Transitions in Illicit Drug Use Status Over 3 Years: A Prospective Analysis of a General Population Sample

Abstract

Objective To examine 3-year transitions among nonuse, asymptomatic use and problem use of illicit drugs for US adults in the general household population. Method Data from the nationally representative NESARC study of 34,653 adults interviewed twice, 3 years apart. Three mutually exclusive categories of baseline drug status comprised past year non-users (n=32,675), past-year asymptomatic drug users (n=861), and past-year symptomatic drug users (n=1,117). Symptomatic drug use was defined as presence of one or more symptoms that operationalize DSM-IV drug abuse and dependence criteria. Variables tested for association with 3-year transitions to different status categories included sociodemographic, health, substance use and psychiatric covariates. Results Among baseline nonusers, 95.4% continued to be nonusers at follow-up, 2.1% became asymptomatic users, and 2.5% developed drug problems. Among baseline asymptomatic users, 66.6% had stopped using drugs at follow-up, 14.3% continued to be asymptomatic users and 19.1% had developed drug problems. Nearly half (49.0%) of those with drug problems at baseline had stopped using drugs at follow-up, 10.9% had transitioned to asymptomatic use and 40.1% continued to have drug problems. Younger age, male gender, white race, and not being married were associated with progression from non-use to use or problematic use, as were alcohol and tobacco categories, major depression and schizotypal, borderline and narcissistic personality disorders. Panic disorder and avoidant personality disorder were associated with less progression. Conclusions Transitions in drug use status are common. The finding that alcohol and tobacco-related variables and co-occurring psychopathology are important correlates of transitions suggests the value of addressing all co-occurring disorders and substance use in patient assessments and treatment planning, both for preventing adverse transitions and promoting positive transitions.

Attention-deficit/hyperactivity disorder subtypes and substance use and use disorders in NESARC

“…The use of cannabis, cocaine, sedatives, stimulants, and heroin/opiates even once was considered as lifetime use of the substance as is the norm in the epidemiological literature (e.g. Compton et al, 2013). …”

Emergence of sex differences in the development of substance use and abuse during adolescence

“…Childhood sexual abuse is reported more frequently in female than male substance-abusing populations and is associated with more drug use and higher rates of relapse (Afifi, Henriksen, Asmundson, & Sareen, 2012; Brady & Randall, 1999; Clark et al, 2012; Hyman, Garcia, & Sinha, 2006; Hyman et al, 2008). The incidence of depression, anxiety and bipolar disorder is greater among female than male substance abusers, while the incidence of conduct disorder and ADHD are higher among male than female substance abusers in most studies (although sex/gender neutral studies with ADHD also exist (Compton et al, 2000; Compton, Dawson, Conway, Brodsky, & Grant, 2013; Compton et al, 2007; Zilberman, Tavares, Blume, & el-Guebaly, 2003). …”

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