings from 1988 to 2003 from the Dutch National School Survey on substance use. Addiction 2005; 100: 963–70. [DOI] [PubMed] [Google Scholar]
  20. Nelson CB, Wittchen H‐U. DSM‐IV alcohol disorders in a general population sample of adolescents and young adults. Addiction 1998a; 93: 1065–77. [DOI] [PubMed] [Google Scholar]
  21. Nelson CB, Wittchen H‐U. Smoking and nicotine dependence. Results from a sample of 14 to 24‐year‐olds in Germany. Eur Addict Res 1998b; 4: 42–9. [DOI] [PubMed] [Google Scholar]
  22. Perkonigg A, Lieb R, Höfler M, Schuster P, Sonntag H, Wittchen H‐U. Patterns of cannabis use, abuse and dependence over time: incidence, progression and stability in a sample of 1228 adolescents. Addiction 1999; 94: 1663–78. [DOI] [PubMed] [Google Scholar]
  23. Perkonigg A, Goodwin RD, Fiedler A, Behrendt S, Beesdo K, Lieb R, Wittchen H‐U. The natural course of cannabis use, abuse and dependence during the first decades of life. Addiction 2008; 103: 439–49. [DOI] [PubMed] [Google Scholar]
  24. Pfeiffer‐Gerschel T, Kipke I, David‐Spickermann M, Bartsch G. 2007. National Report to the EMCDDA by the REITOX National Focal Point: Germany, Drug situation 2006/2007. Muenchen: Deutsche Referenzstelle fuer die EBDD (DBDD) Available at: http://www.dbdd.de [Accessed 07.05.2008] [Google Scholar]
  25. Poelen EAP, Scholte RHJ, Engels RCME, Boomsma DI, Willemsen G. Prevalence and trends of alcohol use and misuse among adolescents and young adults in the Netherlands from 1993 to 2000. Drug and Alcohol Depend 2005; 79: 413–21. [DOI] [PubMed] [Google Scholar]
  26. Reed V, Pfister H, Steiger A, Sonntag H, Trenkwalder C, Sonntag A, Hundt W, Wittchen H‐U. To what degree does the Composite International Diagnostic Interview (CIDI) correctly identify DSM‐IV Disorders? Testing validity issues in a clinical sample. Int J Meth Psychiatr Res 1998; 7: 142–55. [Google Scholar]
  27. Ridenour TA, Lanza ST, Donny EC, Clark DB. Different lengths of times for progressions in adolescent substance involvement. Addictive Behav 2006; 31: 962–83. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Rowe CL, Liddle HA, Greenbaum PE, Henderson CE. Impact of psychiatric comorbidity on treatment of adolescent drug abusers. J Sub Abuse Treatment 2004; 26 129–40. [DOI] [PubMed] [Google Scholar]
  29. Royall RM. Model robust confidence intervals using maximum likelihood estimators. Statistical Rev 1986; 54: 221–6. [Google Scholar]
  30. Saha TD, Chou SP, Grant BF. Toward an alcohol use disorder continuum using item response theory: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Psychological Med 2006; 36: 931–41. [DOI] [PubMed] [Google Scholar]
  31. StataCorp . Stata Statistical Software: Release 10.0. College Station, TX: StataCorp LP, 2007. [Google Scholar]
  32. Therneau T, Grambsch P. Modeling Survival Data: Extending the Cox Model. New York: Springer, 2000. [Google Scholar]
  33. Toumbourou JW, Stockwell T, Neighbors C, Marlatt GA, Sturge J, Rehm J. Interventions to reduce harm associated with adolescent substance use. Lancet 2007; 369: 1391–5. [DOI] [PubMed] [Google Scholar]
  34. Vega WA, Gil AG. Revisiting drug progression: long‐range effects of early tobacco use. Addiction 2005; 100: 1358–69. [DOI] [PubMed] [Google Scholar]
  35. Vega WA, Aguilar‐Gaxiola S, Andrade L, Bijl R, Borges G. Prevalence and age of onset of drug use in seven international sites: results from the international consortium of psychiatric epidemiology. Drug and Alcohol Depend 2002; 68: 285–97. [DOI] [PubMed] [Google Scholar]
  36. Wagner F, Anthony J. From first drug use to drug dependence: developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Neuropsychopharmacology 2002; 26: 479–88. [DOI] [PubMed] [Google Scholar]
  37. Wagner FA, Anthony JC. Male‐female differences in the risk of progression from first use to dependence upon cannabis, cocaine and alcohol. Drug and Alcohol Depend 2007; 86: 191–8. [DOI] [PubMed] [Google Scholar]
  38. Wittchen H‐U. Reliability and validity studies of the WHO‐Composite International Diagnostic Interview (CIDI): a critical review. J Psychiatr Res 1994; 28: 57–84. [DOI] [PubMed] [Google Scholar]
  39. Wittchen H‐U, Pfister H. DIA‐X Interview. Instruktionsmanual zur Durchführung von DIA‐X–Interviews. Frankfurt: Sewts & Zeitlinger, 1997. [Google Scholar]
  40. Wittchen H‐U, Semmler G. Composite International Diagnostic Interview (CIDI). Weinheim: Belt, 1990. [Google Scholar]
  41. Wittchen H‐U, Lachner G, Wunderlich U, Pfister H. Test–retest reliability of the computerized DSM‐IV version of the Munich‐Composite International Diagnostic Interview (M‐CIDI). Soc Psychiatry Psychiatr Epidemiol 1998a; 33: 568–78. [DOI] [PubMed] [Google Scholar]
  42. Wittchen H‐U, Perkonigg A, Lachner G, Nelson CB. Early Developmental Stages of Psychopathology Study (EDSP): objectives and design. Eur Addict Res 1998b; 4: 18–27. [DOI] [PubMed] [Google Scholar]
  43. Wittchen H‐U, Fröhlich C, Behrendt S, Günther A, Lieb R, Perkonigg A, Rehm J, Zimmermann P. Cannabis use and cannabis use disorders and their relationship to mental disorders: a 10‐years prospective‐longitudinal study in adolescents. Drug and Alcohol Depend 2007; 88: 60–70. [DOI] [PubMed] [Google Scholar]

Articles from International Journal of Methods in Psychiatric Research are provided here courtesy of Wiley

RESOURCES