RESEARCH ANALYSIS

and

UTILIZATION SYSTEM

Drug Abuse

and the

American

Adolescent

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service • Alcohol, Drug Abuse, and Mental Health Administration
Drug Abuse and the

American Adolescent

Editors:

Dan J. Lettieri, Ph.D.

Jacqueline P. Ludford, M.S.

National Institute on Drug Abuse

NIDA Research Monograph 38

A RAUS Review Report

DEPARTMENT OF HEALTH AND HUMAN SERVICES

Public Health Service

Alcohol, Drug Abuse, and Mental Health Administration

National Institute on Drug Abuse

Division of Research

5600 Fishers Lane

Rockville, Maryland 20857

For sale by the Superintendent of Documents. U.S. Government Printing Office

Washington, D.C. 20402
The NIDA Research Monograph series is prepared by the Division of Research

of the National lnstitute on Drug Abuse. Its primary objective is to provide

critical reviews of research problem areas and techniques, the content of

state-of-the-art conferences, integrative research reviews and significant

original research. Its dual publication emphasis is rapid and targeted

dissemination to the scientific and professional community

Editorial Advisory Board

Avram Goldstein, M.D.

Addiction Research Foundation

Palo Alto. California

Jerome Jaffe, M.D.

College of Physicians and Surgeons

Columbia University, New York

Reese T. Jones, M.D,

Langley Potter Neuropsychiatric lnstitute

University of California

Son Francisco. California

Jack Mendelson, M.D.

Alcohol and Drug Abuse Research Center

Harvard Medical School

McLean Hospital

Belmont, Massachusetts

Helen Nowlis, Ph.D.

Office of Drug Education DHHS

Washington D.C.

Lee Robins, Ph.D.

Washington University School of Medicine

St Louis. Missouri

NIDA Research Monograph series

William Pollin, M.D.

DIRECTOR, NIDA

Marvin Snyder, Ph.D.

DIRECTOR, DIVISION OF RESEARCH, NIDA

Robert C. Petersen, Ph.D.

EDITOR-IN-CHIEF

Eleanor W. Waldrop

MANAGING EDITOR

Parklawn Building, 5600 Fishers Lane, Rockville, Maryland 20857
Drug Abuse and the

American Adolescent
ACKNOWLEDGMENT

This monograph is based upon papers and discussion from the RAUS

Review Conference on Drug Abuse and the American Adolescent, held

September 8, 1980, in Rockville, Maryland. Arrangements for the

conference, sponsored by the Division of Research, National Institute on Drug Abuse, were made by CDP Associates, Inc., Rockville,

Maryland 20852, under NIDA Contract No. 271-79-3636.

COPYRIGHT STATUS

The table on page 86 is adapted from material copyrighted by the

National Council on Crime and Delinquency and may be under copyright. Before reprinting, readers are advised to determine its

copyright status or to secure permission of the copyright holder.

The quotation on pages 88-89 is copyrighted by Hemisphere Publishing Corporation. It appeared in Johnston, L.D., O'Malley, P.M.,

and Eveland, L.K. Drugs and delinquency: A search for causal connections. In: Kandel, D.B., ed. Longitudinal Research on Drug

Use: Empirical Findings and Methodological Issues. The table on

page 91 is copyrighted by The Sociological Quarterly. All the

above are reproduced with the permission of the copyright holders.

All other material contained in this volume except quoted passages

from copyrighted sources is in the public domain and may be used

or reproduced without permission from the Institute or the authors.

Citation of the source is appreciated.

Opinions expressed in this volume are those of the authors and do

not necessarily reflect the opinions or official policy of the

National Institute on Drug Abuse; Alcohol, Drug Abuse, and Mental

Health Administration; Public Health Service; or the Department of

Health and Human Services.

Library of Congress catalog card number 81-600120

DHHS publication number (ADM)81-1166

Printed 1981

NIDA Research Monographs are indexed in the Index Medicus. They

are selectively included in the coverage of BioSciences Informtion Service, Chemical Abstracts, Current Contents, Psychological

Abstracts, and Psychopharmacology Abstracts.

i v
Preface

The Research Analysis and Utilization System (RAUS) is designed to

serve four functions:

 Collection and systematic classification of findings of all

intramural and extramural research supported by the National

Institute on Drug Abuse (NIDA);

 Evaluation by scientific peers of the latest research findings;

 Regular dissemination of findings to researchers in the

field and to administrators, planners, instructors, and

other interested persons;

 Provision of a feedback mechanism to NIDA staff and planners so that administration and monitoring of the NIDA

research program reflect the very latest knowledge gleaned

from research in the field.

Since there is a limit to the number of research findings that can

be intensively reviewed annually, four subject areas are chosen each

year and subjected to a thorough review. The reviewers, distinguished scientists in the selected field, are provided with copies

of all pertinent literature and reports from NIDA-funded research.

They are invited to add to this any information derived from their

own research and that of colleagues not funded by NIDA. Each

reviewer writes a state-of-the-art paper in his or her particular

subject area. These papers make up a RAUS Review Report in the NIDA

Research Monograph series.

Additionally, an evaluative meeting is held for presentation of the

papers and exchange of ideas among the scientists and with NIDA

staff. This meeting has sometimes been referred to as the "therefore"

meeting: Here is our position: therefore, where are we going next,

and where should further research lead? Should we alter our path?

Step up NIDA support because new needs have arisen or new developments hold special promise? Discussions at the meeting and the

specific recommendations of the experts in the field provide a basis

upon which NIDA evolves its plans for future research.

In Fiscal Year 1980, Drug Abuse and the American Adolescent was chosen as an area for RAUS review. The review centered on the epidemiology of drug abuse among American adolescents, with particular

emphasis on marijuana use because this is the most prevalent type of

illicit drug used by adolescents. The factors which contribute to the

v
init

were also covered.

Dr. Denise Kandel, who chaired the meting, has presented a comprehensive overview of the subject in the first paper. Other aspects

of the topic reviewed include the epidemiology of drug use patterns

among teen-agers; the personality and sociodemographic factors

associated with drug use; the influence of family and peer group on

the adolescent's drug-abusing behavior or lack thereof; the relationship between drug abuse and crime; and a review of the biomedical

consequences of drug use in adolescents.

Dr. Robert Russell has summarized the salient points of the papers

and the discussion in the Executive Summary. Dr. Dan Lettieri,

Chief, Psychological Sciences Branch, NIDA Division of Research,

directed the scientific discussion.

Jacqueline P. Ludford, M.S.

Coordinator

Research Analysis and Utilization System

vi
Contents

Preface

Jacqueline P. Ludford . . . . . . . . . . . . . . . . . . . v

Drug Use by Youth: An Overview

Denise B. Kandel . . . . . . . . . . . . . . . . . . . . . . 1

Epidemiology of Drug Use Among Adolescents

Judith Droitcour Miller . . . . . . . . . . . . . . . . . . 25

Personality and Sociodemographic Factors in Adolescent

Drug Use

Kelin E. Gersick . . . . . . . . . . . . . . . . . . . . . . 39

From Family to Peer: Transitions of Influence Among

Drug-Using Youth

Thomas J. Glynn . . . . . . . . . . . . . . . . . . . . . . 57

The Delinquency and Drug Use Relationship Among

Adolescents: A Critical Review

Richard R. Clayton . . . . . . . . . . . . . . . . . . . . . 82

Adolescents and Drug Abuse: Biomedical Consequences

Sidney Cohen . . . . . . . . . . . . . . . . . . . . . . . .104

Executive Summary, Discussion, and New Directions

for Research

Robert Russell . . . . . . . . . . . . . . . . . . . . . . .113

Participants . . . . . . . . . . . . . . . . . . . . . . . . .127

List of NIDA Research Monographs . . . . . . . . . . . . . . .128

vii
Drug Use by Youth: An Overview

Denise B. Kandel, Ph.D.

DRUG BEHAVIOR AS SOCIAL CHANGE

The spread in the use of marijuana and other illicit drugs in the

population represents one of the most striking instances of social

change of the last decade. As stressed by the National Institute

on Drug Abuse in a recent publication (NIDA 1980) and as discussed

in the paper by Miller, the proportion of young adults 18 to 25 years

of age who have ever experimented with marijuana showed dramatic

increases from 4 percent in 1962 to 68 percent in 1980; the proportion who tried illicit drugs other than marijuana in that same period

increased from 3 percent to 33 percent. While results from the 1977

national household survey of the general population suggested that

rates of marijuana use had begun to level off, results from the most

recent survey carried out in the winter of 1979-1980 indicate, on the

contrary, that rates are continuing to increase both in lifetime

experimentation and current use, Forty percent of young adults report

using marijuana within the last month. Results from Monitoring the

Future, another large-scale national epidemiological effort based on

representative members of the senior high school classes throughout

the country, indicate that the proportion of daily marijuana smokers

among high school seniors is over 10 percent and is higher than the

proportion of daily alcohol users (7 percent) (Johnston 1980a;

Johnston et al 1979a,b). Furthermore, in 1979, 4 years after graduation from high school, half of the young people who were using marijuana daily while in high school were still using it that intensively,

and most (66 percent) were also smoking cigarettes daily (Johnston

198Ob). Use is widespread. It is probable that these figures actually underestimate the number of Americans who are involved in using

drugs since rates derived from household or school-based surveys omit

individuals likely to be the heaviest users, for example, school dropouts, transients, or those living in institutions such as college

dormitories, prisons, or the military.

Increased prevalence of use has been accompanied by decreasing age of

onset; almost twice as many high school seniors in 1979 as in 1975

(23 percent as compared to 13 percent) reported their first experience with marijuana at the eighth grade level or below (Johnston et

al. 1979a,b).

1
Patterns of use of various drugs throughout the life cycle illustrate

dramatically the age-graded nature of illicit drug use as

compared with the socially accepted substances, on the one hand, and

the medically prescribed drugs on the other. As table 1 shows,

the use of marijuana and other illicit drugs and the nonmedical use

of psychoactive substances are most prevalent among individuals aged

18 to 25, with sharp declines thereafter (cf. O'Donnell et al. 1976).

Age-related trends in marijuana use are the most striking. The

socially accepted substances, alcohol and tobacco, are used most

intensively in a wider age range than marijuana, from ages 18 to 34;

although use declines thereafter, prevalence in the mid-thirties

remains at a fairly high level. For the medically prescribed psychoactive substances, on the other hand, highest rates of use begin at

age 26, with age of peak use varying with each of the three major

classes of drugs. Use of stimulants appears to peak at ages

26 to 34, sedative use peaks after age 50, and use of tranquilizers

remains at the same level from age 26 on. Thus medical use begins

to peak in the years following the decline of illicit use. Since

these age-related trends are based on yearly cross-sectional studies,

it is not known yet whether the same persons are involved in the

various patterns of use over the lifespan. Furthermore, it must be

kept in mind that these age differences derived from cross-sectional

studies may reflect true maturational effects as well as historical

differences among cohorts with different drug experiences in adolescence. However, these comparisons of drug use patterns over the

lifespan suggest that certain use of illicit drugs in adolescence

and young adulthood and use of psychoactive substances under medical

supervision later in the lifespan may serve similar psychological

and social functions for the individual.

Because age of onset in drug use has been steadily declining into

the early years of adolescence or even preadolescence, because peak

use of alcohol and illicit drugs and the highest rates of increase

in these rates occur when youths are entering young adulthood and

must make commitments regarding family and work roles, because daily

use of marijuana occurs in such a large proportion of the youth

population and is more persistent than anticipated, because daily

use of marijuana is associated with extensive use of other drugs,

and in particular cigarettes, there is increasing concern within both

the public and Government agencies about the potential health consequences. Health and Human Services Secretary Patricia

Roberts Harris stresses that, "Because the emotional and physical

effects of drug use have far greater consequences for a developing

mind and body, it is important that we focus our efforts on the

young, while continuing our efforts to provide help for all age

groups" (ADAMHA News 1980, p.6). Consequences include not only

changes in physiological and biomedical functioning, such as those

reviewed by Dr. Sidney Cohen, but also in psychological and social

functioning. Of primary concern among the psychosocial consequences

in adolescence arid early adulthood are the users' levels of performance in various social roles, especially schooling, work, and family.

Not only level of performance, but timing is important. Indeed, the

2
Table 1

Current Prevalence of Various Substances in the General Population by Age and Sex in 1977

(Percentages Using--N = 4,594)
assumption of these roles at the proper time in the lifespan marks

transition into adulthood and establishes the individual's psychosocial maturation.

Because drug use may pose a health hazard, particularly to

young people, the Federal Government has played an important role in initiating and supporting systematic data gathering

efforts on patterns of use and the behaviors of users in the population, as well as laboratory studies designed to assess the biomedical

and physiological consequences of various forms of drug use on

humans as well as animals. In a series of extensive clinical assessments, volunteers in a number of medical centers have been studied

when using marijuana in closed wards for lengthy periods ranging

from 30 to 90 days (cf. Jones and Benowitz 1976; Mendelson et al.

1974). These laboratory and field studies have increased our knowledge and understanding of various forms of behavior related to use of

drugs, especially marijuana. The present papers provide extremely useful reviews of knowledge in several areas. In particular, there are

series of the most recent epidemiological data on drug behaviors

by Miller; of the correlates and antecedents of drug behavior, both

in terms of the social environment created by peers and the family

by Glynn; and the individual personality attributes of the users by

Gersick. We also have reviews of some of the consequences of marijuana use, biomedical and physiological consequences by Cohen, on

the one hand, and behavioral consequences with respect to criminality

by Clayton, on the other. The important consequences on driving

have also been reviewed by Cohen.

Longitudinal Drug Studies in Adolescence and Young Adulthood

I would like to complement these reviews by bringing in a systematic

developmenta1 perspective and by focusing on a particular type of

study from which a great deal has been learned, the longitudinal

field study. These are the field studies in which a large number

of young persons in the general population are followed over time

to learn what distinguishes those individuals who start using drugs

from those who do not, and what happens after a certain length of

time to those young people who use drugs. These studies are among

the most useful since they have the potential of making it possible

to disentangle causal factors and consequences in drug use, which

are confounded in any research design in which data are gathered at

a single point in time.

Important insights have now been generated from these studies, both

the patterns of drug use, including alcohol, and psychosocial predictors and the consequences of use (for review, see Kandel 1978b,

1980a,b). It must be stated at the outset that much more is known

about the psychosocial determinants than the consequences of drug

use. For the most part, these longitudinal studies have been studies

of adolescents based on samples of high school or college students

between the ages of 12 through 21, and have focused on the use of

marijuana or other illicit drugs. For selected references on these

studies, see Huba et al. 1979a,b, 1980a,b, 1981; Wingard et al.

1979, 1980; Elinson 1976; Jessor et al. 1973; Jessor and Jessor 1977,

4
1978; Kandel 1973, 1974a,b, 1978c; Kandel et al. 1976a, 1978a,c; Kaplan

1977a,b, 1978a,b, 1980; Kaplan and Pokorny 1978; Mellinger et al.

1976a,b, 1978a,b; Sadava 1973; Sadava and Forsyth 1977a,b; Smith and Fogg

1978, 1979. Lukoff and Brook's followup of a ghetto teenager population is community-based (Brook et al. 1977a,b, 1978, 1980), as is

Kellam's long-term followup of a cohort of black ghetto youths first

contacted at age 6 (Kellam et al. 1977, 1980a,b). Lukoff and Brook

are currently carrying out a new study of high school students in

different ethnic communities.

To date, much greater attention has been paid to the adolescent

years than to the years of early adulthood, with few longitudinal

studies focusing on the transitional years from adolescence to early

adulthood. Of the three completed longitudinal studies that have

bridged the years between the high school and the post-high school

years, two have been carried out by Johnston and his associates:

(1) the followup through age 23 in 1974 of the Youth in Transition

cohort (N=1,608), a nationwide representative sample of the 1966

tenth grade boys initially selected for a study of school dropouts

(Johnston 1973; Johnston et al. 1978; Bachman et al. 1978; O'Malley

1980); and (2) the ongoing yearly followups of successive subsamples

of national high school senior cohorts in Monitoring the Future

(Johnston 1980a,b; Johnston et al. 1979a,b; Bachman 1980a). Since

1975, national representative samples of high school seniors drawn

from over 130 public and private high schools have been surveyed

annually. S&samples of 2,500 cases are selected every year and

are followed annually or biannually for up to 6 years. The oldest

cohort will be approximately 23 years old in 1981. The most noteworthy aspect of the design is that it is cohort-sequential, with

additional cohorts selected in successive years and each followed

over time. This most sophisticated and rarely elemented design

will make it possible to disentangle maturational, cohort, and historical effects in recorded changes over time. Finally, Brunswick's

followup of Harlem youth included young men and women aged 23 to 24

(N=536) at the second interview in 1975-1976 (Brunswick 1979, 198Oa,b;

Brunswick and Boyle 1979). Two studies have followed up adults.

Robins focused on narcotic use by Vietnam veterans. She interviewed

veterans discharged in the United States in September 1971, with an

oversample identified with urines positive for opiates, in 1972 at

age 22 to 23 (N=571), and in 1974; and a matched comparison sample

(N=284) of non-veterans in 1974 (Robins 1973, 1974, 1977, 1978;

Robins et al. 1974, 1977). Cahalan and his collaborators examined

alcohol problems in a national sample of adult men 18 to 65 years

old (N=1,369) over a period of 8 years (Cahalan and Room 1974; Roizen

et al. 1978).

In an interesting development in 1979 and 1980, four new followup

studies of adolescents into young adulthood were initiated almost

simultaneously. These studies share a number of similarities: they

are all followups of earlier longitudinal adolescent studies, cited

above, carried out in the early 1970's, and they contact the former

adolescents at approximately the same age in early adulthood. Richard

and Shirley Jessor are contacting by mail their original high school

5
(N=432) and college cohorts (N=205). Two followups are planned:

the first one in 1979, 6 years after the last contact in 1972-1973,

the second one 2 years later. Respondents will range in age from

approximately 21 to 28 years of age. Beginning in summer 1980,

Kaplan is following up 9,000 respondents who constitute 50 percent

of the seventh graders enrolled in 18 junior high schools in

Houston in 1971. Of these students, 7,800 were included in the

first wave of data collection in 1971; the remainder were presumably

absent from school on the day of the survey. Personal interviews

will be carried out continuously over a 3-year period with successive

units of 100 cases, when respondents will be 22 to 25 years old.

Smith's study is based on a mail followup of 4,000 former eighth

through tenth graders in one school in the greater Boston area,

ranging in age from 22 to 28 years when contacted in 1980. In addition to documenting behavioral consequences of drug use, a major

emphasis of that study will be on perceived consequences of use.

Kandel is following up through personal interviews in summer and

winter 1980 a representative subsample of adolescents formerly

enrolled in the tenth and eleventh grades in 18 New York State public

secondary schools in 1971-1972, and previously studied 8 years earlier.

The target sample of 23- to 24-year-old respondents includes 1,230

adolescents who participated in the initial high school survey and a

complementary group of 330 absentees from the same schools. A fifth

study will be initiated late in 1980, a followup by Clayton of a

subsample of the national cohort of young men aged 18 to 30 included

in O'Donnell et al. 1976.

No results are yet available from these studies. Eventually, they

will provide important opportunities for replication and convergence

of findings of the sort provided earlier by the adolescent studies

(Kandel 1978a, 1980b).

Stages in Drug Involvement

While cross-sectional studies had earlier documented the strong

association that exists in the use of various substances, longitudinal studies have identified important developmental sequences in

usage patterns,. The use of legal drugs precedes the use of illegal

ones, irrespective of the age at which initiation to illegal drugs

takes place (Kandel 1975, 1980; Kandel and Faust 1975). At least

four distinct development stages in adolescent drug involvement

can be identified: (a) beer or wine; (b) cigarettes and/or hard

liquor; (c) marijuana; and (d) other illicit drugs. The same steps

are followed in regression as in progression in drug use. Similar

patterns are found among black and white youths, although blacks may

be more likely to proceed directly from marijuana to heroin without

experimenting with pills and the psychedelics (Johnson 1973; Kleinman

and Lukoff 1978; Brunswick 1979). Further evidence for the existence

of stages in drug use has been provided by the findings that different

sociopsychological factors predict adolescent initiation into

different stages of drug use (Kandel et al. 1978a,b,c). This will

be discussed in greater detail below.

6
It is important to keep in mind that one's position at a particular

point in the sequence is no indication of later progression

to other drugs higher up in the sequence. Rather, the use of an

early sequence drug is a necessary but not sufficient condition for

progression to a later stage, i.e., involvement with more serious

drugs.

Predictors of Drug Initiation in Adolescence

Moving beyond simple correlations that describe the characteristics

of adolescent drug users at one time point, longitudinal studies

have greatly increased our understanding of the predictors of drug

use in the early phases of adolescent drug involvement. In

particular, we know that many of the factors found to be associated

with drug use at one point in time, such as low academic performance,

crime, low self-esteem, depressive mood, rebelliousness, and other

personality characteristics precede the use of drugs (see, in particular, Johnston et al. 1978; Jessor and Jessor 1977; Kandel et al. 1976b,

1978c; Kaplan 1980; Kaplan and Pokorny 1978; Mellinger et al. 1976a,b;

Smith and Fogg 1978; Wingard et al. 1979). Some of the predictive

factors can be identified in childhood, such as behavior disorders

(love 1979), aggressiveness with or without association with shyness

(Kellam et al. 198Oa,b), and rebelliousness (Smith and Fogg 1978).

Most attention has been focused on alcohol and marijuana use. At a n-ore

general level, involvement in a variety of drugs is part of a general

pattern of involvement in deviant and rebellious activities (Jessor

and Jessor 1977, 1978; Johnston et al. 1978; Kaplan 1977a, 1978b;

Segal et al. 1979, 1980; Smith and Fogg 1978, 1979). (Our own longitudinal analyses based on a sequential model of drug use have been

especially helpful in isolating stage-specific predictors of initiation into various legal and illegal drugs (Kandel et al. 1978a,b,c;

Margulies et al. 1977). At the earliest levels of drug involvement,

adolescents who have engaged in a number of minor delinquent or

deviate activities, who enjoy high levels of sociability with their

peers, and who are exposed to peers and parents who drink, start to

drink. The relationship with parental use of hard liquor suggests

that these youths learn drinking patterns from their parents. The

use of marijuana is preceded by acceptance of a cluster of beliefs

and values that are favorable to marijuana use and in opposition to

many standards upheld by adults, by involvement in a peer environment in which marijuana is used, and by participation in the same

minor forms of deviant behaviors that precede the use of hard liquor.

By comparison, use of illicit drugs other than marijuana is preceded

by poor relationships with parents, by exposure to parents and peers

who themselves use a variety of legal, medical, and illegal drugs,

by psychological distress, by heavy involvement in marijuana, and by

a series of personal characteristics somewhat more deviant than

those that characterize the novice marijuana or hard liquor user.

In general, prior behavior is a much stronger predictor of subsequent drug behavior than expressed intentions to use drugs. (Huba

et al. 1981).

7
Alcohol and Illicit Drug Use in Young Adulthood

As noted above, most research has emphasized the teen years, since

these are the years of initiation into drugs. The spread of illicit

drug use into the early twenties as the younger cohorts have matured

has brought about a surge of interest in the early years of adulthood when rates of use of most drugs reach their peak.

However, because few longitudinal studies in early adulthood have

been completed, most of our knowledge about the social psychological

characteristics of drug users in early adulthood is based on crosssectional studies and is at the level of correlates. Very little is

known about the consequences of use. The most important cross--

sectional studies include the national survey of young men 18- to

30-years-old carried out by O'Donnell, Clayton, and their collaborators (O'Donnell and Clayton 1979; O'Donnell et al. 1976; Clayton

and Voss 1977) and the analyses based on national household surveys

of the general population (Cisin et al. 1976; Miller et al. 1978).

A number of associations have been established, pertaining to different areas of functioning, including the educational, the occupational,

the marital, the parental, and the criminal spheres.

The years of intensive use of alcohol and illicit drugs correspond

to the very years in which most individuals make commitments

regarding their education, occupation, and family, commitments that

have long-term social and psychological consequences both for the

individual and for society. Completion of education, entry into the

labor force, marriage, and parenthood all take place in the early

twenties.

1. Marital status. A very consistent relationship to all forms of

drug use is found with marital status. Persons who are married

show the lowest rates of use, while the single, the divorced,

and those living independently show much higher rates (Manheimer

et al. 1969; O'Donnell et al. 1976; Henley and Adams 1973; Brown

et al. 1974; Robins 1974; Bachman et al. 1978). Being married

is one of the most important predictors of cessation of the use

of marijuana and stronger drugs among adults in national samples

(Cisin et al. 1976; Hudiberg and Joe 1976).

2. Higher education. Contradictory findings have been reported on

the drug use of employed youth as compared to their collegegoing peers. McGlothlin (1971) concluded from a review of

existing studies that rates of drug use by college students were

higher than those of nonstudents (see also National Commission on

Marijuana and Drug Abuse 1972). On the other hand, among the

Vietnam soldiers, drugs users tended to have had less education

than nonusers (Robins 1974); Brunswick (1979) reports lower

levels of completed education for heroin users than for nonusers,

especially women. Similarly, O'Donnell et al. (1976) found

lowest rates of use among college graduates. Cisin et al.

(1976) found no essential differences in the use of marijuana

and other illicit drugs between college graduates and those who

had not gone to college.

8
3. Labor force participation. Findings pertaining to labor force

participation are among the most consistent. The unemployed are

consistently found to have the highest rates of use of most

drugs, especially alcohol and illicit drugs other than marijuana

(see, for example, Brunswick 1979; O'Donnell et al. 1976; Bachman

et al. 1978; Robins 1974). In a national sample housewives

were most likely to have stopped the use of marijuana or strong

drugs, while students and those unemployed were least likely to

have done so (Cisin et al. 1976).

Consequences of Drug Use in Natural Populations

As noted above, to date much more attention has been paid to the

precursors than to the consequences of drug use. The evidence available to date in population surveys pertains to four areas of functioning: (1) motivation, (2) criminal activity, (3) psychological

functioning, and (4) health.

1. The motivational syndrome. It is widely feared that the use of

drugs by young people may lead to the motivational syndrome,

the "loss of interest in virtually all activities other than

cannabis, with resultant lethargy, amorality, and social and

personal deterioration" (National Commission on Marijuana and

Drug Abuse 1972, p.64). There is very little evidence to date

on this issue. The available evidence suggests that, while

there is an association at one point in time between indicators

of the "amotivational syndrome" and drug use among college students, such states may precede the use of drugs. The association

is explained away by spurious factors that are simultaneously

related to those states and to drug behavior. Somewhat contradictory evidence is presented regarding adverse consequences on

academic performance, clarity of occupational goals, or dropping

out of school, although the conclusion appears to be that drug

use per se may not lead to the observed consequences. Most of

the documentation is provided by three studies: the Mellinger

et al. (1976a,b, 1978a) study of male college freshmen at the

University of California at Berkeley; Brill and Christie's (1974)

study of undergraduates at the University of California at Los

Angeles; and Johnston's (1973) followup of a national cohort of

tenth grade high school boys. No differences in grade point

average were observed by Brill and Christie (1974) either at one

time point or over time in their sample of college students

classified into six marijuana-use groups: never used, initiated,

increased, remained stable, decreased, or stopped use. Other

investigators, however, report that marijuana users are most

likely to drop out of school (Johnston 1973; Mellinger et al.

1976a,b), to have lower grades (Kandel et al. 1976a), or to have

greater difficulties in deciding on a career (Brill and Christie

1974). In a recent analysis, O'Malley (1980) reports that

cigarette smoking in high school has a small effect in reducing

educational attainment by age 23.

9

388-024 0 - 82 - 2
Differences in dropout rates or in indecision about career goals that

appeared among drug users in their junior year at Berkeley were eliminated in multivariate analyses that took into account the students'

characteristics when they entered college: family background,

scholastic performance in high school, and academic values

(Mellinger et al. 1976b, 1978a). Exceptions involving very

small groups of students were encountered, however. The rate of

dropping out of college was extremely high (53 percent) in a

group (N=19) of continuing multiple drug users with low academic

motivation at entrance to the University of California and with

parents of low educational background. This contrasts with

dropout rates varying between 11 percent and 15 percent for

other students with initially low academic motivation (Mellinger

et al. 1976a,b). Among another group of 22 men whose occupational

goals were clear at Time 1 who remained continuous multiple drug

users (marijuana and other illicit drugs) throughout the first

2-1/2 years of college, a larger proportion became undecided

about their career goals. Also, an even smaller group of continuous multiple drug users (N=12) had lower grades at Time 2

than would be expected on the basis of their prior characteristics.

This result, however, was not statistically significant (Mellinger

et al. 1978b), and the number of students on whom these analyses

are based is very small.

Similarly, O'Malley (1975) found no significant changes in selfreported grades associated with drug use in the cohort of tenth

grade boys in the Youth in Transition cohort when followed for

4 years after high school. Users of hard drugs had lower educational attainments than would be expected on the basis of their

predrug aspirations: The proportion aspiring to college dropped

from 62 percent to 37 percent among these who began to use

barbiturates or heroin, and from 76 percent to 50 percent among

those who began to use hallucinogens. The reduction in college

aspirations, however, tended to precede rather than to follow

the initiation into illicit drugs other than marijuana (O'Malley

1975). Furthermore, the use of these illicit drugs had no effect

on other motivational variables having to do with job attitudes

and self-actualization. It would appear that low school performance does not lead to drug use, but that the same variables that

lead to poor school performance are also related to involvement

in drugs. However, cigarette use appears to lower educational

level attained after high school, when controlling for social

class, ability, and academic performance while in high school

(O'Malley 1980).

It is important to note that to date few studies relevant to the

issue have been carried out on samples of young adults. It is

also possible that certain effects manifest themselves especially

in early adolescence, an earlier stage of psychosocial development

than has been examined to date in the studies concerned with the

academic consequences of drug consumption. Furthermore, to

date, studies have not isolated for special analyses those young

10
people who use drugs, and especially marijuana, on a daily basis.

Johnston and his colleagues are currently carrying out such

analyses, made possible by the large number of cases available

in the Monitoring the Future national cohorts (Johnston 1980b).

2. Crime. The studies on young adult men by Robins (1973, 1974)

and by O'Donnell et al. (1976), as well as an earlier followup

study on a sample of former high school students by Johnston et

al. (1978) document a strong cross-sectional relationship between

the use of marijuana or other illicit drugs and delinquency.

These relationships are confirmed in the data presented by Clayton

in this volume. However, the causal sequence between drug involvement and deviant activities is subject to differing interpretations. Robins (1973, 1974) reported that drug use during military

service in Vietnam had a strong potentiating effect on arrest

rates following return of the soldiers to the United States,

even when the more frequent proservice arrest histories of the

drug users were taken into account. Her conclusions regarding

the causal connection between drug use and delinquency differ

from those reached by Johnston et al. (1978). On the basis of

their continued followup of the Youth in Transition cohort of

tenth grade boys through their early twenties, Johnston et al.

concluded that marijuana use and the use of other illicit drugs

did not lead to an increase in delinquency over time. Differences

among users in their early twenties could be accounted for by

predrug use differences in the late teens. The different conclusions reached by the two groups of investigators may reflect

differences in the characteristics of the cohorts, the patterns

of drug use, and the social contexts involved in each of the

studies. Indeed, the young veterans studied by Robins were

involved in narcotics while the young men followed by Johnston

and his colleagues were involved in non-narcotic drugs. Whether

or not drug use by itself potentiates further criminal involvement, delinquency would appear to precede drug use, as stressed

by Clayton.

3. Psychological distress. Certain forms of drug use may represent

coping strategies to deal with feelings of psychological distress.

Two studies have now reported findings that suggest that the use

of certain drugs may help adolescents handle various forms of

psychological stress such as law self-esteem or depressive mood.

In a three-wave longitudinal study of junior and senior high

school students, Kaplan found that a lowering of self-esteem

over time predicted initiation into various deviant behaviors,

including one of several forms of drug use (marijuana, drinking,

or narcotics) and that adoption of one of these behaviors led to

subsequent improvement in levels of self-esteem (Kaplan 1977a,b;

Kaplan and Pokorny 1978). Similarly, in our own work (Paton et

al. 1977), we found that over the course of a school year depressive mood predicted the onset of marijuana use among nonusers as

well as the use of other illicit drugs by marijuana users.

Furthermore, continued use of illicit drugs other than marijuana

was associated with a decrease in levels of self-reported depressive mood over time. These results suggest that the use of

11
illicit drugs other than marijuana might serve a self-medicating

function. Kellam et al. (1980a) reported that black youngsters

who were symptomatic on scales of psychological well-being as

young children were more likely than their classmates to be

using alcohol in adolescence.

The use of illicit (or licit) drugs as coping mechanisms to deal

with feelings of psychological distress is suggested by three

other lines of inquiry. First, there are the studies carried out

among adults that have shown that alcohol and psychoactive drugs

are used to cope with various life stresses (Parry et al. 1974;

Pearlin and Radabaugh 1976). Secondly, findings from epidemilogical studies indicate that several of the social factors

related to the distribution of depression or depressive mood in

the general population are identical to those related to drug

use, e.g., unemployment or marital separation (Comstock and

Helsing 1976; Weissman and Klerman 1977; Warheit et al. 1973).

Finally, clinical studies of clients in methadone treatment

centers have found a high incidence of depressive symtomatology

in these populations (Altamura 1975; Weissman et al. 1976, 1977;

Senay 1975; Kandel 198Oc). In addition, a followup of a very

small clinical sample of adolescents diagnosed as psychiatrically

ill indicates that a diagnosis of depression without drug abuse

or alcoholism predicts good outcome (Fard et al. 1978). The

implication of the study is that when depression is coupled with

drug or alcohol abuse, outcome may be poor.

As is apparent from a comprehensive review of psychological

factors and drug behavior (Austin and Lettieri 1976), the relationship between depression and drug use in general populations

represents an almost completely unexplored area of investigation.

There does not exist systematic information on the relationship

of various forms of drug use to feelings of depression either in

adolescence or in adulthood. Nor are there data about the longterm consequences of depressive mood and drug use in adolescence

on subsequent drug involvement and depression.

4. Physiological consequences. With one exception, drug studies

carried out on normal populations have not assessed respondents'

health status. Brunswick's research is unique in this respect

since she assessed the health of young blacks in Harlem, both in

adolescence and 6 to 8 years later in young adulthood, at ages

19 to 23 (Brunswick 1979, 198Oa,b). The first assessment was

based on medical examinations and on subjective reports of health

status and experienced symptom in three different areas:

Physical, psychological, and psychophysical health. The second

assessment was exclusively based on self-reports. The results

indicate that the strongest effects of substance use on subjective

health in this black sample appeared with respect to psychophysical symptomtology, and only for heroin use among females,

and glue among males. Controlling for initial health status,

black female heroin users show a decline over time in psychophysical health (i.e., headaches, emotional trouble, dizziness,

or chest pain) and in major activities where no disability

12
existed before (Brunswick 1979, 198Oa,b). There is, however, a

time lag of several years before these consequences appear. No

detrimental effects appeared in adolescence when these young

black women first start experimenting with heroin.

5. Consequences of age at first use. Finally, most findings support

the conclusion that earlier initiation into drugs, such as alcohol

and marijuana, is associated with increased liability: greater

subsequent abuse of that drug, greater probability of involvement

in more serious drugs, lower performance in a variety of social

roles, and greater involvement in deviant activities, such as

selling drugs or criminality (Brunswick and Boyle 1979; Davies

and Kandel 1977; Kleinman 1978; O'Donnell and Clayton 1979).

Implications: What Do We Know About the Psychosocial Determinants

and Consequences of Drug Use?

Participation in drug use, especially in its more severe form, is

associated with social liabilities, such as unemployment, greater

marital instability, or delinquency. The causal sequence between

participation in these social roles and drug use is far from clear,

however. Lower social functioning found to be associated with various

types of drug behavior at one point in time may in fact precede

rather than follow involvement in drug use. Or, lower social functioning may also result from such use. Or, there may be interactive

effects whereby drug use further exacerbates prior deviant and lower

levels of functioning. The potential interactive effects between

drug use and low social performance are best illustrated to date by

data on criminality or involvement in deviant activities. Robins

found that those veterans who had used drugs in Vietnam had highest

arrest rates following return to the United States, even when the

more frequent preservice arrest histories of the drug users were

taken into account. Robins concluded that "the drug experience in

Vietnam may have added considerably to the social liabilities of the

returning veteran" (1973, p.19). Jessor et al. (1973) showed that

involvement in delinquent activities by high school students, which

predicted the use of marijuana, increased with continued use of the

drug.

Peak use occurs in the very same years that young people are entering

their young adult years and have to make commitments regarding their

participation in family and work roles. As noted above, however,

there exist few completed followups of young adolescents past the

period of highest rates of drug use, namely the years 18 to 22, and

few followups longer than 1 or 2 years in duration. Exceptions

include Johnston's and Brunswick's studies. However, a number of

followups of earlier adolescent cohorts into young adulthood have

been initiated by Jessor, Johnston and Bachman, Kaplan, Smith, and

Kandel. Clayton will also follow a subgroup of the national sample

of young men into their thirties.

Much more is known about the social-psychological antecedents of

initiation into drug use in adolescence than about the consequences

of drug use either in adolescence or in young adulthood, or about the

13
correlates of initiation as compared to the correlates of cessation.

Much remains to be learned, not only about the long-term predictors

of involvement in legal and illegal drugs, but about the psychosocial

consequences of such use. Understanding the relationship between

drug use and type of participation in social roles is crucial to

assessing the potential consequences of drug use on psychosocial

maturation in young adulthood. In the same way that parallel longitudinal studies of adolescents in the 1970's complemented one another

and provided unusual and useful convergent understanding of drug

behavior in adolescence, the new longitudinal studies will provide

crucial and complementary understanding of drug behavior in young

adulthood. Additional developments will increase the potential

usefulness of these and other studies to the understanding of drug

behavior. The National Institute on Drug Abuse is stimulating efforts

to develop a core set of items to measure consequences of drug use.

These items could be incorporated into different studies to increase

comparability and replication of findings across samples (Workgroup

on Consequences of Drug Use, NIDA, D. Lettieri and P. Bentler, CoChairmen). The large number of adolescents surveyed in the Monitoring

the Future samples for the first time will make available large

numbers of marijuana users for analysis. In addition, sophisticated

statistical methods for the analyses of causal models newly developed

in social sciences are being incorporated into drug research. Peter

Bentler and the Drug Center at UCLA have taken an important leadership

role in making these techniques available to drug researchers,

Although much progress has been made in our understanding of drug

behavior, much remains to be learned. An important compendium of

theories of drug behavior recently published (Lettieri et al. 1980),

that brings together over 30 contributions from different disciplines,

illuminates the narrow focus of single empirical studies. A complexity of factors will eventually have to be considered to provide

a comprehensive account of the determinants and consequences of drug

use. More interdisciplinary research will have to be initiated and

creative ways developed to encompass both biological variables and

larger contextual factors in the socio-psychological approaches that

characterize much of current behavioral drug research. It will be

important on the one hand to incorporate some of what has come to

light regarding the role of genetic and metabolic factors in susceptibility to drug abuse. On the other hand, greater attention will

also have to be paid to contextual factors and changes in society at

large. For example, rarely have parallels been sought between

increases in rates of drug use and concurrent changes in other areas

of behavior related to lifestyles, such as sexual attitudes and

experimentation, where changes have been striking (Hopkins 1977).

Social factors other than those that characterize the immediate

interpersonal contexts provided by family and peers, such as community

or school contexts, are rarely taken into account systematically.

Yet, as the work by McCoy and his associates has made clear (McCoy

and Chitwood n.d.), cases of drug abuse are clustered within Certain

residential areas within a conmunity. Cross-cultural comparisons

indicate that persistence and intensity of involvement among users

are related to the overall prevalence of use in a particular culture

(Kandel et al. in press).

14
Another issue to be resolved concerns the specificity of factors

identified as determinants or consequences of drug use. Does a

unique set of factors precede each kind of substance use, or does a

common set of factors precede all substances, with the specific

substance used determined mainly by availability? Similarly, does a

unique or a common set of consequences follow the use of various

drugs? Certain investigators stress the specificity of factors.

For example, Kellam and his colleagues (Kellam et al. 1980a) found

that psychological symptomatology in first grade predicted alcohol

use 10 years later but no other forms of drug use. Kandel and her

associates (Kandel et al. 1978a,b) identified stage-specific predictors of three forms of drug involvement. On the other hand,

Jessor and Jessor (1978) and Bachman et al. (1980b) emphasize the

commonality in the correlates and predictors of various form; of

drug behavior, and of minor delinquency. Indeed, the issue of commonality involves a broader concern than commonality among various forms

of drug use. The issue must be broadened to consider the potential

similarities and/or differences that underlie participation in drug

use and in other nonconforming and deviant behaviors, such as delinquency and psychopathology (see comments by Clayton in this volume;

Jessor and Jessor 1977; Kaplan 1980).

Much remains to be learned about the determinants and consequences

of substance use by young people. The papers in this volume contribute to the emerging consensus that the understanding of adolescent

drug behavior requires a developmental perspective in which drug use

is considered within the comprehensive perspective of adolescent

psychosocial development and socialization.

FOOTNOTE

1Data from the 1977 rather than 1979 general household survey are

discussed because the more recent survey does not include data on

medical use of psychoactive active substances (Abelson et al. 1977).

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ACKNOWLEDGMENTS

Work on this manuscript has been partially supported by Research Grants

DAO1097-07 Scope D, and DAO2602-01 from the National Institute on Drug

Abuse.

AUTHOR

Denise B. Kandel, Ph.D.

Department of Psychiatry and School of Public Health

Columbia University College of Physicians and Surgeons

New York, New York 10032

24
Epidemiology of Drug Use Among

Adolescents

Judith Droitcour Miller, M.A.

This review of the epidemiology of adolescent drug use focuses on

typical stages of the drug use career and assesses the diversity of

experience that my characterize special subgroups of youth. As shown

by earlier longitudinal studies (reviewed by Kandel 1978; 1980), drug

use during the adolescent years is a dynamic, multistage phenomenon

which my best be understood by a conceptualization of progressive

stages of involvement. The most recent data on dominant patterns of

drug use in the 12 to 21 age group are provided by two series of

nationwide surveys: the national survey of high school seniors

(Johnston et al. 1979) and the national survey of household population

aged 12 and older (Fishburne et al. 1980). Both of these surveys are

cross-sectional, but because many of the data consist of retrospective

drug use histories, nationwide patterns of use in 1979 can be described

in terms of sequential stages of drug experience.

As Kandel has noted, the study of stages of adolescent drug use does

not imply "that the use of a drug causes the progression to the next

level. Nor can we assume that once started adolescents will progress

through the entire sequence" (Kandel et al. 1978). Rather, during

the adolescent years, each stage of the drug use career represents a

risk factor with regard to more serious stages of drug involvement.

Epidemiologic data can specify the levels of risk associated with

progression to each successive stage. Such a conceptualization at

once facilitates the identification of various kinds of antecedent

factors (Kandel 1978, 1980) and reveals that the progression to each

stage of drug use can be predicted with reasonable accuracy by the

degree of prior contact and experience with drugs as well as the age

at which these earlier drug experiences occurred. The stages-of-druguse conceptualization is also suited to the study of drug use consequences, for, as Cisin (1979) has noted, the consequences of using a

particular drug are most appropriately linked to a specific level of

drug experience.

Stages of drug use involve two distinct dimensions:

An empirical hierarchy of drugs or drug classes, which in studies

of the adolescent population has been examined in terms of the

sequence in which the first use of various drugs occurs; and

25

388-024 0 - 82 - 3
Various degrees of involvement with a single drug or drug class,

including drug use entry, the continuation of use, the move to

abusive levels of consumption, and discontinuation of use.

These two dimensions of drug use careers--progression through a

hierarchy of drugs and involvement with a single substance-are

conceptually distinct. Certainly, an individual could experiment

with a range of substances without continuing to use any of them;

alternatively, a young person could become seriously involved in the

use of a single substance without trying any other drugs. However,

longitudinal data have indicated that, at least in the adolescent

population, the two dimensions are empirically related: Kandel and

Faust (1975) found that the heavier the use of a lower-ranked drug

at Time 1, the more likely it was that progression to a higher-ranked

drug would occur by Time 2, 6 months later. Furthermore, those who

continue to use a higher-ranked drug usually also continue to use a

lower-ranked drug (Kessler et al. 1976).

Stages of drug use thus include progression from lower-ranked to

higher-ranked drugs and progressive degrees of involvement with

various substances; concurrent use of different drugs often occurs,

for the two dimensions typically converge as a young person becomes

more (or less) involved in drug use. It should be noted that one

aspect of multiple drug use that has not been widely examined is the

use of two or more drugs on the same occasion. Data from the study

of young men and drugs (O'Donnell et al. 1976) indicate that this

phenomenon deserves attention, at least insofar as alcohol and marijuana are concerned. Bunce (1977) reports that of the young men who

had used alcohol on at least 10 occasions and had also used marijuana

on at least 10 occasions, over 80 percent said they had used these

drugs in combination. Consequences have typically been studied in

terms of a single drug or drug class, but as Bunce has pointed out,

different consequences may occur as a result of multiple drug use,

particularly simultaneous use of two substances.

In this paper, the most recent findings on dominant patterns of

adolescent drug use, which are provided by the two, series of crosssectional national surveys, will be discussed in terms of the following topic areas: (1) the sequence of first use of various drugs;

(2) stages of involvement with marijuana, including the entry into

marijuana use, the importance of the opportunity factor, the continuation of marijuana use, and later stages of involvement with this

drug; (3) stages of involvement with stronger drugs;2 and (4) the

consequences of marijuana use. A final section addresses questions

of diversity, that is, the extent to which the experience of various

adolescent population groups diverges from the dominant patterns

observed in the national studies.

The survey of high school seniors is conducted by the Institute for

Social Research at the University of Michigan, while the survey of

the household population is jointly conducted by the Social Research

Group of the George Washington University and Response Analysis

Corporation. Both surveys provide data on current patterns of use

and past experience for a broad spectrum of substances, including

26
marijuana/hashish, cocaine, hallucinogens such as LSD and PCP, and

the nonmedical use of psychotherapeutic drugs available by prescription. The most recent survey in each series was conducted in 1979.

The instruments used in the two studies have achieved a high degree

of comparability; while one is administered in the schools and the

other is administered in the home, the results are strikingly similar.3

The two sample surveys (both of which are funded by the National

Institute on Drug Abuse) represent the vast majority of the total

population of adolescents aged 13 to 21; however, certain population

groups are, by definition, excluded from each study: The national

survey of high school seniors excludes high school dropouts, while

the national survey of the household population excludes older

adolescents (aged 18 to 21) who have joined the armed forces or who

reside in college dorms.4 Both surveys also exclude certain fringe

groups such as youths who are institutionalized, as well as older

adolescents who have transient lifestyles and lack a fixed address.

The most recent findings of the survey of high school seniors are

provided in a report of Highlights of the 1979 study (Johnston et

al. 1979). A canprehensive report of prevalent rates from the 1979

household survey is provided by Fishburne et al. (1980) and in separate

volumes of detailed tabulations (Response Analysis 1980); a series

of papers based on special analyses of the data from the household

population survey is presented in a forthcoming volume (Rittenhouse);

in press); and a Highlights report (Miller and Cisin 1980) summarizes

and a Highlights report (Miller and Cisin 1980) summarizes

form the basis of the discussion of dominant patterns of adolescent

drug use, which is organized around the stages-f-drug-use conceptualization suggest& by earlier longitudinal studies.

THE HIERARCHY OF DRUG CLASSES

Recent reports of the order in which young persons recall having first

used various drugs confirm earlier results based on scalogram analysis

(Single et al. 1974; Loiselle and Whitehead 1971) and those of longitudinal studies (Kandel and Faust 1975; Kandel et al. 1978). The

use of alcohol and cigarettes typically precedes the first marijuana

experience (Rittenhouse, unpublished). About half of those who try

marijuana (and/or hashish) in the teen years eventually use stronger

drugs such as cocaine and hallucinogens-although this progression

is often delayed, and in many cases does not occur until young adulthood. Those who begin marijuana use at earlier ages are more likely

than others to progress to the use of these stronger drugs (Harrell

and Wirtz, in press). When the stronger drug list is extended to

include stimulants, sedatives, and tranquilizers, correlational data

indicate that the proportion of older adolescent marijuana users who

report experience with other illicit drugs increases to a clear

majority (Johnston et al. 1979).

27
The first use of marijuana typically occurs prior to the senior year

of high school, often between the ages of 14 and 17; by contrast,

the first use of stronger drugs such as cocaine and hallucinogens is

most likely to take place in late adolescence (Johnston et al. 1979;

Fishburne et al. 1980). Thus, very different lifetime prevalence

levels are observed for the various adolescent groups: less than 10

percent of all 12- to 13-year-olds have ever used marijuana, but the

rate increases to about 30 percent for 14- and 15-year-olds, to about

50 percent for 16- and 17-year-olds, then to 60 percent for high

school seniors, and to almost 70 percent for the 18 to 21 age group

(Fishburne et al. 1980; Johnston et al. 1979). Similarly, less than

10 percent of all youths aged 12 to 17 have ever experimented with

drugs such as cocaine and LSD, but the rate is close to one-third for

18 to 21-year-olds (Fishburne et al. 1980; Response Analysis 1980).

STAGES OF ON CONTACT AND INVOLVEMENT WITH MARIJUANA

Beginning Marijuana Use

The importance of opportunity as an antecedent to first marijuana use

is suggested by a comparison of the opportunity and lifetime prevalence

rates for various adolescent age groups shown in table 1. Clearly,

during the early adolescent years, lack of opportunity represents an

effective barrier to beginning drug use; the large majority of 12-

and 13-year-olds have never had the chance to try marijuana, and,

indeed, less than 10 percent of this age group has ever used this

drug. But by the later adolescent years, opportunities to try marijuana are widespread and the majority have used it. Thus, the opportunity factor explains much--but not all--of the difference in the

lifetime prevalence rates observed for various adolescent age groups.

As may be deduced from table 1, the older adolescent age groups are

more likely to have taken advantage of the chance to try marijuana.

However, the earlier in life the first marijuana opportunity occurs,

the more likely it is that the individual will eventually try the drug

(Somerville and Miller, forthcoming); when this result is considered

with the previously noted finding of early marijuana use as predictive

of eventual progression to stronger drugs, the importance of early

contact with drugs for subsequent stages of involvement seems clear.

Interestingly, few young persons in any age group take advantage of

their first chance to try marijuana--even when fairly long-term

acquaintance with a user precedes the first opportunity experience

(Somerville and Miller, forthcoming). The usual time lapses or time

lags across first acquaintance with a marijuana user, first opportunity and first use, suggest that few young persons seek out the

chance to try marijuana, that many are at first hesitant to begin

use, and that repeated opportunities account for the fact that the

substantial majority of those youths who are exposed to marijuana

opportunity eventually try the drug.

28
Table 1

Marijuana Opportunity and Lifetime Prevalence Rates,

by Adolescent Age Croups (1979 data)a

12-13 14-15 16-17 18-21

(671) (721) (773) (1,016)

Percent who have the

chance to try marijuana 20% 51% 69% 83%

Percent who have ever

used marijuana 8% 32% 51% 69%

a

 Based on Fishburne et al. (1980) and Response Analysis (1980).

Continuing Marijuana Use

In earlier years, lack of availability my have constituted a barrier

to continuing marijuana use, but this is not the case today--at least

not in the older adolescent age groups. The survey of high school

seniors indicates that marijuana is almost universally available:

90 percent of the respondents to this survey said that marijuana would

be fairly easy or very easy for them to obtain (Johnston et al. 1979).

Few young persons can be characterized as one- or two-time experimental

marijuana users. While 60 percent of high school seniors report experience with marijuana, less than 10 percent say they have used it on

only one or two occasions; indeed, almost one-half of the high school

seniors who ever tried marijuana say they have used it 40 or more

times (Johnston et al. 1979). Similarly, in the 18 to 21 age group,

use on 100 or more occasions is three times as likely as one- or

two-time use. Even among youths aged 12 to 17, only one-fourth of

the ever-users say that their experience has been limited to one- or

two-time use; a similar number have used marijuana on 100 or more

occasions. More than one-half of all adolescents who ever tried this

drug are current users, i.e., reported use during the month prior to

interview (Johnston et al. 1979; Fishburne et al. 1980). Thus, it

seems clear that once in young person tries marijuana, he or she is

likely to repeat the behavior and to continue use during the adolescent years.

Tabulations showing current use rates among 18- to 25-year-olds by

their recalled age at first use (Response Analysis 1980) indicate

that those who began use earlier in life are more likely to be current

users; thus, the earlier the age at the first use of marijuana, the

more likely the young person is to continue use through the young

adult years. Again, the importance of the onset of the drug use

career is emphasized.

29
Finally, it should be noted that almost all current marijuana users

are also current alcohol users; indeed, among 18- to 25-year-olds

who are current users of both drugs, the number of days on which

alcohol was used during the month prior to interview correlates with

the number of days on which marijuana was used (Miller and Cisin

1980). Thus, continuing marijuana users are also continuing alcohol

users, and the simultaneous or combined use of these substances

clearly deserves investigation.

Later Stages of Involvement with Marijuana

Turning to heavier patterns of marijuana consumption, how likely is

it that a young person will use this drug on a daily or near-daily

basis? While no data are available on the number of youths who ever

used marijuana on a daily or near-daily basis, both major surveys

indicate that among current marijuana users in the adolescent age

range, about one-fourth or more (depending on age) used this drug on

at least 20 days or occasions during the month prior to interview:

17 percent of all youths aged 12 to 17 are past-month users and 4

percent of this entire age group reports use on at least 20 days

during the month prior to interview (Miller and Cisin 1980). Johnston reports that 36.5 percent of all high school seniors are current

users, and that 10.3 percent of this high school class used marijuana

on 20 or more occasions during the preceding 30 days. The corresponding figures for 18- to 21-year-olds, reported by Response Analysis

(1980), are 40 percent (current use) and 12 percent (daily or neardaily use).

How often do youths discontinue the use of this drug? Quitting, or

discontinuation of marijuana use, appears to be an unlikely outcome--

at least until the adolescent years are past. Focusing on 12- to

17-year-olds who had first used marijuana more than 6 months prior

to interview and who had used the drug on more than 10 occasions,

Parry and Cisin (forthcoming) found that only about 10 percent of this

user group reported no use during the past 6 months. Discontinuation

of use is somewhat more likely in the years that follow adolescence

if the young person marries and forms a family of his/her own.

STAGES OF INVOLVENENT WITH STRONGER DRUGS

Patterns of beginning use of stronger drugs are similar to those discussed for the entry to marijuana use: Acquaintance with a cocaine

or hallucinogen user precedes the young person's first opportunity

to use one of these drugs. Few take advantage of their first chance

to use either of these drugs, but many eventually try one or both--

although the tendency eventually to try these substances is not as

strong as the tendency to use marijuana (Somerville and Miller, in

press). Stronger drug opportunity typically occurs subsequent to

marijuana opportunity but may precede marijuana use; nonetheless,

the decision to use a stronger drug is typically delayed until after

marijuana has been tried.

Once a stronger drug has been used, continued use is less likely than

was the case for marijuana. While the figures vary depending on the

30
specific drug and the specific age group in question, it is clear both

that experimental one- or two-time use is a more likely outcome for

stronger drugs than for marijuana, and that current use, considered

as a proportion of ever use, is lower for stronger drugs than for

marijuana. Yet, one-third or more of the older adolescents who have

ever tried cocaine report current use; e.g., 15 percent of high school

seniors have tried cocaine and 6 percent of this high school class

report current use (Johnston et al. 1979). Almost all current users

of stronger drugs also report current use of both marijuana (Miller

and Cisin 1980) and alcohol (Response Analysis 1980).

Among current users of stronger drugs, daily or near-daily use is rare

(Response Analysis 1980; Johnston et al. 1979). As Johnston notes:

Less than 1% of the respondents report daily use of

any of the illicit drugs other than marijuana. Still

0.6% report unsupervised daily use of amphetamines,

and the comparable figure for cocaine and hallucinogens

...now stands at 0.2%. While very low, these figures

are not inconsequential considering that 1% of each

high school class represents over 30,000 individuals.

(Johnston et al. 1979, p. 15)

Discontinuing use of stronger drugs has not yet been examined, in part

because of the relatively small numbers of adolescent respondents who

have been classifiable as continuing stronger drug users.

CONSEQUENCES OF MARIJUANA USE

Given that so many young persons not only try marijuana, but also

continue the use of this drug--in some cases on a daily or near-daily

basis--the consequences of marijuana use are of increasing concern.

Some current survey data are available on the perceived consequences

of use among 18- to 25-year-olds, i.e., older adolescents and young

adults. These data are limited to two selected consequence areas:

impaired driving ability and the loss of motivation. Reports of

experience with these adverse effects of marijuana are most likely

among young adults who have used the drug on 100 or more occasions:

50 percent of these most experienced users say they performed less

well when driving "shortly after getting really high," and 30 percent

reported that at one time they "stopped caring and didn't try as hard"

because of steady or daily use (Miller and Cisin 1980).

While these data do indicate that large numbers of young persons may

be at risk for negative consequences of drug use, they are limited in

a number of ways. This is particularly evident for the data on the

amotivational syndrome, since the defining phrase, "stopped caring and

didn't try as hard," was not further specified as to duration or

severity of motivation loss, nor as to the perceived seriousness or

ramifications of the experience. Nonetheless, it seems clear that

respondents are willing to admit that they have experienced negative

outcomes of marijuana use, and further investigations along these

lines would seem justified.

31
The dominant patterns of drug use among adolescents today may be

summarized as follows: alcohol use precedes marijuana use, which,

in turn, is a prerequisite for stronger drug use. As children

progress through the teen years, they are increasingly likely to

experience opportunities to use marijuana. Though teenagers are at

first hesitant to use the drug, the majority of those who have the

chance eventually do try it. Once marijuana has been tried, there

is a strong tendency to continue the use of this drug (as well as

alcohol) throughout the adolescent years. By the senior year of

high school 60 percent have tried marijuana and 37 percent report

current use; more than one-fourth of these current users (10 percent

of the entire senior class) say they consume the drug on a daily or

near-daily basis. By the late teens and early twenties, about half

of those who began with marijuana have gone on to use stronger drugs

such as cocaine and hallucinogens. The continuing user of marijuana

and the stronger drug experimenter or occasional user is likely to

be a young person whose first contact with marijuana occurred at an

early age. Many of the older adolescents who have had extensive

experience with marijuana report adverse effects of use, but an

assessment of the seriousness of these consequences must await more

careful definition of item in future studies. These represent the

dominant patterns for the adolescent population as a whole. But

important questions remain regarding the extent of diversity that

may characterize the drug use experience of adolescents in various

cultural groups and in different geographic locations.

DIVERSITY OF EXPERIENCE

The broad view of variation in drug use experience that the national

studies provide indicates an increasing homogeneity across major

demographic groups in the adolescent population. Young white and

nonwhite respondents now report similar levels of marijuana experience

(Fishburne et al. 1980) and the earlier study of young men and drugs

also showed similar levels of drug experience for the younger cohorts

of black and white males (O'Donnell et al. 1976). Trend analyses

indicate that the predictive power of several other demographic

variables has also diminished in the past decade; for example, rural

drug use rates are now catching up with national prevalence levels

(see Harrell and Cisin, 1981, for a special report on rural

drug use). And while prevalence levels are lower in some regions than

in others, the differences are not particularly striking (Miller and

Cisin 1980; Johnston et al. 1979).

Despite the dominant picture of relative homogeneity that the nationwide surveys suggest, there is evidence of considerable diversity,

including the potential for numerous pockets of drug abuse. The

national surveys indicate that boys are still more likely than girls

to be more heavily involved in substance use (Johnston et al. 1979;

Miller and Cisin 1980), and that older adolescents (and young adults)

who have left the parental home to live with friends or roommates

are characterized by extremely high prevalence rates. For example,

90 percent of this group have tried marijuana and 65 percent are

current users (Miller and Cisin 1980). Furthermore, as noted in

the most recent Marijuana and Health report:

32
Nationwide statistics may obscure considerable local

variation. For example, in Maryland and Maine,

where drug surveys were conducted in 1978, higher

levels of daily or near-daily use of marijuana were

found than among high school seniors nationwide (10.7

percent of seniors nationally). In Maryland, use

"daily or several times a week" was reported by a

quarter (25.3 percent) of the twelfth graders....In

Maine nearly one in six high school students reported

daily marijuana use.... (National Institute on Drug

Abuse 1980, p. 5; see also State of Maine 1979; Maryland

Department of Health and Mental Hygiene 1979).

Considerable diversity may also characterize various cultural and

minority groups; for instance, Kandel's study of New York high school

students indicated high drug use rates for American Indian youths

and low rates for Asian-American children (Kandel et al. 1976).

But, while a good deal of information appears to exist on drug use

by members of minority groups (Austin et al. 1978), current knowledge

falls short of adequate epidemiologic description. Neither nationwide

surveys of general population groups nor small studies conducted at

the neighborhood or community level can adequately describe the

experience of minority groups that, although relatively small in

comparison to the total population, may be marked by internal cultural

diversity.

A major research effort has recently been directed toward one such

group. In 1977, 3,000 Native American adolescents from several

tribes located in different regions of the country were surveyed by

Oetting and Goldstein (1978a,b). This large-scale study revealed

considerable diversity across the various tribes and also showed

that, as a whole, Native American children are characterized by

'prevalence rates that are substantially higher than those reported

in national studies, for alcohol, marijuana, various stronger drugs,

and particularly inhalants. In addition to presenting lifetime and

current use prevalence data, the investigators report the prevalence

of various types of drug use patterns. These data suggest that

among Native American youths, stages of experimentation and involvement are similar to the dominant patterns observed at the national

level; the primary difference seems to be that at each stage Indian

children are at higher risk of progressing to further drug involvement.

In sum, an increasing homogeneity characterizes the experience of

major adolescent population groups; dominant patterns described in

detail by national surveys indicate the importance of the earliest

drug experiences and document high levels of risk for the typical

young person today. But even higher risks obtain for certain identifiable population groups. Some pockets of drug abuse can be identified in nationwide research efforts; for instance, the exceedingly

high prevalence levels observed for older adolescents who have substituted peer-group living for the daily influence of family life.

However, the full extent of diversity cannot be portrayed by studies

with a national focus. Statewide surveys and the study of Native

33
American youths indicate that fairly large-scale studies directed at

smaller populations are necessary to uncover concentrations of drug

use in certain adolescent populations.

Finally, the adolescent groups that are by definition excluded from

the national survey frames deserve special concern, since there is

reason to believe that high school drop-outs, young members of the

armed forces, and residents of college dormitories may be characterized

by higher levels of involvement with drugs than their same-age peers

who are routinely surveyed.

FUTURE RESEARCH DIRECTIONS

The surveillance function of epidemiologic research continues to be

well served by national studies that describe risk factors for the

majority of the adolescent population. Given the wealth of data

that has now been amassed by the two series of nationwide studies,

important questions concern future research directions. Certainly,

large populations that are ordinarily excluded from national survey

frames deserve separate study. Two other research directions should

also be considered: First, data that already exist could be further

mined to increase our knowledge of drug use in certain population

groups. For instance, each year the survey of the household population includes a relatively small number of high school drop-outs; by

pooling data across recent survey years, it would be possible to

obtain reasonably reliable information on this under-studied population group. Second, in planning future national studies, it might

be advisable each year to select a special alternative population

group for oversampling sufficient to allow separate analysis and to

identify pockets of drug abuse that deserve further investigation in

specially designed research efforts.

Thus, the mass of data that has been gathered in successive waves by

the two national surveys should be subjected to further analysis, and

future waves of such studies can be made more sensitive to detecting

pockets of drug abuse in special adolescent population groups. In

considering separate studies of special groups, priority should be

given to those groups of young persons who are by definition excluded

from the national surveys--and for whom we have almost no data at

the present time.

FOOTNOTES

1

 This review covers general epidemiology and is based on survey

research. Information on treated prevalence and officially identified cases is provided by two information systems maintained by

the National Institute on Drug Abuse: CODAP (the Client Oriented

Data Acquisition Process) and DAWN (the Drug Abuse Warning Network).

See National Institute on Drug Abuse, 1979a,b.

34
2

 Because of the small numbers of adolescent survey respondents who

report heroin use (e.g., 1.1 percent of high school seniors say

they have tried heroin and 0.2 percent report past-month use;

Johnston et al. 1979), the discussion of stronger drug use will

omit specific reference to heroin.

3

 Methods of sampling and response rates are described by Fishburne

et al. (1980) and Johnston et al. (1979). Briefly, the national

survey of the household population is based on a stratified random

sample selected in several stages, including selection of 111

primary geographic areas, 500 smaller areas, specific households,

and random selection of respondents from within designated households; the response rate for 12- to 17-year-olds was 86 percent,

while the response rate for 18- to 25-year-olds was 84 percent.

Overall, 2,165 youths aged 12 to 17 participated in the 1979 study,

as did 1,016 18- to 21-year-olds (Fishburne et al. 1980). About

125 to 130 public and private schools participate in the national

survey of high school seniors. Normally, between 66 and 88 percent

of the schools originally designated agree to participate; for

each refusal, a similar, replacement school is recruited. About

30 percent of all sampled students complete the questionnaire,

with absences from class being the chief reason for nonresponse.

Altogether, 15,500 high school seniors completed the 1979 questionnaire (Johnston et al. 1979).

4

 In recent years, between 15 and 20 percent of each age cohort has

dropped out of high school before graduation (Johnston et al. 1979);

and, of those who completed the senior year in 1972, about 80 percent were living in households 2-1/2 years later, i.e., in the fall

of 1974, while about 15 percent were residing in college dormitories

or fraternity/sorority houses, and about 3 percent resided in military accommodations (Peng and Holt 1977). These figures are provided to give the reader a rough idea of the size of the excluded

groups.

A worldwide survey of alcohol and drug abuse among members of the

armed forces has recently been carried out by Burt Associates

under the sponsorship of the Department of Defense; results have

not yet been made available by DOD. While a number of surveys of

college students were conducted circa 1970 (e.g., Groves 1974),

these have not been recently replicated.

5

 Whether cocaine use precedes hallucinogen use or vice versa appears

to depend on the historical time when the young person's move from

marijuana to one of these stronger drugs occurred. In earlier

years, hallucinogens apparently preceded cocaine, but in recent

years, cocaine is increasingly used prior to a hallucinogen.

6

 The authors note, "Since the sample is fortuitous rather than specifically planned to represent all adolescents living on reservations, any comparisons should be treated with caution. The age

balance, however, is fairly close to that of the most recent national

survey, and the geographic distribution is quite wide. The results

are, at a minimum, suggestive of a severe drug use problem for

this minority group." (Oetting and Goldstein 1978a, p. 11)

35
Austin, G.A., Johnson, B.D., Carroll, E.E., and Lettieri, D.J., eds.

Drugs and Minorities, National Institute on Drug Abuse Research Issues

21. DHHS Pub. No. (ADM)78-507. Washington, D.C.: Supt. of Docs.,

U.S. Govt. Print. Off., 1978.

Bunce, R. Use of drug combinations involving alcohol. Paper prepared

for the National Institute on Drug Abuse and the National Institute

on Alcohol Abuse and Alcoholic. Berkeley, California: Social

Research Group, School of Public Health, UC-Berkeley, 1977.

Cisin, I.H. Critique. In: Rittenhouse, J.D., ed. Consequences of

Alcohol and Marijuana Use. National Institute on Drug Abuse. DHHS

Pub. No. (ADM)80-920. Washington, D.C.: Supt. of Docs., U.S. Govt.

Print. Off., 1979. pp. 207-211.

Fishburne, P.M., Abelson, H.I., and Cisin, I.H. National Survey on

Drug Abuse: Main Findings 1979. National Institute on Drug Abuse.

DHHS Pub. No.(ADM) 80-976. Washington, D.C.: Supt. of Docs., U.S.

Govt. Print. Off., 1980.

Groves, W.E. Patterns of college student drug use and lifestyles.

In: Josephson, E., and Carroll, E., eds. Drug Use: Epidemiological

and Sociological Approaches.

Corp., 1974.

Washington, D.C.: Hemisphere Pub.

Harrell, A.V., and Cisin, I.H. Drug Abuse in Rural America. National

Institute on Drug Abuse. DHHS Pub. (ADM)81-1050. Washington, D.C.:

supt. of Docs., U.S. Govt. Print. Off., 1981.

Harrell, A.V., and Wirtz, P.W. Developmental sequences of illicit

drug use. In: Rittenhcuse, J.D., ed. National Survey on Drug Abuse

During the Seventies: A Social Analysis. Rockville, Maryland:

National Institute on Drug Abuse, forthcoming.

Johnston, L.D., Bachman, J.G., and O'Malley, P.M. 1979 Highlights:

Drugs and the Nation's High School Students, Five Year Trends.

National Institute on Drug Abuse. DHHS Pub. No. (ADM)79-930. Washington, D.C.: supt. of Docs., U.S. Govt. Print. Off., 1979.

Kandel, D.B. Convergences in prospective longitudinal surveys of drug

use in normal populations. In: Kandel, D.B., ed. Longitudinal

Research on Drug Use: Empirical Findings and Methodological Issues.

Washington, D.C.: Hemisphere Press-John Wiley, 1978.

Kandel, D.B. Drug and drinking behavior among youth. In: Coleman,

J., Ikeles, A., and Smelser, N., eds. Annual Review of Sociology.

Vol. 6. 1980. pp. 235-285.

Kandel, D.B., and Faust, R. Sequences and stages in patterns of

adolescent drug use. Arch Gen Psychiatry, 32:923-932, 1975.

36
Kandel, D.B., Kessler, R.C., and Margulies, R. Adolescent initiation

into stages of drug use: A developmental analysis. In: Kandel,

D.B., ed. Longitudinal Research in Drug Use: Empirical Findings

and Methodological Issues. Washington, D.C.: Hemisphere-Wiley,

1978. pp. 73-90.

Kandel, D.B., Single, E., and Kessler, R.C. Epidemiology of drug use

among New York State high school students: Distribution, trends,

and change in rates of use. Am J Public Health 66:43-53, 1976.

Kessler, R.C., Paton, S.M., and Kandel, D.B. Reconciling unidimensional and multidimensional models of patterns of drug use. J Stud

Alcohol, 37(5):632-647, 1976.

Loiselle, P., and Whitehead, P.C. Scaling drug use. An examination

of popular wisdom. Can J Behav Sci, 3:347-356, 1971.

Maryland Department of Health and Mental Hygiene, Drug Abuse Administration. 1978 Survey of Drug Abuse Among Adolescents--General

Report. Annapolis, MD: March 1979.

Miller, J.D., and Cisin, I.H. Highlights from the National Survey on

Drug Abuse: 1979. National Institute on Drug Abuse. DHHS Pub. No,

(ADM)80-1032. Washington, D.C.: Supt. of Docs., U.S. Govt. Print.

Off., 1980.

National Institute on Drug Abuse. Marijuana and Health Eighth Annual

Report to the U.S. Congress. DHHS Pub. No. (ADM)80-945. Washington,

D.C.: supt. of Docs., U.S. Govt. Print. Off., 1980.

National Institute on Drug Abuse. Data from the Drug Abuse Warning

Network (DAWN), Quarterly Report, January-March 1979. Statistical

Series G, No. 1. DHHS Pub. No. (ADM)80-913. Rockville, Maryland:

National Institute on Drug Abuse, 1979a.

National Institute on Drug Abuse. Data from the Client Oriented Data

Acquisition Process (CODAP). Statistical D, No. 13, OctoberDecember, 1979. DHHS Pub. No. (ADM)80-906. Rockville, Maryland:

National Institute on Drug Abuse, 1979b.

O'Donnell, J.A., Voss, H.L., Clayton, R.R., Slatin, G.T., and Room,

R.G. Young Men and Drugs--A Nationwide Survey, National Institute

on Drug Abuse Research Monograph 5. DHHS Pub. No. (ADM)76-311.

Washington, D.C.: Supt. of Docs., U.S. Govt. Print. Off., 1976.

Oetting, E.R., and Goldstein, G.S. Native American Drug Use. Ft.

Collins, Colorado: Western Behavioral Studies, Department of

Psychology, Colorado State University, 1978a.

Oetting, E.R., and Goldstein, G.S. Sample report to tribes. Native

American Drug Use, Appendix A. Ft. Collins, Colorado: Western

Behavioral Studies, Department of Psychology, Colorado State University, 1978b.

37
Parry, H.J., and Cisin, I.H. Discontinuing marijuana use. In:

Rittenhouse, J.D., ed. National Survey on Drug Abuse During the

Seventies: A Social Analysis. Rockville, Maryland: National

Institute on Drug Abuse, forthcoming.

Peng, S.S., and Holt, M.M. National Longitudinal Study: Tabulation

Summary of the Second Follow-Up Questionnaire Data, 2-1/2 Years After

High School, Vol. 1. Washington, D.C.: National Center Educational Statistics, 1977.

Response Analysis. Detailed Tabulations of the 1979 National Survey

on Drug Abuse. Princeton, NJ: Response Analysis Corporation, 1980.

Rittenhouse, J.D. Learning drug use: From legal substances to marijuana and beyond. paper presented at the American psychological

Association Annual Convention, Montreal, September 1980, unpublished.

Rittenhouse, J.D., ed. National Survey on Drug Abuse During the

Seventies: A Social Analysis. Rockville, Maryland: National

Institute on Drug Abuse, forthcaning.

Single, E., Kandel, D., and Faust, R. patterns of multiple drug use

in high school. J Health Soc Behav, 15(4):344-357, 1974.

State of Maine, Department of Human Services, Office of Alcoholism and

Drug Abuse prevention. An Evaluation of the Decriminalization of

Marijuana in Maine. January 1979.

Somerville, S.N., and Miller, J.D. Opportunity and decision: An

analysis of drug use entry. In: Rittenhouse, J.D., ed. National

Survey on Drug Abuse During the Seventies: A Social Analysis.

Rockville, Maryland: National Institute on Drug Abuse, forthcoming.

AUTHOR

Judith Droitcour Miller, M.A.

Social Research Group

The George Washington University

2401 Virginia Avenue, N.W.

Washington, D.C. 20037

38
Personality and

Sociodemographic Factors in

Adolescent Drug Use

Kelin E. Gersick, Ph.D., Katherine Grady, Ph.D., Elizabeth

Sexton, A.C.S.W., and Michael Lyons, Ph.D.

Various theories on adolescent drug abuse have moved in and out of

favor over the past 30 years as society's perspectives on youth and

human behavior in general have varied. This paper reviews recent

work in two areas that at different times have generated large amounts

of research interest: sociodemographic and personality correlates

of drug use in adolescence. Each of these areas has been characterized by a consensus in earlier work on variables deserving attention, and by a need to rethink many earlier findings in light of new

findings on changing drug use patterns in recent years. This paper

will discuss a selection of representative studies that illustrates

the most commonly investigated variables, and will suggest some new

directions that deserve special emphasis. In addition the paper

will highlight sane implications of work in these areas for prevention efforts.

PERSONALITY FACTORS

Personality research has had a long and uneven history in relation

to adolescent drug abuse. The search for drug-using types, more

common in research done before the late 1960's (summarized in Sadava

1975), gave way to cross-sectional studies of correlations between

drug use frequency and scores on standardized personality inventories.

These studies vary in the degree to which they control for multiple

levels of drug use, demographic variables, and general sociocultural

factors. While some consistent tendencies have emerged, contradictory results have been very common, and the percentage of variance

explained by the measured personality variables has characteristically

been disappointingly low.

Psychoanalytic and depth-psychological theorists have continued to

offer psychodynamic models for drug use, including deficits in ego

functioning (Arnini et al. 1976; Naditch 1976), guilt mechanisms

(Evans et al. 1978), oral-dependent personality structures (Zinberg

1975), and defense mechanisms (Zimmering et al. 1952). However,

most of the recent work has broadened the scope of psychoanalytic

explorations to include more general developmental issues (Greenspan

1977), and to emphasize the need to consider social factors along

with psychodynamic factors (Blaine and Julius 1977; Chein et al. 1964).

39
Some writers, including Zinberg (1975), have gone so far as to argue

that there has been too much emphasis on personality in the face of

contradictory evidence, and the focus should shift to what psychodynamics have to add to social dynamics.

Certain personality characteristics have consistently received

attention from researchers across orientations and methods. These

are discussed below.

Conformity to Societal Values

The single personality dimension that has emerged most often from

research in the past decade has been the orientation characterized

as conformity to societal values, traditionality, or, conversely,

rebelliousness (Cunningham et al. 19774; Goldstein and Sappington 1977;

Simon 1974; Loper et al. 1973; Hogan et al. 1970; Smith and Fogg 1978;

Green 1979). Increased drug use or earlier onset of drug use has

been found to be correlated with nonconformity to traditional values

(Gorsuch and Butler 1976; Kay et al. 1978; Weckowicz and Janssen 1973;

Jessor and Jessor 1977; Knecht et al. 1972); lack of support for

traditional social structures (Knight et al. 1974); high tolerance

of deviance (Brook et al. 1977; Jessor 1976; Jessor and Jessor 1975);

high resistance to traditional authority (Goldstein and Sappington

1977); and high need for independence or autonomy (Simon 1974;

Jessor 1976; Segal 1975, 1977; Simon et al. 1974).

In addition, other variables indicating a lack of commitment to traditional noms and institutions have been found to be related to drug

use. Knight et al. (1974) found that adolescents scoring high on drug

use item were also high on social alienation but not on personal

alienation, and Paton and Kandel (1978) report high normlessness in

this group. More liberal or radical political orientation has been

found to correlate with drug use behavior of high school students

(Kohn and Annis 1978; Krug and Henry 1976). For variables such as

these in particular, part of the variability in results appears to

be related to the age of the subject sample. Studies on junior high

and high school-age youth find more emphasis on rebelliousness,

deviance, and rejection of traditional authority (Spevack and Pihl

1976; Smith and Fogg 1978), while studies of college-age youth focus

more on independence (Cunningham et al. 1974).

Self-Esteem

Low self-esteem was one of the first and most consistently suggested

personality correlates of drug use (Steffenhagen 1977). However,

cross-sectional studies characteristically find weak or partial

correlations between lower self-esteem and various categories of

drug use (Ferguson et al. 1977; Ahlgren and Norem-Hebeisen 1979;

Norem-Hebeisen 1976). Longitudinal studies show mixed results on the

value of self-esteem as a predictor of subsequent drug use (Paton and

Kandel 1978; Jessor and Jessor 1978; Smith and Fogg 1978; Kandel

1978a,b). Kaplan (1977, 1978) has published some of the most recent

work in this area, investigating the relationships among sociodemographic and self-concept variables in relation to deviant behavior.

40
Aside from these studies, there has been surprisingly little research

published in the last 6 years that directly assesses the predictive or

correlative power of self-esteem on adolescent drug use. One affective

measure that may be related, depressive mood, has been consistently

found to be an important variable in Paton and Kandel's longitudinal

work (Paton et al. 1977; Paton and Kandel 1978).

Locus of Control

This variable was also hypothesized as a key discriminator of drug

use, and is still defend& as a useful construct despite much nonsupportive literature (Plumb et al. 1976). There has been some evidence

of a relationship between external control and drug use, but recent

research has shown weak and conflicting results (Carman 1977; Brook

et al. 1977; Smithyman et al. 1974; Jessor and Jessor 1977).

Sensation-Seeking

There has been some consistency in finding higher sensation-seeking

and need for stimulation in drug users (Gorsuch and Butler 1976;

Segal 1976). Recent studies find associations between sensationseeking and other variables such as alcohol use (Schwarz et al.

1978) and positive attitudes toward marijuana use (Kohn and Annis

1978). This construct has suffered in particular from poor operationalization and weak construct definition and has been given less

attention in research in recent years.

Psychopathology

The preponderance of correlational studies has failed to find evidence

of gross pathology in samples of drug users as compared to nonusers

(Stokes 1974; Davis 1977-1978; Naditch 1976). Loper et al. found

no identifiable pathology in MMPI scores of college freshmen who later

became alcoholics (1973). Work with younger students has been more

mixed, with some indications of pathology correlating with illegal

drug abuse (Anhalt and Klein 1976). Studies of precursors to heroin

use show a tendency for more pathological or deviant behavior patterns

(Crawford 1978), but few studies address this issue with the kind of

samples that support generalization.

In recent years, most research on personality factors in adolescent

drug use has focused on marijuana users, drawing primarily from

college-age samples. The results of this work have often presented

a dilemma to the researchers. Overall, the findings of research in

the last 6 to 10 years have begun to present a different picture of

the personality characteristics of marijuana users than had been

assumed in much of the earlier writing. Hogan et al. (1970) described frequent users as " ...characterized by high scores on Capacity

for Status, Social Presence, and Flexibility. Such persons tend to

be self-confident, socially poised, skilled in interpersonal relations,

and possess a wide range of interests. On the other hand, they also

tend toward narcissism, self-aggrandizement, and overconcern with

personal pleasure and diversion" (p. 61). While not ideal, both

41

388-024 0 - 82 - 4
aspects of that description fit well the mainstream personality

style reflected continually in the media and commerce of our culture.

Other researchers report marijuana-user profiles such as flexible,

independent, and open to new experiences (Segal 1977); intellectually

more effective, trusting, confident, and with greater ego strengths

(Green and Haymes 1973); socially skillful, adventurous, impulsive,

and resistant to authority (Goldstein and Sappington 1977); scoring

higher on cognitive development, asthetic sensitivity, and high on

consideration (Weckowicz and Janssen 1973); high on developmental

maturity (Jessor and Jessor 1978); spontaneous and adventurous (Kay

et al. 1978); and with evidence of lower distress (Ginsberg and

Greenley 1978). At the same time nonusers, in some cases "principled"

or "adamant" nonusers, are described as higher on responsibility and

lower on ascendancy (Gulas and King 1976); higher on deference, order,

and endurance (Simon et al. 1974); submissive, lacking self-insight,

dependent on external structure, judgmental (Green and Haymes 1973);

and less skilled, reserved, compliant, compulsive, and better adjusted

(Goldstein and Sappington 1977).

These are not the only points of view. Braucht et al. (1973), summarizing results from research primarily conducted earlier in the 1960's,

found conflicting data concerning marijuana use, and a generally

negative set of personality characteristics correlated with alcohol

and narcotic use. They conclude that "The widespread use of unrepresentative, uncontrolled subject samples and mall-sample observational data make it difficult to delineate the salient personality

correlates of adolescent drug use" (p. 102). Longitudinal studies

focusing on prediction of onset of drug use also showed mixed results.

Smith and Fogg (1978) present an impressive array of negative personality variables predicting drug use. Other studies, including

Jessor and Jessor (1978), Ginsberg and Greenley (1978), and Kandel

et al. (1978) do not find important negative personality predictors.

The most reasonable conclusion appears to be that for college-age

samples at least, prevalence of marijuana use has become so widespread

that negative personality correlates differentiating users from nonusers are no longer found (Gorsuch and Butler 1976; McCann et al.

1977; Green and Haymes 1973). For younger adolescents, the pattern

may be different. Especially for very early marijuana and other

illicit drug users, personality variables my still arise as important

differentiators in the early teens between those who seek out the

earliest possible drug use experience and those who defer it.

In summary concerning the personality variables: Data on personality

factors in adolescent drug use are considerably more equivocal than

is generally acknowledged. Cross-sectional studies have not reached a

high degree of consensus on significant effects of personality factors

beyond a general rebelliousness/conformity-to-traditional-values dimension, and it is not clear in what ways the results oh this factor represent maladjustment. Concerning marijuana, researchers argue that normative behavior among the college-age population has shifted from nonuse

or experimentation to moderate use. In particular, many correlational

studies reflect this shift, as personality variables demonstrate a

42
weakening ability to discriminate marijuana-using subgroups. There

remains only limited data with which to update our understanding of

personality correlates as predictors for use of most other drugs,

including alcohol, barbiturates, the hallucinogens, and the opiates.

SOCIODEMOGRAPHIC FACTORS

In recent research, sociodemographic factors are rarely the central

variables of interest. Current findings on the relationship between

demographic variables and adolescent drug use cane either from epidemiological survey efforts (Beschner and Friedman 1979; Dunnette, n.d.;

Miller 1976), or as control variables in cross-sectional and longitudinal studies. Overall, the past decade has witnessed some improvement in the methodology and specification of sociodemographic research,

but there has been only mixed success at integrating demographic

results into useful theoretical frameworks.

Recent sociodemographic findings are discussed in the following

sections.

Age

It has been generally found that experimentation with licit and illicit drugs begins at or near the early teens, peaks differentially for

different drugs throughout the teen years, and begins to recede by

the mid 20's (Sorosiak et al. 1976; Carlisi 1979; Curtis and Simpson

1977; Green 1979; Kandel 1978a,b). There is some evidence that the

age of onset for marijuana use overall is decreasing (Kaplan et al.

1978); on the other hand, McCoy et al. (1979) found that the age at

initial use of heroin was increasing. Freeman and Freeman (1977)

found that awareness of drugs and drug terms occurs early in elementary school.

Sex

Recent work presents evidence that sex differences in the prevalence

of adolescent drug use in general are disappearing or have already

disappeared (Tolone and Dermott 1975; Galchus and Galchus 1977-1978;

Kirk 1979; Hanson 1977; Becker 1977; Eichberg and Bentler 1976).

Other studies, especially those focusing on drugs other than mari- '

juana, have found differential patterns and sequences of drug use

"careers" for males and females (Brunswick 1979). In general the

studies that have found different patterns have identified a more

psychodynamic, family-oriented, and interpersonal style for females

in contrast to a more subcultural, deviance-oriented etiology for

males (Miller 1976; Klinge et al. 1976; Margulies et al. 1977;

Beschner and Treasure 1979). However, most researchers now argue

that for intervention purposes, the gender differences are too

small and subtle to justify differential interpretations or program

design.

43
Socioeconomic Status

The traditional view that marijuana users cane from higher socioeconomic backgrounds (Cunningham et al. 1974; Eichberg and Bentler

1975), has received less support in the most recent studies (Green

1979). Spevack and Pihl, in their review (1976), report about equal

numbers of studies confirming and repudiating associations of drug

use with residence SES and parental occupation, for both high school

and college samples. While most often appearing in interaction

effects with other variables, socioeconomic status when standing

alone has not been demonstrated as a powerful correlate or predictor

of drug use (Dembo et al. 1979, 1980; Kandel et al. 1978).

Religion

Two separate factors have commonly been assessed in relation to

religion and drug use: denominational affiliation, and degree of

religiosity. Some studies have found that adolescents who identify

themselves as members of more fundamentalist religions tend to be

underrepresented among drug users (Schlegel and Sanborn 1979),

although not uniformly so (Rathus et al. 1976). One denominational

effect that is specifically mentioned is that Jewish college students

show the highest prevalence of alcohol use but the lowest rate of

heavy drinking (Wechsler and McFadden 1979), interpreted as a result

of that religion's prescriptive rather than proscriptive norms on

alcohol (Braucht et al. 1973).

The more common variable reflecting religion in recent years, and

the construct providing stronger effects, has been religiosity.

Higher scores on religiosity scales or items such as frequency of

church attendance have been consistently correlated with lower

incidence of drug use (Gorsuch and Butler 1976; Margulies et al.

1977; Jessor 1976; Schlegel and Sanborn 1979; Murty 1979; Wechsler

and McFadden 1979).

Level of Academic Achievement

While not a demographic variable in the same way as the other categorical constructs, academic achievement has been studied frequently

as a predictor, correlate, and outcome of adolescent drug use.

Overall findings are inconsistent; some studies find lower levels

of school achievement (usually grade point average) associated with

marijuana use (Simon 1974; Anhalt and Klein 1976; Jessor 1976), while

others find no relationship (McCann et al. 1977; Miranne 1979;

Simon et al. 1974). An important factor in the discrepancy seems

to be age of the sample. Most of the positive findings cane from

junior high school populations, while nonsignificant findings cane

from college populations (Cohen and Santo 1979). Research on opiate

use is less common on this variable because of the heavy reliance

on treatment samples rather than school samples. There is sane

evidence that heroin use is associated with disruptive school

behavior (Rathus et al. 1976), or severe underachievement (Zimmering

et al. 1952).

44
Race and Ethnicity

Research in this area has evolved over the past two decades from a

focus on primarily white/nonwhite distinctions to more complex breakdowns of ethnicity and more differentiated data on subcultural patterns, although many aspects of drug use among minority racial groups

remain infrequently studied (Harper and Dawkins 1976). Many of the

recent studies on marijuana and alcohol use in college samples have

not found significant differences in use patterns among racial groups

(Galchus and Galchus 1977-1978; Poulsen et al. 1978). Dembo et al.

(1979) did not find main effects for ethnic group in their urban junior

high sample, although there were interaction effects with home environment variables. Concerning other drugs, most recent researchers

have found overrepresentation of black, Hispanic, and Native American

subsamples among users of drugs other than marijuana (Galchus and

Galchus 1977-1978; Curtis and Simpson 1977; Padilla et al. 1979;

Iiyama et al. 1976). Studies that include Asian Americans typically

find them underrepresented in most categories (Wechsler and McFadden

1979). There has been some recent work focusing on Native American

populations, once again generally showing overrepresentation in most

use categories (Cockerham 1977; Oetting and Goldstein 1979). Race

and ethnicity frequently show interaction effects with other sociodemographic variables, such as sex (Szapocnik et al. 1979), and sociocultural variables, such as relationship with peers (Kleinman and

Lukoff 1978). Some recent formulations support a somewhat

different pattern of drug use development for black and Hispanic

youth (alcohol to marijuana to heroin and cocaine) than for most

white ethnic groups (alcohol to marijuana to psychedelics and barbiturates to cocaine and heroin) (Brunswick 1979; Kandel 1978a,b).

Iiyama et al. (1976) have compiled a very useful bibliography of

research on race and drug use, including an introductory chapter by

Johnson and Nishi that assesses the applicability and adequacy of

recent theory and research in this area.

In summary, sociodemographic variables have most often emerged as

interesting, but very limited, explanatory factors in both crosssectional (Murty 1979) and longitudinal (Jessor and Jessor 1978;

Kandel 1978a,b) research in recent years. Certain findings do hold

up on the basis of current evidence, including the negative correlation between religiosity and most drug-use measures, and some differences in patterns of drug use over time on the basis of race and

sex. There are some consistent findings or overrepresentation of

sane ethnic or racial groups in certain drug-use samples, particularly the opiates (McCoy et al. 1979). However, overall, current

research supports a movement away from analyses focusing on traditional sociodemographic variables to more integrative theories of

social context (especially peer and family) for both the prediction

and understanding of adolescent drug use (Thomas et al. 1975; Schuman and Polkowski 1975; Bembo and Burgos 1976; Dembo et al 1978,

1980).

45
CONSIDERATIONS FOR THE FUTURE

The authors of these reviews have been asked to include suggestions

for new directions for future work. In the case of personality and

sociodemographic factors, the most interesting findings in recent

research point the way to the most promising areas of investigation.

The developmental perspective, represented by a new attention to longitudinal study, has obviously taken a prominent place in current

research. Some of the most provocative work in the field is specifically addressed to the "career" of drug use behavior and the stages

of adolescent drug use (Kandel 1978a,b; Coombs et al. 1976). The

personality literature now needs to give more attention to the cognitive and character development that parallels these behaviors (Fiddle

1978; Hockhauser 1978; O'Donnell and Clayton 1979). Specific stages

or behaviors have different meanings depending on the age of the

individual. Variables such as chronological age and grade in school

do not capture all of what personality and developmental theory have

to offer to the understanding of adolescent drug use. Issues such

as responses to first opportunity for drug use; interaction patterns

in peer networks; conceptualization of choices, decisionmaking, and

consequences; stress responses; and psychosexual maturation all have

unexplored relevance to the interpretation of drug use behavior.

What is called for is more research that will integrate drug use

behavior into comprehensive views of adolescent maturation and personality development. Of particular value would be research that

can identify adaptive and maladaptive phasing of the different stages

in drug use, cognitive development, moral development, and social

skills.

New Directions for Sociodemographic Factors: The Importance of

Environmental Relativity

It. is probably impossible to overestimate the importance of context

in considerations of psychosocial behaviors such as drug use. An

overview of the demographic research highlights the need for attention to contextual issues, both in terms of subculture and environment, and in terms of historical factors. In addition, the mainstream

of new work in this area has already moved to complex models of peer

and family influence, with obvious contextual implications.

What is needed is increased research on detailed characteristics of

particular social environments at various points in time. This means,

for example, more specific data on differences within racial and

ethnic categories and between neighborhoods, and greater attention to

cohort effects and rapidly changing cultural events. In short, it

suggests a more anthropological perspective on sociodemographic issues.

This kind of work is very complicated and methodologically challenging.

Researchers like Padilla et al. (1979) give examples of how creative

data gathering techniques will be necessary to maintain validity.

Robins (1978) discusses the integration of setting and predisposition,

and demonstrates one way to explore the impact of context on drug use.

46
Other researchers have raised similar issues (Shute 1975; Trice and

Beyer 1977; Dembo et al. 1978; Johnson and Preble 1978; Huba et al.

1979).

One appropriate direction might be to accompany the current longitudinal survey work with more intensive analyses of smaller cohorts,

as suggested by Clausen (1978). As the personality research needs

to become more developmental and less categorical, the sociodemographic research would also benefit from moving away from efforts

to explain variance by assigning individuals to categories, and

focusing strongly oh efforts to understand the meaning of behavior

in specific contexts.

IMPLICATIONS FOR PREVENTION

The trends in recent research in these two areas have sane implications for primary prevention activities. Most of the traditional

personality research leads more naturally to discussions of the

implications for therapy and treatment program design than to designing preventive interventions. The more prevention-minded personality

researchers often point to early identification of high-risk types as

the desired outcome. However, the broad sample personality correlate

research has not isolated the designations of such types that would

be specific and stable enough to guide the design of practical prevention interventions based on personality characteristics.

Concerning marijuana use, based on the data on the changing meaning

of marijuana use in most adolescent networks, the issue of identifying "high risk" personality types for experimentation or occasional

use is clearly beside the point. What would be useful to planners is

more intensive analyses of data from converging sources (as in Smith

and Fogg 1978) seeking the personality attributes that characterize

those adolescents who move out of the mainstream into more seriously

deviant behavior, such as criminal activities and addiction. This

kind of information on different kinds of samples at various points

along the drug use stages might begin to identify more clearly the

leverage points for preventive interventions.

The sociodemographic variables, at their best, provide essential

information for intervention design. Issues of prevalence, characteristics of target populations, and accurate data on changing

patterns of drug use across subgroups are key inputs for prevention

planning. Most of the recent research, however, suggests that traditional sociodemographic variables are not very useful for these

purposes. Sex, SES, religion, rural/urban environment, and to sane

extent even race do not offer consistent direction on differential

exposure to risk among subgroups. Situational variables like drug

availability and characteristics of peer culture consistently provide

more guidance on risk than sociodemographic variables (Smart 1977).

If first-use ages are declining (Kaplan et al. 1978; and others),

then the age at which preventive interventions must take place must

also be adjusted. Many prevention planners have already responded

to this need. However, working with younger populations raises two

47
serious problems for intervention design. First, since so many programs rely on school settings, program developers (as well as

researchers) are faced with shifting their intervention sites from

junior high and high schools to elementary and middle schools. More

difficult community responses, teacher attitudes, and administrative

structures will be major obstacles to this essential shift. Second,

planners and researchers must take into account the developmental

capacity of the children they seek to affect. For example, the

cognitive abilities, comprehension, social behavior, and emotional

development of latency-age children are very different from those of

adolescents. For many programs, moving to younger ages will require

at least extensive revision of content and technique, and some interventions may have to be abandoned because they require cognitive

abilities beyond the capacities of younger children.

Finally, in considering new interventions, there is the need to continue to ask "Prevention of what?" As Goldberg and Myers (1980)

point out, the realities of contemporary youth culture and epidemiological evidence call for a new focus on health promotion and the

prevention of "harmful use," rather than an inflexible approach to

all adolescent drug behavior. This will require more sophisticated

data on the developmental stages of drug use among preadolescents

and adolescents, a more complete understanding of cultural contexts

within which behaviors must be interpreted, and more information on

the lifetime consequences of various adolescent drug use patterns

(Shute 1976; Myer 1976; Dembo et al. 1978; Kandel 1978a,b).

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AUTHORS

Kelin E. Gersick, Ph.D.

Katherine Grady, Ph.D.

Elizabeth Sexton, A.C.S.W.

Michael Lyons, Ph.D.

Department of Psychiatry

Yale University School of Medicine

c/o Consultation Center

19 Howe Street

New Haven, Connecticut 06511

56
From Family to Peer:

Transitions of Influence

Among Drug-Using Youth

Thomas J. Glynn, Ph.D.

There are a growing number of parent groups, in this country and

abroad,1,2 concerned with the use of drugs among children and youth.

These groups raise a number of legitimate questions. The most essential of these questions revolves around a concern with the struggle

for control of adolescent and even preadolescent behavior. Many of

these parents have begun to feel, at least regarding their children's

drug use, that their authority is being undermined by various social

elements. They believe that families no longer have primary control

over their children's behavior, that this control has been eroded by

and passed into the hands of such external elements as the media,

the government, and the peer group. Althoughmany parents may see

the media and the government as the ultimate sources of this erosion

of control, it is with the more proximate and accessible peer group

that most parent groups are primarily concerned (Manatt 1979). They

feel that more can be accomplished by actively attempting to regain

control on a local, more manageable level while continuing to exert

pressure on the more nationally oriented media and government.

'Ibis concern with conflict between parents and peers is, of course,

not new. It is one of the most predictable and, in Western society,

probably least avoidable of developmental conflicts. What is new,

however, is the sharp and specific focus upon the relative influence

of parents and peers-on youthful drug use. This focus upon drug use

is not surprising since this behavior has increased substantially

over the past several years (Johnston et al. 1979, 1980) and attitudes toward drug use provide what is one of the most distinctive

and emotional conflicts between the generations (Kandel 1974a, 1978;

Stone et al. 1979). Yet, as important as this issue has became, there

conflicting evidence and assumptions remain concerning the nature

of parent and peer influence on drug use. The purpose of this paper,

then, is to 1) review the evidence and assumptions that have been

developed thus fax and 2) present these conflicts in such a way as

at least to delineate clearly their nature and source, if not to

resolve them.

This review will begin by noting sane of the more significant work in

the area of family and peer influence on adolescent behavior and

then focus more specifically on those studies related to drug use.

A brief final section will attempt to summarize the current state of

knowledge in this area as well as suggest future directions for

research.

57

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FAMILIES AND PEERS: INTERACTIONAL AND INDEPENDENT INFLUENCES

The study of the relative influence of family and peers on adolescent

behavior has, in general, been considered from a developmental perspective (Ausubel et al. 1977; Douvan and Cold 1966). This view

regards the family as the primary provider of status, nurture,

training, and other crucial elements of socialization until adolescence. Then, as the youth strives to assert his or her independence,

a wider array of active influence sources come into play, the most

significant being the peer group.

While these other sources of influence, e.g., the media, school, and

government, are of importance, they are nevertheless mediated by the

adolescent's primary sources of socialization: the family and the

peer group. These two remain as primary sources because they are

able to satisfy the adolescent's "intense preoccupation with social

experience" (Ausubel et al. 1977).

Although research in this area appears to agree that these two groups

account for a substantial portion of the influence on adolescent

behavior, there is considerable disagreement concerning their relative contributions to this influence. Within the broad developmental

perspective which characterizes this area of study, several theoretical approaches have been developed that demonstrate this divergence

of views.

THEORETICAL APPROACHES: EXAMPLES

While there is no widely accepted theory concerning the relative

influence of family and peers on adolescent behavior, a number of

researchers have suggested theoretically based approaches that aid in

illuminating their findings.

Strength of Parental Influence

Hirschi (1969), for example, has developed what he calls social control theory, a basic premise of which is that parents have a direct,

independent effect on their adolescent's delinquent behavior. Hirschi

believes that this effect holds regardless of whether or not the

adolescent interacts with delinquent friends. His schema asserts that

the influence of the peer group is causally unnecessary in the development of delinquent behavior. Hirschi bases his assertion on his

belief that delinquents are not socially integrated, that they have

failed to develop a bond with society and that, as such, the more

socially integrated peer groups are not able to exert social control

over the delinquent. Hirschi's data (and Jensen's 1972 reanalysis of

the same data) suggest, instead, that within the social framework it

is the delinquent's parents who may exercise the most control over

his or her behavior. Neither Hirschi nor Jensen, of course, suggests

that parental control is total or unchallenged but that, relative to

the influence of peers, it appears to be the stronger of the two.

58
While not as theoretically based, perhaps, others have supported

Hirschi's position. Blum and associates (1972), for example, present

data that suggest that the family may remain ultimately more influential than the peer group throughout adolescence. Others supporting

this position include Coleman 1961; Clausen 1966; Larsen 1972, 1974;

and Solomon 1961.

Strength of peer Influence

Sutherland (Sutherland and Cressey 1970), on the other hand, does not

believe that parents have an immediate, direct effect upon their

children's deviant behavior. Sutherland's theory of differential

association, more comprehensive than Hirschi's and based on such basic

social psychological theories as those of Mead (1934) and Cooley

(1909), asserts that the crucial factor in adolescent delinquent

behavior is the availability of deviant role models in the adolescent

peer group. The basis of this assertion is Sutherland's prediction

that an individual's behavior is based on the sum total of the interaction he or she has with individuals who provide role models favorable or unfavorable to that behavior. Regarding deviant behavior,

therefore, he theorizes that unless they teach or model deviant

behavior themselves, the only significant effect parents will have

on their adolescent's deviant behavior is to create situations in

which their children will have access to deviant peer groups.

Again, support for this theory exists, although not anchored in

theory to the extent of Sutherland and in less categorical form.

Bowerman and Kinch (l959), for example, suggest that most adolescents are primarily influenced by peers, but that this influence is

processual rather than exclusive. Their data indicates that a transition or shift from a family to a peer orientation takes place over

a number of years. Ausubel (Ausubel et al. 1977) also suggests the

existence of a transitional phase in the adolescent's shift from

family to peer orientation. His "satellization" theory suggests that

young children initially identify with and derive status from the

family. During adolescence the process of "desatellizing" usually

takes place as the children begin to look beyond their family for

sources of attitudes and values. Other sources of support for this

transitional movement toward an exclusive, or nearly exclusive, .

adolescent peer orientation include Glueck and Glueck 1950; Edwards

and Brauberger 1973; Floyd and South 1972; Gottlieb and Ramsay 1964;

Freidenburg 1963; and Rosen 1955.

Selective Influences of Family and Peers

Finally, in between these "exclusive" or "hydraulic" theories (Kandel

and lesser 1972) of family and peer influence, lie several theoretical approaches that view these influences as situation- or domaindependent.

Kandel et al. (1978a), for example, propose a "generalized social

interaction" model of interpersonal influence. According to this

model:

59
...Adolescents could display different levels of responsiveness to social influences. There may be areas of

behavior in which adolescents will show high reliance on

parents and low reliance on peers, or vice versa, that is,

they will behave according to an exclusive theory. In

other domains of behavior and under different social or

cultural conditions or both, adolescents will display

high reliance on both parents and peers, that is, they

will confirm a theory of generalized social interaction.

(Kandel et al. 1978b, p. 94)

Curtis (1974) presents a "theory of adolescent's shifts in reference

sources," which is less a theory in itself than an amalgamation of

previous theories. He suggests four processes by which adolescents

shift their valuations between family and peers: (1) Push: This

process assumes that adolescents seek extrafamilial interaction to

fulfill needs unmet in the family context; (2) Pull: This process is

postulated on a decline in the adolescent's valuation of parental

opinions because of an increased attraction to peer positions;

(3) Selective Attachments: This process suggests, in a manner similar

to Kandel et al. (1978a.b), that adolescents support both peer and

parent orientations but only on an activity- or-value-specific basis;

and (4) Drift: This process is the least specific and suggests that

adolescents move into and through family and peer alliances by chance

circumstance.

Curtis' own data (1974) support the notion that the process of "selective attachments" may be the most useful of the processes he suggests

in explaining the relative influence of family and peers on adolescent

behavior.

Additionally, both Brittain (1963) and Kandel and Lesser (1972) present data that further reinforce the contention that continuity or

discontinuity between family and peers is neither total nor pervasive.

Their data suggest that adolescent and adult separateness is relative

and varies with the issue involved. For example, topics that are of

immediate importance or are present-oriented are most likely to be

influenced by peers; for future or goal-oriented topics, the family

and other adults are likely to be more influential.

The theoretical positions outlined above demonstrate the diversity and

divergence of both opinion and data-based research results on this

issue. The following section, focusing on family and peer influence

on adolescent drug use, may aid in clarifying some of these findings.

FAMILY AND PEER INFLUENCE ON ADOLESCENT DRUG USE

Kandel (198Ob,c) observes that much of the existing research in the

drug field is either atheoretical or, where an attempt has been made

to operate within a theoretical framework, poorly developed. While

some attempt has been made to remedy this situation, either through

efforts to integrate relevant theories (Lettieri et al. 1980) or

through the development of sophisticated methodologies (e.g., Bentler

60
1980; Bentler et al. 1976), it is clear that without guiding theories

our understanding of drug behavior cannot be significantly advanced.

Any attempt to consider the relative influence of family and peers in

a theoretical context, then, is made difficult by this paucity of

applicable theory. A model such as that developed by Jessor and Jessor

(1977) to explore problem behavior and adolescent psychosocial development may eventually serve as a framework for theoretical development

of this problem, but appears to be too broad to serve adequately at

this time. The Jessors' model encompasses three major system--the

personality, the perceived environment, and the behavior system. The

amount and sophistication of the work carried out thus far on family/

peer influence on drug use is not sufficient to be appropriately

applied to this complex theoretical structure.

At the present time, a model more relevant for this problem is that

developed by Kandel and her colleagues (e.g., Kandel 1973, 1974a,b;

Kandel and Faust 1975; Kandel et al. 1976a,b, 1978a,b). This developmental model considers each of the three stages of drug use (initiation

into hard liquor, marijuana, and other illicit drugs) from the perspective of four conceptual clusters (parental influences, peer influences,

adolescent's beliefs and values, and involvement in certain activities;

figure 1). In this way, Kandel is able to include both of the major

sources of interpersonal influence as well as the relevant intrapersonal characteristics of the adolescent. Methodologically, Kandel

considers the elements of each of these clusters "...as additive

sources of influence in a multiple regression analysis" (Kandel et al.

1978a). As such, their relative contribution to adolescent drugusing behavior can be reasonably assessed.

Figure 1

Model of Family and Peer Influence on Adolescent Drug Use

(based on concepts of Kandel et al. 1978a)

61
For the purposes of this review, only a portion of this model, that

dealing with sources of interpersonal influence, will be followed in

presenting the research conducted thus far on family and, peer influences on adolescent drug use. It is important to remember, however,

that the other two conceptual clusters, adolescent beliefs/values and

adolescent activities, may contribute equally or more to the prediction of adolescent initiation into the use of certain substances.

Naturally, with the exception of the work of Kandel et al., this

research has not been conducted to conform to this model. Therefore,

sane results will not adequately fit into either of the two conceptual clusters being considered here, and there will be considerable

overlap among findings. Nevertheless, as will be seen, the bulk of

current research in this area falls within these conceptual clusters.

A final note regarding this research concerns the notion of causality.

Only a few researchers, among them Kandel and her colleagues, the

Jessors, Brook and Lukoff, and Bentler, Huba, and their colleagues

have conducted longitudinal studies that directly address relative

family and peer influences on drug use; only Kandel et al. collected

family and peer data from the family and peers themselves, rather

than relying on the respondent's perceptions. All other research

cited either directly addresses family and/or peer influences in a

cross-sectional approach or else presents data on this issue which are

a by-product of the primary aims of the research. Therefore,

ascribing causal status to any of the variables discussed below would

not be appropriate.

Interpersonal Influences on Adolescent Drug Use:

Independent and Relative Effects

In discussing the basis of their model, Kandel et al. (1978a,b) posit

three ways in which interpersonal influences may operate: (a) Directly: One person influences the behavior of another by providing

a model, appropriate reinforcement, or an intimate relationship;

(b) Indirectly: One person influences the development of another's

values. attitudes. or behaviors. an influence that takes place over a

period of time and may not be strictly linear; and (c) Conditionally:

One source of influence affects a focal person's opportunity or susceptibility to be influenced by another. Further, Kandel et al.

suggest that two primary social learning processes, imitation and

reinforcement (Bandura and Walters 1963; Hotter 1966; Maccoby 1968),

provide the means by which direct, indirect, or conditional interpersonal influences may be transmitted. Finally, the conditions necessary for either of these processes to become operative, and the

extent to which they will do so, depend upon the quality and nature

of the relationship of the source of influence and the focus of the

influence, the characteristics of the focal individual, and the

situation at hand. This complex process of interpersonal influence

builds upon the field theory of Lewin (1936), the communication

theory of Hovland et al. (1953) and, more recently, the social and

personality theories of Clausen (1968) and Mischel (1973).

62
The process described above provides the foundation, whether explicitly or by implication, for much of the research conducted thus far

on family and peer influences on adolescent drug use. The relative

effects of these two sources of interpersonal influence, family and

peers, will be considered on the basis of the extant research.

Kandel's model of stages of drug use provides the outline for this

review.

Independent Family Influence on Adolescent Drug Use

There is an extensive and growing literature concerning the role of

the family in the drug use of one or more of its members (Seldin 1972;

Harbin and Maziar 1975; Stanton 1978, 1979). As in any relatively

new field, much of this literature is either descriptive, e.g.,

characteristics of the addict's family, or quite broad in scope, e.g.,

the need for and methods of family therapy for the user. More

specific topics, such as that under consideration here, have not yet

been extensively subjected to rigorous, systematic research. Nevertheless, family influences on adolescent drug use have certainly been

addressed in the literature and, in some cases, quite rigorously

(e.g., Kandel 1979a,b; Jessor and Jessor 1977). This interest appears

to be in two phases, the first in the early 1970's in response to

initial concerns with growing adolescent drug (and particularly

marijuana) use, and the second more recently, after a mid-1970's

hiatus when early concern with adolescent use somewhat abated and

harmful, if not benign. In the review of this literature, as noted

marijuana was accorded the status of a substance at least only mildly

above, the role of family influence will be considered for each of

the stages of initiation to drug use suggested by Kandel.

Stage One: Initiation into Hard Liquor

Kande14 suggests that parents play a substantial, but quite specific,

role in influencing adolescent initiation into the use of hard liquor.

Her data suggest a direct modeling effect in which the process of

imitation on the part of the adolescent is at work, a finding

enhanced by Bandura and Walter's (1963) suggestion that imitation is

fostered when it takes place within a nurturing relationship. While

parental use of hard liquor is a moderately good interpersonal predictor of adolescent use, the quality of the parent-child relationship

and parental attitudes and values appear to be of considerably less

importance. The one attitude/value area that may have some influence

is parental attitude toward the harm of casual liquor use. A parental

approach based on reasoning, rather than control through the setting

of strict rules and limits, appears to be more successful in delaying

or minimizing adolescent initiation into hard liquor use.

Considerable support for both of these findings-the influence of

parental drinking and the effect of parenting styles in approaching

adolescent liquor use--is found in the literature.

Maddox (1970) found that knowledge of parental drinking patterns was

the single most important tool for predicting adolescent drinking

patterns. Although not limiting their studies to alcohol use, others

63
have also found parental drinking behavior to be a strong factor in

influencing adolescent initiation into alcohol use (Braucht et al.

1973; Gorsuch and Butler 1976; Annis 1974; Smart and Fejer 1972;

Goode 1975; Jessor and Jessor 1975; Scherer 1973; Chein et al. 1964;

Rosenberg 1969). Lawrence and Vellerman (1974) reported similar

findings and, in addition, reported that the most significant factor

influencing adolescent alcohol use was not just whether and how often

one or both parents drank but how much they drank each time, i.e.,

whether they drank to intoxication or had a single drink. Blum and

associates (1969, 1972) also suggested an association between parents

who offered a predinner cocktail to guests and adolescents who were

more susceptible to initiation into the use of liquor.

Support for the finding that a reasoned, democratic parenting style

may have a positive effect on adolescent drug (including alcohol)

use is found in the review by Braucht et al. (1973) of correlates of

deviant drug use in adolescence, in which they note that adolescent

users are usually subject to deficient parenting styles, particularly

those involving over- or under-domination or rejection; in Hunt (1974)

and Blum and associates (1972), who suggest that a laissez-faire or

liberal parenting style may make the adolescent particularly susceptible to initiation of use; and in Baumrind (1971, 1975), who suggests

that a prolonged period of parental effort at strict control may

promote rather than discourage use.

Finally, some evidence is found for the positive influence on adolescent drinking of good parent-child relationships, a factor which

Kandel's data do not strongly support. Once again citing studies

that do not necessarily distinguish alcohol use from other drug use

(a point, of course, which confounds any direct comparison with the

Kandel data)5, there is sane indication that attachment to the family,6

positive family relationships (Adler and Lotecka 1973; Wechsler and

Thum 1973a,b; Shibuya 1974), and positive involvement with the family

(Jessor and Jessor 1975, 1977) discourage initiation into use, while

family friction and fights (Russell 1972; Lawrence and Vellerman 1974)

may encourage use.

Stage Two: Initiation into Marijuana

Kandel found parental influences on adolescent marijuana use to be

quite small. In particular, and in contrast to use of hard liquor,

adolescent initiation into marijuana was "virtually unrelated" to any

type of drug use on the part of parents. What parental influence was

found appeared to be based on parental attitudes and closeness of

relationship with their children, i.e., parents whose relationships

with their children were strong enough to enable them to forbid or

strongly discourage marijuana use and still hold the relationship

together were more successful in minimizing initiation than those

parents whose attitudes and behavior suggested a more permissive

stance, a finding supported by both Jessor and Jessor (1977) and Blum

and associates (1972). Kandel cautions, however, that this view may

reflect adolescent selective perception since these same attitudes

as reported by parents were not significant predictors of initiation.

64
While there is no research that indicates that parents have a powerful influence on adolescent initiation into marijuana use, there are

several studies suggesting that parents may have a somewhat more

influential role than that reflected in the Kandel studies. These

findings, however, are subject to the direct-comparison and selfreport difficulties cited earlier and therefore may reflect the Same

selective perception that Kandel speculated was active in her data.

Nonetheless, in addition to those studies cited in the corresponding

section in Stage One suggesting that parental drug use directly influences adolescent drug use, others supporting this finding and relating

it specifically to adolescent marijuana use (among other drugs) are

Brook et al. (1977), Hochman (1972), Tec (1970, 1972,a,b,c, 1974a,b),

and Lavenhar et al. (1072).

Studies supporting the notion that positive parent-child relationships

will influence marijuana use include those cited in the corresponding

section in Stage One and the following studies, which are more specifically addressed to marijuana use. Burkett and Jensen (1975) found

a relationship between family involvement/attachment and adolescent

marijuana use; Jessor (1076) and Jessor et al. (1073) reported that

the perception of strong parental support and greater involvement with

parents was related to minimized initiation to adolescent marijuana

use; Tec (1974a) suggested that the salience of the family and the

degree of satisfaction the adolescent derived from the family influenced his/her marijuana use; Blum and associates (1972) reported that

adolescents whose families made strong efforts to meet their

emotional needs were not at great risk of being significantly involved

in marijuana use; and Stone (1979) presented data that suggested that

adolescents with a strong family orientation experience minimized

initiation into marijuana use.

Stage Three: Initiation into Other Illicit Drugs

Kandel reports that adolescent initiation into the use of illicit

drugs other than marijuana appears to be strongly related to parental

influences. The quality of the parent-child relationship appears to

be particularly important. The adolescent's feelings of closeness to

the family predicted low likelihood of initiation into other illicit

drugs, while strict controls (see discussion, Stage One) and parental

disagreement about discipline predicted higher likelihood of initiation. Additionally, parental drug use was, again, an important

predictor.

There are few other data in the literature that specifically address

parental influences on adolescent use of illicit drugs other than

marijuana. The majority of the studies cited earlier investigate

and note the importance of the influence of parent-child relationships

and parental use patterns with regard to adolescent use of these drugs.

They do not, however, single out this stage of initiation for analysis

as does Kandel, thus making comparisons a speculative activity.

65
A report by Smart and Fejer (1972), however, does support the data

presented by Kandel et al. (1978a,b) which suggest a strong

relationship between parental use, both licit and illicit, of psych+

active, mood-changing drugs (other than marijuana) and adolescent

initiation into illicit use of these substances. Further, Kandel

(1974a), in an early article, characterized adolescent use of illicit

psychoactive substances as a manifestation of "...the cultural ethos..,

a juvenile manifestation of behavior engaged in by adults" (pp. 110-

111). Support for this theory may be seen in Tec (197413) and Goode

(1975), who both discussed this phenomenon in terms of "generational

continuity."

As may be seen above, the influence of the family differs in each

stage of adolescent drug use. Parents appear to be influential

concerning adolescents' initiation into hard liquor use and, in

particular, their initiation into use of illicit drugs other than

marijuana. Parental influence appears to be somewhat diminished,

however, with regard to initiation into marijuana use. With these

differences in mind, the following section will now consider the

existing research on independent peer influences upon the adolescent's

initiation into different stages of drug use.

Independent Peer Influence on Adolescent Drug Use

Peer influences on adolescent drug use have received less research

attention than the role of the family in this behavior. The role

of peers has not been ignored as much as it has been considered as

one of many factors influencing adolescent drug use; the role of the

family, on the other hand, has often been singled out for study.

Peer influence has, nevertheless, been examined by a significant number of researchers. Braucht et al. (1973), Ferguson et al. (1974)

and Gorsuch and Witler (1976), for example, each devote a considerable

portion of their reviews of adolescent drug use to research on peer

influence. Also, Kandel, Jessor and Jessor (1977), Johnson (1973),

Bentler and his colleagues (e.g., Huba et al. 1979) and others have

gathered a significant amount of peer-related data within their more

extensive research programs. Finally, a number of individual studies

(see below) have considered independent peer influences on adolescent

drug use. A review of this research, continuing to utilize Kandel's

stages model as an outline, is presented below.

Stage One: Initiation into Hard Liquor

Adolescents' and their friends' perceptions of how many of their

friends are using hard liquor, actual use of hard liquor by friends,

best friends' attitudes about the harmfulness of hard liquor, and the

degree of adolescent involvement in peer activities (e.g., attending

parties, driving around) were the most important peer factors found

by Kandel to predict adolescent initiation into hard liquor use.

As noted by Kandel (1974a,b) and Bowker (1974), reliance upon adolescent perceptions of their friends' drug use may be misplaced because

these perceptions may be highly inaccurate due to factors such as the

66
respondents' attitudes, current use patterns, parents' attitudes, and

so on. The modeling effect based on friend's actual use, however,

may be the most important factor in initiation to hard liquor use.

Although only Kandel and Brook et al. (1977) have obtained actual use

data from friends, a number of other studies have also suggested that

peers’ use of hard liquor (among other drugs), may be the best peerrelated predictor of adolescent initiation to these substances (Suchman 1968; Jessor et al. 1972; Jessor and Jessor 1975, 1977; Gusfield

1970; Haberman et al. 1972; Forslund and Gustafson 1970; Braucht et

al. 1973; Gorsuch and Butler 1976; Lavenhar et al. 1972; McKillip et

al. 1973; McBride6).

Also, there is some indication that certain peer behaviors and attitudes may cluster around particular drugs (including hard liquor),

rather than there being any one "peer drug culture" (Johnson 1973;

McKillip et al. 1973; Huba et al. 1979). Further, Suchman (1968)

suggests that peer pressure to use particular substances increases

as the adolescent moves from alcohol to marijuana to other illicit

drugs.

Stage TwO: Initiation into Marijuana

Peer influences on marijuana use are, according to Kandel, "substantial and varied." Friends' actual and perceived use, friends' actual

and perceived espousal of values and attitudes conducive to use, and

availability of the drug are peer factors that strongly predict

adolescent initiation to marijuana use. Kandel notes that marijuana,

as opposed to alcohol, is a substance associated with youth, and that

the range and importance of peer factors in predicting use are considerably greater for marijuana than for alcohol. As such, exposure

to peers who USC marijuana and/or have favorable attitudes toward it

has in fact become a source of adolescent socialization.

The strength of peer influence, direct and indirect, on marijuana use,

as reported by Kandel, has considerable support in the literature.

Considering marijuana use specifically, peer modeling effects appear

to be substantial (Jessor 1976; Jessor and Jessor 1975, 1977; Hochman

1972; Stone et al. 1979; Goode 1969, 1970; Griffin and Griffin 1978;

Krohn 1974; Tec 1970, 1972a,b,c, 1974a,b; Sadava 1973a,b; Sadava and

Forsyth 1977; Suchman 1968; Braucht et al. 1973; Gorsuch and Witler

1976; Burkett and Jensen 1975; Burkett 1977; O'Donnell et al. 1976;

Huba and Bentler, in press; Huba et al., in press).

Also, a number of studies suggest that what, as noted earlier, Kandel

and Lesser (1972) referred to as a "hydraulic" or "exclusive" influence process may be active with regard to peer influences on adolescent marijuana use. This is particularly true with regard to attitudes and beliefs rather than specific behaviors. Adler and Lotecka

(1973) and Block et al. (1974), for example, suggest that peer influence grows as the reliable (whether perceived or actual) drug-related

information peers are able to provide grows; Johnson (1973) considers

the attitudes and beliefs of the peer culture to be a transitional

stage between the family and drug cultures; Tec (1972a) describes

67
growing peer influence as attachment to parents diminishes; and Stone

et al. (1979) suggest that as "peer orientation" grows, so also does

initiation to marijuana use.

Stage Three: Initiation into Illicit Drugs

Kandel has found that the influence of the peer group as a whole, in

comparison to alcohol and marijuana use, is considerably diminished

with regard to use of other illicit drugs. Rather, it is the actual

use of all types of drugs by the adolescent's best friend and low

levels of intimacy with even that best friend that are the strongest

peer-related predictors of an adolescent's initiation into use of

illicit drugs other than marijuana. Based on this evidence, Kandel

et al. (1978a) suggest that

Youths who start using other illicit drugs, although

greatly influenced by association with individual drug

users, may be youths who have been unable to develop

intimate and meaningful ties with their peers. (P. 89)

There do not appear to be other studies that have focused on peer

influences and adolescent initiation into use of these drugs. Studies

have suggested, as noted earlier, that adolescents' attitudes and

behaviors my differ by the drug(s) they are using (Huba et al. 1979;

Johnson 1973; McKillip 1973) but a clear delineation of these influences by drug has not been forthcaning.

CONCLUSIONS: RELATIVE FAMILY AND PEER INFLUENCES ON

ADOLESCENT DRUG USE

As a concession to clarity of presentation this review has discussed

the research on family and peer influences as independent factors.

Adolescent development, of course, does not proceed along such linear,

independent paths. Rather, there are multiple, continual, simultaneous influences of varying strengths acting not only upon the adolescent but upon these influence sources and between these influence

sources and the adolescent. This section presents the findings

described earlier in the context of this complex matrix of interpersonal influences. Although, recognizing the numerous sources of

influence on adolescent behavior, it limits the sources of influence

under consideration to family and peers and their relative influence

on adolescent drug-related behavior. It should be remembered, also,

that the source of these conclusions is studies that are not necessarily comparable either in their focus or methodology. Nevertheless,

the following conclusions, however tentative, should offer researchers

hypotheses and research questions on which to base future study.

General Conclusions

There does not appear to be any point at which the drug behavior

of most adolescents is wholly influenced by either family or

peers. The "hydraulic" or "exclusive" theory of family versus

peer influence, in which gross family influence is theorized to

68
diminish as peer influence grows, does not seem to be fully

supported, although the overall balance of influence appears to

shift toward the peer group; this shift to the superiority of

peer influence is particularly noted in initiation to marijuana

use, where the family may have very little influence.

Adolescent acceptance of either family or peer influence with

regard to the use of any particular drug has not been found to be

a rejection of the others' values and influence. Adolescents who

reject parental influence and follow their peers in marijuana use,

for example, have not necessarily been found to be rejecting their

parents across all other influences. Rather, adolescents seem to

rely upon peers and family as resources at different times and

under different circumstances.

Family and peer influence appears to follow a somewhat predictable

pattern across the stages of drug use. Parent and peer influences

on adolescent alcohol use appear to be relatively equal; peer

influence appears substantially greater than family influence in

marijuana use; and the influence of the family appears to be

stronger where illicit drugs other than marijuana are concerned.

The most effective family influences appear to be those that are

developed in advance of adolescence. Satisfactory family relationships and climate, emotional support, and moderation in the use of

alcohol are influences that appear to delay or diminish adolescent

initiation into drug use. These are influences that are developed

over a long period of time and attempts to make for their absence

by measures such as a sharp increase in parental control of the

adolescents' behavior may lead to increased rather than diminished

use.

Peer influence appears to be of a more limited duration than family

influence and directed at what are perceived to be issues of more

immediate than long-term import. Peer influence is most effective

in the first two stages of drug use: the last stage. where the

family appears to have more influence, mast often comes after the

peak of peer influence and also involves use of drugs (e.g., hallucinogens, heroin), which the adolescent perceives as having a

greater potential effect on his/her future behavior than either

alcohol or marijuana.

Among interpersonal influences, family and/or peer actual drug use

patterns appear to be the strongest influence on adolescent drug

use. Parental alcohol use seems to be the strongest interpersonal

predictor of adolescent alcohol use, peer marijuana use appears to

be the strongest interpersonal predictor of marijuana use, and

family and best friend's use of other illicit drugs appear to be

among the better interpersonal predictors of adolescent use of

these substances.

69

368-024 0 - 82 - 6
Family influence on marijuana use, although small, my be most

effective when (1) a strong parent-child relationship exists prior

to adolescence and (2) the nature of that relationship is such

that parents do not feel that they risk rupturing it by strongly

and explicitly stating their position on their child's marijuana

use. Although peer influence appears to be strongest with regard

to adolescent marijuana use, the potential for family influence

is most significant on the level of parent-child relations.

These general conclusions provide a basis for future research in this

area.

FUTURE RESEARCH

Developing suggestions for future research in this area is, for several reasons, a difficult task. First, as with the study of any

developmental area, the foci of study, in this case families, peers,

and adolescents, are constantly changing and thus require sophisticated research methodologies to separate as well as possible the

effects of normal development from those of the variables under

consideration. Second, adolescent and preadolescent drug use (NIDA

1980) is a relatively recent phenomenon that requires more basic

study as well as research concerning family and peer influences upon

it. Finally, the drug use field is in a nearly constant state of

flux--antidrug parent groups are forming, fad substances corms and

go, laws are passed and challenged concerning such diverse areas as

the criminal status of marijuana use and the constitutional right of

merchants to sell drug-related material-all the while making fruitless exercises of research questions that were valid at one pint in

time.

Nevertheless, the uncertain and novel areas presented by this field

and the specific concerns being discussed here do provide the basis

for a nunber of questions that should be considered in the near future:

HoW will relative family and peer influence change as age of first

drug use drops? There is evidence suggesting that the age of initiation to both alcohol and marijuana use is dropping and often

includes preadolescents (NIDA 1980). Since data now suggest that

parental modeling is the most important predictor for adolescent

initiation into alcohol use, and peer modeling for marijuana use,

will the strength of these influences change as they are applied

to younger children or will the same patterns be followed, only

earlier?

What are the dynamics of sex differences in family and peer

influence on adolescent drug use? While this question has been

addressed (e.g.,

Shute7),

Jessor and Jessor 1977; Shute 1975; Stone and

there has been little systematic, focused investigation

of this important issue. What sex parent has most influence over

what sex adolescent, at what age(s), for what drug(s)? What effect

does sex of sibling model have? What sex peer has most influence

over what sex adolescent, at what age(s), for what drug(s)?

70
What cultural, racial, and ethnic differences are there in family

and peer influences? There is some evidence to suggest that Native

American adolescents, for example. are heavy users of inhalants

(Goldstein et al. 1979; Oetting and Goldstein8); can family and peer

influence contribute to the explanation of this phenomenon? Are

peer influences on drug use more salient in some cultures? Family

influences?

Does peer influence on adolescent drug use follow a predictable

process? Kandel's findings suggest that a generalized peer influence in the early stages of drug use gives way to the more specific

influence of a best friend. Are other behaviors and attitudes

influenced in this way or is this limited to drug use? Can these

findings be replicated by other longitudinal studies?

What effect will the activities of antidrug parent groups have

on the relative influence of family and peers? Until now, all

research on this topic has assumed that family and peer relations

will follow traditional paths; the emergence bf the parent groups

questions that assumption. For example, data presented earlier

suggested that very strict parental control over adolescent

behavior may increase rather than diminish adolescent drug use.

These data assume, however, that this control is carried out in

isolated instances, providing the adolescent with "cause" for

negative comparison of his/her parents with others and leaving the

parents with little support for their actions. What will the

result be, however, if large groups of united families take such

actions?

What effects do the developmental crises of parents have on their

ability to exercise influence on adolescent drug use? Baumrind

(1975, 1980) suggests that many parents, particularly as our society tends toward delayed childbirth, will be experiencing their

own midlife crises just at the time their adolescents are being

faced with increased peer influence concerning drug use. How do

parental and child developmental crises interact? How do parent

and adolescent cope with simultaneous difficulties in their lives?

Does initiation to adolescent drug use increase as a coping mechanism or is it due to a vacuum of family influence?

What is the relative persistence of family and peer influence on

adolescent drug use? As presented earlier, there are data that

suggest that adolescents rely on peer influence for immediate

issues and family influence for future, life-oriented issues, and

that most significant drug use and the danger of initiation to

use is over by the mid-20's. This suggests that family influence

may have greater persistence but, as use starts earlier, will this

increase the period of peer influence? Are some youths more

susceptible to longer periods of family or peer influence?

How can family and peer influence be optimally used to delay or

diminish adolescent initiation to drug use? This question has

been addressed a number of times (e.g., Iverson et al. 1978; Capone

et al. 1973; Pyle 1977; Rachman and Heller 1976; Ryan and Hettena

7 1
1976; Nilsongiebel 1980; Johnson 1980; Smart et al. 1976; Eiseman

1974; Rollin and Arey 1974; Bell 1978) in the context of formal

education program, but has not provided a strong base for future

implementation, particularly concerning family influence. The

emergent parent groups appear anxious to address this issue and it

is here that a coordinated effort by researchers and the interested

public may have a significant impact.

The questions noted above are only sane of the issues that must be

addressed if we are to understand the relative influence of the family

and peers with regard to adolescent drug use. The theoretical models

developed by the Jessors and by Kandel and her colleagues provide a

basis for that research.

FOOTNOTES

1

 Boin, S. Parents unite to fight drug abuse. US J Drug Alcohol

Abuse, Miami, Florida, May 1980.

2

 Anonymous. Drogenszene: Eltern Helfen Eltern (Drug Scene: Parents

Helping Parents). Mod Med 7:318-319, 1979.

3

 Glynn, T. Families, drugs and responsive research. Unpublished

manuscript, Rational Institute on Drug Abuse, Division of Research,

1980.

4

 Since there are numerous reports on the work of Kandel and her colleagues that provide rigorous data on family and peer influences on

adolescent drug use, these reports will not be listed each time they

are referenced. Thus, unless a finding is limited to a specific

report, when Kandel is cited as a source, this citation refers the

reader to the following reports: Kandel 1973, 1974a,b, 1975a,b,

1978, 1980a,b,c; Kandel and Faust 1975; Kandel et al. 1976a,b,

1978a,b.

5 Kandel, D. Family Processes in Adolescent Drug Use.

Grant No. 1-R01-DA 0064, National Institute on Drug Abuse, Division

of Research, 1978.

6

 McBride, D. Parental and Peer Influence Upon Adolescent Drug Use.

Final Report, Grant No. 1-R01-DA 01073, National Institute on Drug

Abuse, Division of Research, 1978.

7

Stone, C.I., and Shute, R.E. Persuader sex differences and peer

pressure effects on attitudes toward drug abuse. Paper presented

at the Annual Meeting of the American Educational Research Association, San Francisco, California, 1976.

8 Oetting, E.R., and Goldstein, G. Native American Drug Use, Ages

12-17. Final Report of Grant No. 1-RO1-DA 01054, National Institute

on Drug Abuse, Division of Research, 1977.

72
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ACKNOWLEDGMENTS

Drs. Denise Kandel (Columbia University), Diana Baumrind (University

of California, Berkeley), and Dan Lettieri (NIDA) helpfully reviewed

an earlier version of this paper.

AUTHOR

Thomas J. Glynn, Ph.D.

National Institute on Drug Abuse

Division of Research

Psychological Sciences Branch

Rockville, Maryland 20857

81
The Delinquency and Drug Use

Relationship Among Adolescents:

A Critical Review

Richard R. Clayton, Ph.D.

The primary purpose of this paper is to review what is now known about

the delinquency-drug use relationship among adolescents. A related

task is to use the review to target aspects of the delinquency-drug

use relationship that require further research scrutiny and more

elaboration.

Most of the research on the crime-drug nexus has dealt with drug use

among criminal offenders (cf., Barton 1976; Eckerman et al. 1971;

Kozel et al. 1972; Weissman et al. 1974) and criminality among

narcotics addicts (cf., Inciardi and chambers 1972; Voss and Stephens

1973; Ball et al. 1975; Nurco and DuPont 1977; Inciardi 1979). In

the recent past a number of reviews of the crime-drug relationship

have been published, usually with a special emphasis on narcotics

use (Chambers 1974; Cushman 1974; Could 1974; Greenberg and Adler

1974; Research Triangle Institute 1976; Weissnan 1979; Gandossy et

al. 1080).

The story with regard to the delinquency-drug use relationship among

adolescents is different. While there are a multitude of studies

that examine the etiology of adolescent drug use or juvenile delinquency and some that focus on both drug use and delinquency as separate

indices of deviance, there are relatively few studies that attempt to

understand how delinquency and drug use are related to each other.

However, these latter studies have been thoroughly reviewed by Elliott

and Ageton (1976b). They divided the extant literature into "studies

of officially defined drug users and delinquents" (Chein 1964; Chein

et al. 1964: Weitzner et al. 1973; Friedman and Friedman 1973a) and

"studies involving normal youth populations" (Robins and Murphy

1967; Jacoby et al. 1073; Friedman and Friedman 1973b; Goode 1973;

Johnston 1973; O'Donnell et al. 1976; Jessor and Finney 1973; Jessor

1976; Gold and Reimer 1974; Elliott and Ageton 1976a; Hindelang and

Weiss 1972).

It would be redundant to review in detail each of the studies reviewed

by Elliott and Ageton (1976b). Therefore, in the remainder of this

paper findings and conclusions from the studies reviewed by Elliott

and Ageton will be used only to highlight the points being made.

Before the substantive findings and conclusions are reviewed, it would

be useful to delineate the methodolological and scientific bases from

which the delinquency-drug use relationship should be examined. In

82
the next section a model of the relationship is presented along with

a discussion of the criteria of causality that should be applied to

this relationship.

THE DELINQUENCY-DRUG USE RELATIONSHIP: A METHODOLOGICAL MODEL

The methodological model that is most appropriate for examining the

delinquency-drug use relationship (Clayton and Tuchfeld, unpublished)

is based on the multivariate "elaboration" approach of Lazarsfeld

(1955), Hyman (1955), and Rosenberg (1968) at the nonparametric level

and the causal modeling approach of Blalock (1971), Heise (1975),

Joreskog (1970), and Duncan (1975) at the parametric level.

Model A

The Elaboration Model of the Delinquency-Drug Use

Relationship Among Adolescents

Source : Clayton, R.R., and Tuchfeld, B.S. The drug-crime debate:

Obstacles to understanding the relationship. Unpublished.

This model is based on the probabilistic concept and criteria of causality accepted by virtually all social scientists. Hirschi and Selvin

(1967) identified the three essential criteria of causality as follows:

The predictor and effect variables must be correlated (i.e., statistical association).

The predictor variable must be antecedent to the effect variable

in time-order occurrence. Because social scientists usually

aggregate data for individuals according to group characteristics

(e.g., gender, ethnicity, etc.), the predictor variable must be

antecedent to the effect variable in the "majority" of cases, not

necessarily in all cases.

83
It must be demonstrated that the observed statistical correlation

between the predictor and effect variables does not result from

both being "caused" by variables antecedent to both (i.e., the

zero-order relationship must be tested for "spuriousness" by

partialing out the influence of antecedent variables).

Model A has several component parts that deserve attention. First,

there are two-headed arrows between delinquency and drug use. This

implies that (a) drug use could be antecedent to and predictive of

delinquency and (b) delinquency could be antecedent to and predictive

of drug use. In either case, the first order of research business

is to establish the degree of association between the two variables.

Second, the two-headed arrows imply that one must establish the predominant temporal order among drug-using and delinquency behaviors.

There are several meanings of temporal order found in the literature

on the delinquency-drug use relationship. The most common meaning

focuses on "onset." Does age at first delinquent act predate age at

first drug use, or vice versa? The answer to this question usually

hinges on whether the researcher is interested only in illicit drug

use, in which case delinquency is usually the predictor and illicit

drug use the effect variable. If the researcher has data on first

use of alcohol or cigarettes or first experience with alcohol intoxication, in addition to onset of use of illicit drugs, the temporal

sequence might be: first use of licit drugs to first delinquent act

to first use of illicit drugs. A second and less common meaning of

temporal order involves charting the dynamic intersection of drugusing and delinquent behaviors over time. For example, the research

question using this meaning of temporal order is: Among personswho

have already engaged in delinquent acts, does initiation of drug use

increase the frequency, seriousness, and variety of delinquent activities, and does this lead to greater drug involvement, and so on?

While both meanings of temporal sequencing are relevant to the

delinquency-drug relationship, design and other considerations have

led most researchers to use the first meaning, onset events by onset

events.

Determining whether a relationship is spurious is the most difficult

criterion of causality to establish beyond reasonable doubt. It is

also the criterion that is least understood. In model A the delinquency-drug use relationship is tested for spuriousness by controlling

on or partialing out the effects of variables that are antecedent to

and possibly causal of both drug use and delinquency. This requires

that (a) one provide evidence that these variables are, in fact, antecedent to both X and Y, and (b) that the partial correlation coefficients (XY: al

, a2, a3 . . . an) reduce to zero or become statistically

nonsignificant.

The last component of model A that should be discussed is located in

the oval sphere between delinquency and drug use. These are variables

that intervene temporally and/or theoretically between X and Y. A

statistical control on the intervening variable(s) should produce a

zero or statistically nonsignificant partial correlation coefficient.

If this occurs it does not mean that X is not a cause of Y. Instead,

84
it means that the influence of X on Y is indirect, not direct, and

that knowledge of the variables intervening between X and Y enhances

understanding of the XY relationship. Stated differently, evidence

of intervening variables elaborates understanding of the XY causal

chain.

There is a great deal of variation in the methodological rigor among

the studies that have dealt with the delinquency-drug use relationship. Predictably, on that score, more confidence can be placed in

the findings from studies conducted in the recent as opposed to

distant past. Findings from studies that are based on normal populations will likewise be more credible than those conducted on officially

identified delinquents or drug users.

DELINQUENCY AND DRUG USE AMONG ADOLESCENTS: ARE THEY CORRELATED?

The first criterion of causality concerns the presence of a relationship: Are delinquency and drug use correlated? In a general way,

Jessor's observation about marijuana provides an answer to this

question. "The most ubiquitous generalization that can be made is

that marijuana use, far from being an isolated behavior, is generally

part of a larger behavioral pattern involving the use of other drugs

and engaging in a variety of other unconventional or nonconforming

actions such as delinquency, sexual experience, political activism,

and attenuated academic performance" (Jessor 1979, p. 346). At a

more specific level, Elliott and Ageton (1976b) found sane association

between delinquency and drug use in every study they reviewed. The

only exception to this was a study by Scott and Wilcox (1965) that

focused exclusively on amphetamines. Overall, the delinquency-drug

use relationship is general and seems to hold for both serious and

nonserious delinquency.

DELINQUENCY AND DRUG USE AMONG ADOLESCENTS: WHAT IS THE

PREDOMINANT TEMPORAL ORDER?

In the broader literature on the crime-drug nexus there is consensus

on the question of temporal order. Most studies of opiate addicts

reveal that criminal involvement precedes use of narcotics and addiction (cf., Winick 1974; Lukoff 1974; McGlothlin et al. 1978; Nurco

and DuPont 1977). The only recent study of addicts that found minimal

criminal activity prior to first use of narcotics was conducted among

residents at the Lexington Hospital by Voss and Stephens (1973).

Inciardi's (1979) study of apprehended and unapprehended criminals in

a sample of 356 active heroin users from Miami shows that onset of

delinquency precedes use of illicit drugs, including marijuana. Data

on the median ages of initiation into various stages of drug/crime

careers for this sample are found in table 1.

85

388-024 0 - 82 - 7
Table 1

Drug/Crime Careers: Median Age at Initiation for a

Sample of Active Heroin Addicts (Inciardi 1979)

Drug/Crime Events

Median Age of Initiation

Males Females

First alcohol use 12.8 13.8

First alcohol intoxication 13.3 13.9

First criminal activity 15.1 15.9

First drug abuse 15.2 15.2

First marijuana use 15.5 15.4

First arrest 17.2 18.3

First barbiturate use 17.5 17.0

First heroin use 18.7 18.2

First continuous heroin use 19.2 18.4

Adapted from Inciardi, J.A. Heroin use and street crime.

Crime and Delinquency, 25:335-346, 1979.

While delinquency precedes illicit drug use, use of alcohol and first

alcohol intoxication are clearly antecedent to delinquency. In fact,

there is a 2-year average hiatus between first alcohol intoxication

and first criminal activity for both males and females who later

become heroin addicts. It is probably safe to assume that alcohol

intoxication episodes occurred with some frequency for these individuals prior to commission of their first criminal act. Another

safe assumption is that these alcohol intoxication episodes usually

occur as group events, suggesting that (a) it is important to consider

alcohol use in any examination of the delinquency-drug use relationship

and (b) alcohol may be a key factor in the movement of youth from the

influences of family for conventionality toward the influences of

peers for unconventional conduct.

In his review of the etiological aspects of drug abuse, Nurco underscored the important role of alcohol in transition proneness:

...addicts appear to begin drinking before their age

and social class peers in the general population--that

is, addicts might be called "norm breakers." Not only

do they appear to be more deviant than the general

population, but they prove this by engaging in the

 "marginally acceptable" before others do. (Nurco 1979,

p. 315)

Elliott and Ageton (1976b) reach the following conclusion about temporal order:

86
There is considerable consensus that involvement in

delinquent behavior precedes any use of illicit drugs.

This generalization clearly does not apply to alcohol

use but does apply to the total range of illicit drugs

investigated.... There is consistent, compelling evidence

that delinquency precedes illicit drug use.

THE DELINQUENCY-DRUG USE RELATIONSHIP: IS IT SPURIOUS?

There is also a consensus that the delinquency-drug relationship among

adolescents is spurious; that is, the observed correlation between

these two variables washes out when variables antecedent to and

causally related to both delinquency and drug use are statistically

controlled.

Goode (1973), in a study conducted for the Marijuana Commission, said

that his findings strongly support the view that marijuana use by

itself is not related in any meaningful way to criminal behavior. He

claims that the spurious model seems to be a far more accurate description of the relationship between marijuana use and criminal behavior

than the causal model.

Elliott and Ageton (1976a) reached the same conclusion in a crosssectional survey of probability samples of over 8,000 youths 11 to

17 years old drawn from 7 cities. They compared their findings from

this study of "normal" youths with those obtained when only those

youths reporting substantial involvement in delinquency were examined

(n = 1,920). Summarizing the findings in their review article,

Elliott and Ageton (1976b) say:

The results of this study which involved surveys of

large normal youth populations suggest that the

association between marijuana use and income-producing

or violent crimes is spurious and that marijuana use

is normative for youth involved in any significant

amount of delinquency. The same finding was observed

for alcohol use. At the same time, these results

suggest that the use of hard drugs and the sale of

marijuana or hard drugs is associated with both incomeproducing and violent crimes, and that this relationship is not explained by one's general involvement in

delinquency.

Johnston et al. (1978) used a national probability sample of young men

studied at five points in time to examine the delinquency-drug use

relationship. While the ages covered were 15 to 23, items concerned

with initial age at onset of drug use did not appear in the schedule

until the fourth data collection. At this time, most of the respondents had been out of high school for a year. At this point, they

were asked to recall their drug use during the year prior to graduation, when they were 17 to 18 years old, and for the year after

graduation when they were 18 to 19 years old. Similar data on drug

use were obtained when the respondents were 19 to 22 years old

87
(fifth wave) and for the year immediately prior to the fifth point

of data. Elliott and Ageton (1976b) note: "It should be remembered,

however, that by the time the initial drug measures were obtained,

the cohort was approximately 19, recalling drug use 2 years earlier

when they were 17. The initial onset of drug use was probably missed

for a large proportion of sample subjects."

Johnston et al. (1978) used a composite measure of drug use involving

marijuana, other drug use (not including heroin), and heroin use, with

both a frequency and a seriousness dimension. Measures of delinquency

were gathered in all five waves yielding two indices: a Theft and

Vandalism Index (e.g., item on arson, car theft, theft of an expensive car part, school vandalism, theft of an inexpensive car part,

theft of objects worth over $50, trepassing, shoplifting, and theft

of objects worth under $50); and an Index of Interpersonal Aggression

(e.g., hit an instructor or supervisor, aimed extortion, injurious

assault, gang fight, and fight at school or work).

Their conclusions relate specifically to the question of whether the

delinquency-drug use relationship is spurious. The finding from this

study is especially important because the sample is from a normal population, it is representative of a nationwide cohort, and the data are

from a longitudinal study of the same subjects.

Johnston et al. (1978) state:

What we do conclude from these explorations is that

nonaddictive use of illicit drugs does not seem to play

much of a role in leading users to become the more

delinquent people we know them to be on the average.

The reverse kind of causation seems considerably more

plausible, that is, that delinquency leads to drug use.

For example, we think it quite possible that delinquents

who, because of their delinquency, become part of a

deviant peer group are more likely to become drug users

because drug use is likely to be an approved behavior

in such a peer group. We also suspect that the correlation between delinquency and drug use stems not only

from such environmental factors but also from individual

differences in personality. Both delinquency and drug

use are deviant behaviors, and therefore both are more

likely to be adopted by individuals who are deviance

prone. The fact that other forms of delinquency tended

to precede drug use (at least in this cohort) may simply

reflect the fact that proneness toward deviance is

expressed through different behaviors at different

ages. Further, for this cohort, the notion of using

illicit drugs at all was just rising to consciousness

among these young people as they passed through high

school. Studies of a more recent class cohort would

undoubtedly show less precedence of drug use by other

forms of delinquency because the average age of first

drug use has declined markedly.

88
So, while, we have relatively little direct evidence from

this study to buttress these alternate hypotheses for

explaining the connection between nonaddictive drug use

and other forms of delinquency, we intuitively find them

most convincing at present. Certainly the hypothesis

that the association exists because such drug use somehow

causes other kinds of delinquency has suffered a substantial, if not mortal, blow. (Johnston et al. 1978, p. 156)

The studies by Elliott and Ageton (1976a) and by Johnston et al. (1978)

are in agreement--the delinquency-drug use relationship is spurious.

However, whether the idea that the relationship is causal has suffered

a "substantial, if not mortal, blow," is still debatable for several

reasons. First, Johnston et al. (1978) focused only on illicit drug

use, ignoring the possible role of alcohol. They state: "Neither

would we suggest that alcohol, which was not investigated but which

is certainly a drug, does not lead to criminal or violent behavior"

(p. 155). Second, there is solid evidence that marijuana use is

strongly related to drug sales (see Single and Kandel 1978; Johnson

1973; Clayton and Voss, in press), and thus may be related to subsequent delinquency/criminality and use of other illicit drugs, both

directly and indirectly. If this is so, the marijuana use-delinquency/

criminality relationship may be elaborated by controls on drug sales.

Third, neither the Elliott and Ageton (1976a) study nor the study of

Johnston et al. (1978) tested the delinquency-drug use relationship

by controlling on variables antecedent to both that might be causally

related to them in a theoretical sense. In other words, these two

studies are essentially atheoretical. In order to address in this

paper the issue of spuriousness of the delinquency-drug use relationship and to determine if the conclusion that it is spurious is still

debatable, a correlation matrix from an unpublished paper by Krohn

and Massey (1979)1 was analyzed.

KROHN AND MASSEY (1979): SOCIAL BONDING THEORY, DRUG USE, AND

DELINQUENT BEHAVIOR

Krohn and Massey (1979) gathered data via self-administered questionnaires from a representative sample of male and female students (n =

3,065) in grades 7 through 12 in six communities within three midwestern states. Four forms of deviance were measured and used as

independent indices.

Alcohol/Marijuana Use. Self-reported frequency with which these

two drugs were used.

Hard Drug Use. Self-reported frequency with which stimulants,

depressants, psychedelics, and narcotics were used.

Minor Delinquency. Self-reported involvement in (a) running away

from home, (b) sexual intercourse, (c) truancy, and (d) school

suspension and/or expulsion.

1

Since Dr. Clayton’s paper was written, a paper based upon the Krohn and Massey

study has been published as: Krohn, Marvin D., and Massey, James L. Social

control and delinquent behavior: An examination of the elements of the social

bond. Sociological Quarterly, 21:529-544, autumn 1980.

89
Serious Delinquency. Self-reported involvement in (a) vandalism,

(b) motor vehicle theft, (c) assault, (d) use of or threatening to

use a weapon, (e) theft of things worth $2 to $50, and (f) theft

of things worth over $50.

The primary purpose of the study was to test the relative efficacy of

three major concepts from Hirschi's (1969) social bonding theory of

delinquency: attachment, commitment, and belief.

Attachment was measured by scales tapping the components of

(a) supervision, (b) praise, (c) discouragement, (d) closeness,

and (e) satisfaction. The questions composing these scales were

similar to those used by Hirschi and yielded indices of Maternal

Attachment, paternal Attachment, and Peer Attachment. Krohn and

Massey (1979) say: "The item to scale correlations indicate that

all three scales have a high degree of internal reliability."

(p. 10)

Commitment was measured on four dimensions: (a) grade point

average, and by questions similar to Hirschi's dealing with

(b) education aspirations and (c) career aspirations. In addition, Krohn and Massey created a (d) commitment scale by asking

the students to indicate how important participating in each of

the following activities is to them: school work, athletics,

musical groups, pep groups, other school activities, church

activities, and community clubs.

Belief was measured by three items concerning the degree of agreement or disagreement respondents have with parental norms (i.e.,

parents' morals are good for me), legal norms (i.e., moral duty

to obey the law), and the value of education (i.e., school learning

helps find job).

Thus, Krohn and Massey (1979) have a total of 10 predictor variables

representing the three major concepts from social bonding theory.

They used these variables to predict alcohol/marijuana use, use of

hard drugs, minor delinquency, and serious delinquency. While they

have the data to do so, neither Krohn and Massey (1979), nor Akers

et al. (1979), nor Krohn et al. (undated) seem to have examined the

efficacy of these variables in elaborating relationships among the

indices of deviance.

Krohn and Massey did provide a zero-order correlation matrix (see

table 2 for Pearson r values) for relationships among the three

attachment variables, the four commitment variables, the three belief

variables, and the four indices of deviance (alcohol/marijuana use,

use of hard drugs, minor delinquency, and serious delinquency). With

model A and Hirschi and Selvin's (1967) three criteria of causality

as guides, this matrix will be analyzed using partial correlation

and multiple regression techniques. This analysis will address a

basic research question: Is the delinquency-drug abuse relationship

among adolescents really spurious?

90
Table 2
ASSOCIATION AMONG FOUR INDICES OF DEVIANCE: THE KROHN AND

MASSEY (1979) STUDY

The data in table 2 indicate the presence of strong relationships among

the four measures of deviance.

Alcohol/Marijuana--Hard Drugs (r = .491)

Alcohol/Marijuana--Minor Delinquency (r = .593)

Alcohol/Marijuana--Serious Delinquency (r = .477)

Bard Drugs--Minor Delinquency (r = .424)

Hard Drugs--Serious Delinquency (r = .378)

Minor Delinquency--Serious Delinquency (r = .474)

It is clear that delinquency and drug use are associated and thus met

the first criterion of causality. The average correlational value

among the four measures of deviance is .473. Given the conservative

nature of the Pearson r measure, this is quite high. The average

correlational value among the three attachment indices is .263 compared

to a value of .086 among the four commitment items and .287 among

the three belief item.

TEMPORAL ORDER AMONG THE FOUR INDICES OF DEVIANCE: THE KROHN

AND MASSEY (1979) STUDY

Demonstrating association between delinquency and drug use was a simple

task. However, establishment of temporal ordering among the four

measures of deviance, the second criterion of causality, will be more

difficult since the paper by Krohn and Massey (1979) and other papers

based on these data (Akers et al. 1979; Krohn et al. undated) provide

no information on the question of time-order of occurrence. Another

complicating factor is that the data are cross-sectional. Therefore,

any temporal ordering imposed on these variables must be logically

and empirically defensible.

We can assume with confidence that minor delinquency and alcohol/

marijuana use are both antecedent to use of hard drugs and serious

delinquency. Since the data are cross-sectional, it is somewhat

more difficult to say with certainty where the social bonding variables

should be temporally located with respect to alcohol/marijuana use

and minor delinquency. However, given the relatively young ages

(12 to 17 years old) of the respondents and the fact that the social

bonding items reflect attachments, commitments, and beliefs that are

probably stable over time, we have assumed that the theory-based items

are antecedent to all four measures of deviance. Finally, it would

be unwise to posit a time-order among (a) alcohol/marijuana use and

minor delinquency or (b) use of hard drugs and serious delinquency

without further data analysis. Therefore, at this point we are

dealing with the relationships implied by model B.

92
With partial correlation techniques we can test sane of the assumptions about the temporal order among alcohol/marijuana use and minor

delinquency and serious delinquency and hard drug use.

Model B

A Social Bonding Model of Delinquency-Drug Use

Relationship Among Adolescents: The Krohn-Massey Study

Four Variables Found in Model B

93
The zero-order and partial correlations among these variables are:

Alcohol/Marijuana--Serious Delinquency (r = .477), controlling on

Minor Delinquency produces a partial r of .276, a reduction of .201.

Minor-Delinquency--Serious Delinquency (r = .474), controlling on

Alcohol/Marijuana yields a partial r of .270, a reduction of .204.

Alcohol/Marijuana--Hard Drugs (r = .491), partial r controlling on

Minor Delinquency equals .329, a reduction of .162.

Minor Delinquency--Hard Drugs (r = .424), partial r controlling on

Alcohol/Marijuana equals .189, a reduction of .235.

Simply put, these findings do not a1low us to unambiguously assign

temporal ordering to these four indices of deviance. Therefore, for

the present we will assume that the blocking of these four variables

as seen in model B is a fair reflection of reality for this sample.

Another way of attempting to unravel the time-order among these variables is to regress serious delinquency and use of hard drugs against

all variables possibly antecedent to them in model B. It is likely

that the standardized partial betas will be higher for those variables

most proximate to the dependent variable. It should be noted that the

standardized partial betas are synonymous with the unstandardized beta

values when a matrix without means and standard deviations constitutes

the input.

As the data in table 3 indicate, the order in which alcohol/marijuana

use and minor delinquency enter the equation is similar for both

serious delinquency and hard drugs. It is clear that alcohol/marijuana

use accounts for considerably more of the variance in serious delinquency. It is also clear that the beta for the alcohol/marijuana path

to use of hard drugs is considerably stronger than the path from minor

delinquency. When the dependent variable is serious delinquency,

alcohol/marijuana enter the equation first, but the path from minor

to serious delinquency is somewhat stronger. Overall, more than 30

percent of the variance in both serious delinquency and use of hard

drugs is explained by all of the predictor variables, although there

is a sharp diminution in incremental variance explained after the

three behavioral variables enter the equation.

The conclusion that seems best justified, although it is not as clear

as one would prefer, is that minor delinquency seem to be marginally

more antecedent to alcohol/marijuana use than vice versa. Therefore,

model C has been constructed to represent a best guess as to the

structure of the relationships among the variables in the Krohn and

Massey study.

94
Table 3

Regression of Use of Hard Drugs and Serious Delinquency

on 13 Predictor Variables: The Krohn-Massey Study

Dependent Variable = Use of Hard Drugs

Alcohol/marijuana use .291 196.877 .241

Minor delinquency .133 43.815 .268

Serious delinquency .126 48.061 .284

Commitment scale -.080 20.979 .291

Career aspiration .069 19.892 .295

School learning helps find job -.050 8.920 .298

Educational aspirations -.046 8.848 .300

Paternal attachment -.036 3.912 .302

Maternal attachment -.032 2.775 .302

Grade point aver-e -.016 .906 .302

Peer attachment .012 .604 .302

Parents morals are good for me .016 .770 .303

Moral duty to obey the law -.014 .646 .303

Dependent Variable = Serious Delinquency

Alcohol/marijuana use .212 104.535

Minor delinquency .231 140.710

Use of hard drugs .123 48.263

Peer attachment -.075 23.838

Grade point average -.072 19.377

Maternal attachment -.055 8.471

Parents morals are good for me -.046 6.709

Career aspiration .035 5.378

Moral duty to obey the law -.036 4.337

Commitment scale -.030 2.966

School learning helps find job .015 .831

Paternal attachment .O11 .342

.228

.284

.299

.308

.314

.318

.320

.321

.322

.322

.323

.323

Beta

Cumulative

F Value r Square

Educational aspirations Not in Equation

95
Model C

A Revised Model of the Delinquency-Drug Use Relationship Among

Adolescents: The Krohn-Massey (1979) Test of Social Bonding Theory

IS THE DELINQUENCY-DRUG USE RELATIONSHIP SPURIOUS?: THE KROHNMASSEY (1979) STUDY

With the association between delinquency and drug use firmly established and the temporal order tenuously established, it is now possible

to test the relationship for spuriousness. It should first be noted

that the items designed by Krohn and Massey (1979) to represent the

central concepts of Hirschi's (1967) social bonding theory are reliable

and are solidly grounded in a widely accepted theory of deviance, In

terms of conceptual grounding this test of the delinquency-drug use

relationship for spuriousness is somewhat superior to the tests conducted by Elliott and Ageton (1976b) and Johnston et al. (1978).

The data in table 4 indicate unambiguously that Johnston et al. (1978)

were not accurate in stating that the "causal" model of the delinquency-drug use relationship "has suffered a substantial, if not

mortal, blow." In fact, the data in table 4 indicate that the relationship between minor delinquency and alcohol/marijuana use in the

Krohn and Massey study is not spurious. The original relationship

(r = .593) is not substantially lower in any of the 10 first-order

partials. A simultaneous control on all of the 10 antecedent predictor

variables produces a 10th order partial r of .458, still statistically

significant and significantly different from the zero that would be

expected if the original relationship were spurious. While it is

true that statistical controls on sociodemographic variables such as

age and sex and psychosocial variables such as self-esteem, rebelliousness, and impulsivity were not employed, it is highly unlikely

that they would be sufficiently related to both minor delinquency

and alcohol/marijuana use to render that relationship spurious.

96
Table 4

The Minor Delinquency-Alcohol/Marijuana Relationship:

Testing for Spuriousness with the Krohn-Massey Study

Minor Delinquency-Alcohol/Marijuana Use

Zero-Order Partial

r r

.593

Attachment

Maternal attachment

Paternal attachment

Peer attachment

.550

.565

.593

Commitment

Commitment scale .542

Educational aspirations .593

Career aspiration .593

Grade point average .555

Belief

Parents morals are good for me

Moral duty to obey the law

School learning helps find job

Simultaneous control on all 10 variables listed

above (10th order partial)

.554

.545

.568

.458

SUMMARY AND CONCLUSIONS

The primary purpose of this paper has been to review critically what

is known about the delinquency-drug use relationship among adolescents.

In doing so the focus has been on applying the widely accepted criterion of causality outlined by Hirschi and Selvin (1967): association,

temporal order, and testing the relationship for spuriousness. The

extant literature has consistently proven a statistical association

between delinquency and drug use. There is also consensus that onset

of delinquency usually precedes involvement with illicit drugs. The

two studies (Elliott and Ageton 1976a; Johnston et al. 1978) that have

most rigorously applied the third criterion of causality also agree

that the delinquency-drug use relationship is spurious.

97
Data from a study of a representative sample of over 3,000 adolescents 12- to 17-years-old were analyzed with regard to the three

criteria of causality. While previous findings about association

and temporal order were confirmed, analysis of data from the Krohn

and Massey (1979) study provides strong evidence that the delinquencydrug use relationship is not spurious.

This finding is quite important and deserves additional comment for

several reasons. First, this is the first time that the delinquencydrug use relationship among adolescents has been systematically tested

for spuriousness with the results supporting the causal instead of the

spurious model. Second, the analysis on which these results were

obtained was completely secondary (i.e., the data input was from a

matrix in a paper unpublished at the time. Third, this study allowed

for testing the relationship for spuriousness with a series of items;

derived from a widely accepted theory of deviance. One might conclude

from these comments that there my be numerous data sets that could

be "reanalyzed" using model A and the three criteria of causality as

guides.

A preliminary list of such data sets would include the Treatment

Outcome Prospective Study (TOPS), the youth sample from the Supported

Work study, the national study of adolescent drinking behavior (Rachal

et al. 1975), the various national surveys of high school seniors

conducted annually by Johnston and his associates, and Howard Kaplan's

ongoing longitudinal study of over 9,000 youths in the Houston area,

to mention just a few.

It is also important to note again that the Krohn and Massey study was

designed explicitly to test a theory of deviance. In recent years a

great deal of attention has been devoted to refining and synthesizing

extant theories of deviance (Elliott et al. 1979) and theories in

the drug field (Lettieri et al. 1980). It is time for these studying

drug use and delinquency among adolescents to move beyond description

and into the etiology of those phenomena with vigor.

However, the implications of the finding that the delinquency-drug use

relationship may be causal instead of spurious extend far beyond the

empirical finding. Assume that the relationship, at least among

"normal" adolescents, is causal. With such an assumption, it may be

possible to devise efficacious early detection and drug education/

prevention programs that fall much closer to the primary than the

secondary and tertiary end of the prevention continuum. As Blum and

Richards (1979) note:

Drug abuse has become such a field in itself that its

practitioners sometimes forget that their clients are by

legal definition delinquents, and for those heavily drug

involved, there are likely to be continuing nondrug crimes as

well. (p. 263)

98
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AUTHOR

Richard R. Clayton, Ph.D.

Professor

Department of Sociology

University of Kentucky

Lexington, Kentucky 40506

103
Adolescence and Drug Abuse:

Biomedical Consequences

Sidney Cohen, M.D.

Many facets of the biomedical aspects of substance abuse in adolescents have not yet been adequately researched. Little is known about

the biological elements, if any, that contribute to the genesis of

substance abuse. In the instance of alcoholism a genetic vulnerability appears to be established from the studies of identical

twins, one raised by the natural parent and the other placed at an

early age in the home of nonalcoholic foster parents. In the studies

conducted both in this country (Goodwin 1974) and in Denmark (Goodwin

et al. 1973) the incidence of problem drinking of both groups of

twins was similar. It is well established that among people of

Mongolian descent, a widespread sensitivity to alcohol, based upon

the rapid accumulation of acetaldehyde, is observed (Seto 1978).

Facial flushing and more upsetting symptoms, including asthma and

hypotension, can be present. In those with marked discomfort after

drinking small amounts of ethanol, a certain preventive role is

probably played by this inborn racial change in the ability to metabolize alcohol.

Such genetic factors have not yet been uncovered for other psychoactive drugs. With the recent identification of opiate (Synder 1977)

and benzodiazepine (Braestrup and Squires 1978) receptor sites, and

the hint that other drug-specific receptors will be found, it becomes

conceivable that receptor site or endogenous ligand deficiency or

excess may come to constitute one of the variables in the pathogenesis

of the dependency disorders.

A fair amount of clinical and investigational information of varying

"hardness" is available about the biomedical consequences of adolescent drug abuse. What remains essentially unknown is whether juveniles

and adults respond to the mind-altering chemicals in a manner that

is qualitatively or quantitatively different. Do young organism

manifest a relative psychophysiologic vulnerability to any of the

drugs of abuse, as compared to the mature organism? Is it possible

that differences in the rates of absorption, distribution, metabolism,

and excretion my exist? Alternatively, adaptive mechanism on a cellular or on the human level are likely to be differentially developed.

Since adolescence is a period of high drug abuse, and since subsequent

careers of drug-taking are established and fixed at this time, the

medical sequelae are of considerable interest. These effects will

vary according to the drug group involved. In polydrug-using

104
individuals the consequences tend to be greater than in monodrug

abusers because of drug synergism, intensified psychic state, or

drug-drug interactions.

CANNABIS

As the most widely used illicit drug, the impact of cannabis is of

particular interest, especially since a more potent product is being

smoked by younger age groups, with more daily smokers being counted.

A controversy exists regarding the exact amount of harm that consistent

smoking of marijuana can do. Dosage levels are obviously one of the

interacting variables that determine whether adverse effects will

occur.

The immediate side effects of cannabis use consist of acute anxiety,

panic, and confusional and paranoid states. These side effects are

infrequent, however. A small number of case reports of schizophreniform reactions has been reported in the American literature (Treffert

1978). These are probably psychotic reactions precipitated by marijuana in predisposed individuals. Impaired psychmotor performance

for complex tasks has been well demonstrated (Willette 1977). The

impairment of immediate recall also seems well documented (Loftus

1980).

Intermediate side effects include flashbacks (an uncommon event)

(Stanton et al. 1976), tracheobronchitis that is similar to tobacco

smoker's cough (Henderson et al. 1972), and psychologic dependence

(Nowlan and Cohen 1977). Immunologic (Cushman and Khurana 1977),

chromosomal (Morishima et al. 1976), cellular protein synthesis

(Blevins and Regan 1976), and hormonal changes (Smith et al. 1979)

have been described, but these are difficult to evaluate, not only

because they have not been invariably confirmed, but also because

much of the work has been done on in vitro and animal preparations

and their relevance to the human condition remains to be established.

Now, nevertheless, sufficient evidence is accumulating, and these

findings cannot be ignored.

Perhaps the most frequently asked question about cannabis is whether

the amotivational syndrome (Kolansky and Moore 1972) that appears to

occur most often in adolescents and young adults is a drug-related

event, or whether the loss of drive and goal-directedness is primarily

a psychosocial process that marijuana reinforces. It is most likely

that both possibilities occur. For some, consistent usage will

promote passivity and loss of motivation, for others who drop out

because of situational and personality difficulties, marijuana will

act as a satisfactory reinforcer.

The reduction in drive states seen in certain young users may have a

biologic substrate. It may be a reflection of lowered drive hormones

like testosterone or leutinizing hormone (Harclerode et al. 1979). It

could represent the limbic system changes described by Heath et al.

(1979). It is also quite likely that a good part of the picture can

be accounted for by the sedative quality of marijuana. It is employed

105
by some people for its tranquilizing and sleep-inducing effects. When

large amounts of a sedative are used during the waking hours, it must

be expected that a loss of ability to perform and a drop in motivation

will result. Alcohol, opiates, and hypnosedatives will induce similar

effects.

The long-term changes of concern include the possibilities of chronic

obstructive lung disease and pulmonary carcinogenicity (Alper and

Cohen, 1980). The comparison with tobacco is justified, since

similar coal tars are present in both plants. The combined use of

both products may be particularly undesirable (Tennant 1980). Whether

cannabis produces physical dependence is contingent on dosage. In

amounts not commonly used on the street at present, tolerance and a

withdrawal syndrome are discernible on sudden discontinuance (Hollister

1979).

OPIATES

Most of the serious adverse consequences of opiate use are secondary

to the contamination of the injected bolus. The exceptions include

overdose and anaphylactic reactions (Cherubin 1968). Of the infections resulting from inattention to sterile techniques, hepatitis is

the most frequent, almost invariable complication. Endocarditis,

thrombophlebitis, and a variety of pulmonary insults are not infrequent. Metastatic infections originating from the heart valves and

lungs can lodge in any organ and cause inflammatory reactions or

abcess formation.

The dangers in the life of a heroin user must be noted: they include

the "hot shot" (an intentionally lethal dose provided by the dealer)

and other homicidal events, accidents due to oversedation, and diseases

caused by malnutrition and poor hygiene. The rigors of withdrawal

are not great at present, since only small mounts of the drug are

to be found in the "bag," and detoxification facilities are generally

available.

SEDATIVES

The intoxicated state, with its hazards from poor judgment, impaired

motor skills, and irritability, contributes to accident proneness.

Violent behavior is seen just as in the closely related alcoholintoxicated states. Sedatives are the most frequently used chemicals

for suicidal purposes, with the barbiturates being the preferential

drugs for this use (Cohen and Blutt 1978).

Physical dependence occurs with continued use of sedatives. The withdrawal syndrome is more impressive than opiate withdrawal, and it

can be life-endangering. Another ominous feature is that, although

tolerance to large amounts of barbiturates takes place, the lethal

dose may be only a few capsules more than the well-tolerated amount.

The combined use of sedatives with a related drug such as alcohol has

resulted in fatalities even when the blood levels of both substances

were at less than lethal concentrations. Barbiturates also interfere

106
with the metabolism of a number of classes of therapeutic drugs, and

may nullify the efficacy of these agents.

Adolescents appear to react much like adults to acute or chronic sedative abuse.

VOLATILE SOLVENTS

Volatile solvents have particular relevance for youths: they may be

the initial drug abused by grammar and junior high school students

(Carroll 1977).

Bass (1970) described a sudden sniffing death, that is, a cardiac

arrest from a combination of the solvent, the relative unavailability

of oxygen, and sensitization of the pacemakers of the heart to the

overproduction of adrenalin in response to stress.

Depending upon the solvent, occasional peripheral nerve cell, liver,

kidney, or bone marrow damage might occur. Heavy usage in children

has resulted in neuropsychological deficits that have not cleared

over a few months of abstinence (Berry et al. 1979).

HALLUCINOGENS

The acute toxicity of drugs such as LSD consists of anxiety, panic,

and psychotic reactions. Prolonged psychotic reactions are likely

to be underlying schizophrenic disorders unleashed by the hallucinogenic experience. Flashbacks are not uncommon and are more apt to

occur in those who have had multiple LSD exposures (Stanton et al.

1976).

Certain features of the phencyclidine (PCP) state permit its inclusion

with the hallucinogens (Lerner and Burns 1979). In addition, hypertension, ataxia, analgesia, amnesia, confusion, agitation, and depersonalization combine to induce behavioral toxicity greater than that

seen with the LSD-type hallucinogens. A toxic and a schizophreniform

psychosis have often been seen, the latter being difficult to differentiate from acute paranoid schizophrenia without blood or urine tests

for phencyclidine. Therefore, acute psychotic breaks in youngsters

should be checked with urinary PCP and amphetamine tests. A severe

depression may occur during the waning phase of the experience.

PCP-related death can be caused by suicide, homicide, accident, respiratory depression, convulsions, or cerebral hemorrhage. The

schizophrenic-like state may persist for weeks or months. Recurrences

of the psychosis after recovery are possible without further drug

ingestion. Multiple psychoses are observed in individuals who return

to the use of PCP, in sane instances because of amnesia regarding

the psychotic experience. Violence is a real problem. During the

sober interval after many PCP exposures, mood and thought disturbance

may continue to be measurable.

107
STIMULANTS

The amphetamines are prototypical compounds of the stimulant class.

Hypertension, arterial wall changes, heart rhythm disturbances, and

convulsions are some of the occasional complications of high dose or

prolonged use. The actual hypertension my cause cerebral hemorrhage

and, as with PCP, this group is to be considered in instances of

teenage stroke. Overdose is infrequent. A paranoid thought disorder

or paranoid psychosis will emerge when the amphetamines are used in

increasing quantities over time (Griffith et al. 1972).

Behavioral toxicity causes much of the morbidity and mortality associated with stimulant abuse, and its biochemical basis consists of

increased availability of dopamine and norepinephrine at the neuronal

synapse. Hyperactivity, impulsiveness, aggressiveness, and paranoid

thinking combine to cause accidents and homicides. Suicide is a

possibility during the withdrawal phase when serious depression can

occur. A decade ago the fad of injecting enormous quantities of

amphetamines became rather popular. This was was the "speedfreak" phenomenon (Cohen 1989). Apparently, because of the intensity of the

state and the miserable withdrawal period, the fad eventually subsided

and hardly exists at present.

As a rule, adolescents only use cocaine occasionally, since it is

priced out of the market for regular use. The intravenous use, and

particularly the smoking of cocaine base (Jeri 1978) is much more

likely to provoke adverse effects than snorting. These effects

consist of strong psychological dependence, paranoid modes of thinking,

heart rhythm irregularities, and the behavioral toxicity of the other

stimulants.

ALCOHOL

Alcohol is mentioned here because it is a substantial adolescent problem in its own right (Blane and Hewitt 1977) and is often combined

with the other drug classes already mentioned. In adolescents the

excessive use of alcohol produces impaired behavioral controls. This

can result in belligerence, accident proneness (especially while

driving), impaired school performance, and problems involving the

law. Young people drink less consistently than older people, but

tend to consume more on a single drinking occasion (Third Special

Report 1978). Therefore, the various chronic organ impairments are

less likely to occur in youths than in adults. However, the age of

first diagnosis of cirrhosis of the liver is decreasing, and 25- to

30-year-olds with cirrhosis, which takes 10 years or more of heavy

drinking to develop, are being seen. The acute effects of heavy

drinking, such as gastritis or bleeding peptic ulceration are more

likely in the adolescent.

If heavy drinking patterns are established during the early years of

life, they tend to persist. Then the biomedical consequences are

considerable. Damage to the pancreas, liver, nerves, muscles, endocrine glands, heart, and brain become likely. In large quantities

108
alcohol is a protoplamic poison affecting all cells. Its first

metabolic product, acetaldehyde, is believed to be responsible for

some of the tissue damage (Korsten et al. 1975) in heavy drinkers.

In addition, the acidic shift associated with alcohol metabolism

affects carbohydrate, fat, and protein metabolism, producing a large

array of disease states.

SUMMARY

The consequences of excessive drug use may be substantial. This is

true for every abused drug, the only requirement being that sufficiently large amounts be taken over a sufficiently long period of

time. In some instances the untoward effects are imediate, during

the period of acute intoxication; in others they may be delayed for

decades.

The adolescent, at a stage of psychophysical development when adaptive

responses are being learned, is probably more vulnerable to the loss

of learning time than the adult. If intoxication with the depressant

class of drugs occupies much or all of the waking hours, or if the

overuse of drugs becomes the only learned technique for coping with

life stresses, the developmental process stops.

Since youth is a period of exploratory, risk-taking, sensation-seeking

behavior, it is this group that has traditionally become over-involved

in experiences such as drug misuse. It would be a major undertaking

to understand the nature of adolescence and to develop strategies to

reduce its destructiveness.

FUTURE RESEARCH DIRECTIONS

1. It is important to cane to an understanding of the risk factors

in cannabis use by adolescents, particularly the effect on the

gonadal hormones and the question of amotivation. The matter of

cannabis' carcinogenetic potential should also be studied. Certain clinical questions, such as whether daily cannabis use leads

to increased vulnerability to infections in pre-adolescents and

adolescents, could be determined with well-designed investigations

of large samples.

2. It may be necessary to await additional basic information before

a search for biomedical causes of various types of drug abuse in

juveniles can be designed.

3. A search for any differences between adolescent and adult drug

abuse effects would be well worth undertaking. An appropriate

animal could be used for such comparative work.

4. Animal work with abusable psychoactive drugs should sometimes

include younger experimental groups when the drug involved is

favored by the youthful population, e.g., when the pharmacology

of the solvents is being examined.

109
5.

6.

7.

8.

When certain drugs, PCP for example, are particularly damaging

and are widely used by teenagers, research into early intervention

strategies seem worthwhile.

Something might be learned from a retrospective look at former

"speedfreaks," why they quit, and their subsequent history.

Perhaps the information may be applicable to some of today's drug

abuse problems.

The causes and careers of amotivation require immediate research

attention.

Cannabis use in the 8- to ll-year-old group must be studied to

confirm or refute the impression that this age group is becoming

more heavily involved

FOOTNOTE

1

 A brief review is given in Cohen, S. Cannabis and Driving, 1980.

Alper, K., and Cohen, S. Pulmonary effects of Marijuana. Drug Abuse

Alcohol Rev, 3(1/2):1-13, 1980.

Bass, M. Sudden sniffing death. JAMA, 212(12):2075-2079, 1970.

Berry, G.J., Heaton, R.K., and Kirby, M.W. Neuropsycholcgical assessment of chronic inhalant abusers: A preliminary report. In: Sharp,

C.W.) and Carroll, L.T., eds. Voluntary Inhalation of Volatile

Solvents. DHEW Pub. No. (ADM)79-779. Washington, D.C.: U.S. Government Printing Office, 1979. pp. 111-136.

Blane, H.T., and Hewitt, L.E. Alcohol and Youth: An analysis of the

literature: 1960-1975. Prepared for the National Institute on Alcohol

Abuse and Alcoholism under Contract No. ADM 281-75-0026. Rockville,

MD, 1977.

Blevins, R.D., and Regan, J.D. Delta-9-THC: Effect on macromolecular

synthesis in human and other mammalian cells. Arch Toxicol, 35:127-

135, 1976.

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1977.

AUTHOR

Sidney Cohen, M.D.

Neuropsychiatric Institute

UCLA School of Medicine

Los Angeles, California 90024

112
Executive Summary, Discussion,

and New Directions for Research

Robert Russell, Ph.D.

The spread in the use of marijuana and other illicit drugs represents

one of the most striking instances of social change of the last decade.

The health consequences of this change are of special concern because

they involve young people at most crucial and vulnerable phases of

their biological and psychological development, and because increasing

drug usage has been accompanied by decreasing age of initiation into

drugs and by peak rates of use in the years of young adulthood when

individuals must make commitments regarding family and work participation.

In addition to laboratory and field surveys, our knowledge of the

antecedents and consequences of drug behavior has been greatly enhanced by longitudinal followup studies of normal populations of

youths that have observed young people both before and after they get

involved in drugs. Most of the completed studies have dealt with

adolescents. Only recently have a number of new studies been initiated

that follow young people into young adulthood to provide much-needed

data on the potential consequences of drug use on psychosocial functioning in early adulthood. At this time, more is known about the

psychosocial determinants than the consequences of adolescent drug

behavior. In particular, longitudinal studies have defined the

developmental process of involvement in drugs in which experimentation

with one of the legal drugs is a necessary, although not sufficient,

experience for subsequent experimentation with other illicit drugs.

Many of the factors found to be related to drug usage at one point in

time are, in fact, precursors to drug use, with different factors predicting initiation into different stages of use. Peer influences and

attitudes favorable to marijuana use are especially important for

initiation to marijuana. Poor relationships with parents, feelings of

depression, and peer influences predict initiation into more severe

illicit drugs. The data so far do not indicate that marijuana use is

associated with any increases in criminal activity. The evidence concerning effects on the "amotivational syndrome" is ambiguous. Newly

initiated followup studies in early adulthood and studies that focus

on daily users will provide information about the social functioning

of drug users in young adulthood.

113
Epidemiology

The most recent epidemiological data on drug use patterns in the 12

to 21 age group are provided by two series of nationwide surveys:

the national survey of high school seniors (Johnston, Bachman and

O'Malley, 1979) and the national survey of the household population

aged 12 and older (Fishburne, Abelson and Cisin, 1980), both funded

by the National Institute on Drug Abuse. The use of alcohol and

cigarettes typically precedes the first marijuana experience. About

half of those who try marijuana in their teen years eventually

progress to stronger drugs. Those who begin marijuana use at an early

age are more likely to progress to the use of "stronger" drugs.

First use of marijuana typically occurs prior to the senior year of

high school, but first use of such drugs as cocaine or hallucinogens

is most likely to take place in late adolescence.

Opportunity to try marijuana is an important factor in prevalence

rates. The large majority of 12- to 13-year-olds have never had the

chance to try marijuana, and indeed, less than 10 percent of this age

group have ever used the drug. In contrast, 83 percent of 18- to

to 21-year-olds have had an opportunity to try marijuana, and 69

percent have "ever used." Less than 10 percent of these say they

have used on only one or two occasions; most have used many more

times.

Few young persons take advantage of their first opportunity to try;

repeated exposure to marijuana-using peers seems to be necessary.

The "time lapse" across first acquaintance with a marijuana user,

first opportunity, and first use suggest that few young persons

"seek out" the chance to try marijuana.

Personality and Sociodemographic Factors

The relationship between personality factors and drug abuse is not

clear-cut, and findings are frequently contradictory. However,

findings suggest:

The single personality dimension most linked with drug abuse is

lack of traditional values and related dynamics: rebelliousness,

resistance to traditional authority and social structures, high

need for autonomy, and social alienation (but not personal

alienation).

Characteristically, studies find weak correlations between lower

self-esteem and drug use. One study, however, found depression

to be an important variable in drug use.

Some relationship exists between high sensation seeking and drug use.

The majority of correlational studies have failed to find

convincing evidence of gross pathology in samples of drug users

as compared to non-users.

114
Among college-age populations, marijuana use has become the

normal behavior so that the personality variables associated

with drug users in college tend to be those for the age group

as a whole.

Sociodemographic factors indicate:

Age for licit or illicit drug experimentation begins in teens and

begins to recede by mid-20's. The age of first marijuana use

seems to be decreasing, but the age of initial heroin use is

increasing.

Sex differences in drug use are disappearing, but remain for

certain classes of drugs and age groups.

Socioeconomic status has not keen demonstrated as a powerful

predictor of drug use when considered alone.

Religiosity is consistently correlated with lower incidence

of drug use.

Most recent studies of marijuana and alcohol use in college

samples have not found racial differences; however, among

younger adolescents, researchers find an overrepresentation

of blacks, Hispanics, and Native Americans among users of some

drugs other than marijuana.

Peer and Emily Influence

The family and peer group are the adolescent's primary sources of

socialization, but there is considerable disagreement about the

relative contributions of each group with respect to drug abuse.

Hirschi's theory suggests that parents have a direct, independent

effect on their adolescent's delinquent behavior regardless of peer

group. Sutherland's theory, on the other hand, asserts that the

crucial factor in adolescent delinquent behavior is the availability

of deviant role models in the peer group. Other approaches view

influence as situation- or domain-dependent.

Kandel has proposed a developmental model for three stages of drug

drugs.

use: initiation into hard liquor, marijuana, and other illicit

Kandel suggests that parents play a substantial and specific

role in influencing adolescent use of hard liquor. This is through

a direct modeling effect and parenting styles in approaching

adolescent liquor use. A reasoned, democratic parenting style may

have a positive effect on adolescent drug use, as will good parentchild relationships.

parental influence, however, is quite small with regard to initiation

of marijuana use. In contrast to liquor, adolescent initiation into

marijuana was virtually unrelated to any type of drug used by parents.

parental influence is based only on attitudes and closeness of relationship.

115
Initiation into use of illicit drugs other than marijuana appears to

be strongly related to parental influence, particularly the quality

of the parent-child relationship. Parental drug use is also a

predictor.

Delinquency and Drug Use

The three criteria of causality, as outlined by Hirschi and Selvin,

are association, temporal order, and testing the relationship for

spuriousness. The extant literature has consistently proven a

statistical association between delinquency and drug use. There is

also a consensus that the onset of delinquency temporally precedes

involvement with illicit drugs. The two studies that have most

rigorously applied the third criterion, testing for a spurious

relationship, have also agreed: the delinquency-drug use relationship is spurious. A third analysis by Krohn and Massey disagrees

and provides strong evidence that the delinquency-drug use relationship is not spurious. obviously, further work is needed in

this area.

Biomedical Consequences of Drug Use in Adolescence

A genetic vulnerability factor has been established for alcohol abuse.

Such genetic factors have not yet been uncovered for other psychoactive drugs, but the recent identification of opiate and

benzodiazepine receptor sites seem to indicate that there may well

be a biological basis for susceptibility to dependency disorders.

The effects of drugs on adolescents are open to further study. Are

the effects in term of absorption, distribution, metabolism, and

excretion different for young organism versus mature organisms?

What are the effects on developing endocrine systems and psychosocial

development?

Cannabis, the most widely used illicit drug, can cause these side

effects, albeit infrequently: acute anxiety, panic, and confusional

and paranoid states. Impaired psychomotor performance in complex

tasks and reduced peripheral vision have been demonstrated with

special implications for driving. Impairment of immediate recall

seems well documented, with possible implications for learning. Continued use of cannabis undoubtedly results in lung damage, and it may

be a carcinogen with effects similar to those of tobacco.

Most of the serious adverse consequences of opiate use are secondary

to the contamination of the injection site, although overdose and

anaphylactic reactions are very real, direct dangers. Of the

secondary infections, hepatitis is most frequent, with endocarditis,

thrombophlebitis, pulmonary insults, and metastatic infections also

possible.

Sedatives cause physical dependence with continued use, and unsupervised withdrawal from sedatives can be a life-threatening event.

Further, although tolerance to large amounts of barbiturates takes

116
place, the lethal dose may be only a few capsules more than the

amount well tolerated. The combined use of sedatives and alcohol

can easily be fatal, and this seems to be the combination of choice

for suicides. Barbiturates also interfere with certain therapeutic

drugs, nullifying their effect.

Volatile solvents are particularly dangerous for youth. A "sudden

sniffing death" syndrome has been described, as well as nerve,

liver, kidney, and bone marrow damage. The damage is not reversible

with abstinence.

Hallucinogens typically produce anxiety, panic, "flashbacks," and

psychotic reactions. Phencyclidine (PCP), a particularly toxic

hallucinogen, can cause hypertension, ataxia, analgesia, amnesia,

and a schizophreniform psychosis difficult to distinguish from the

real thing. The psychosis lasts for months and may recur without

further drug ingestion. Death may result from suicide, homicide,

accident, cerebral hemorrhage, or overdose.

Stimulants may cause hypertension, arterial wall changes, heart rhythm

disturbances, convulsions, and cerebral hemorrhage. A paranoid thought

disorder may be associated with prolonged use.

117

388-024 0 - 82 - 9
Discussion

The Epidemiology of Drug Use Among Adolescents

. . . Judith Droitcour Miller

The need to take a broader perspective in investigations of drug use was

the primary theme of the discussion. More specifically, the reviewers

suggested that such research should include a broader age span, a consideration of polydrug use, especially drugs used concurrently with

marijuana, and more sensitive treatment of sex differences in

drug use.

Two age groups adjacent to adolescents were of particular interest--

young adults and older children ( 9 to 13 years). An interest

in the changing nature of drug use across the lifespan was an underlying

concern regarding both age groups. A general hypothesis was that the

availability or perceived availability of drugs determines, in part, the

sort of drugs used by a particular age group. Older children might find

it easier to obtain marijuana than alcohol. Likewise, young adults my

switch from marijuana or other illicit drugs to prescription drugs when

adult status makes prescriptions more readily available.

Survey data concerning these possible trends in drug use were discussed.

It seems clear that marijuana use is increasing among older children,

but drug use trends among young adults are unclear and must be examined

with caution for possible cohort effects. Some cohort effects may not

become apparent for years (e.g., "drug era" adolescents will not reach

middle age for at least another decade).

The study of drugs used concurrently with marijuana was also discussed

with interest. Some survey data indicate that the use of marijuana is

rising faster than the use of other illicit drugs--thus, the proportion

of marijuana users who use other drugs may be declining. This may

indicate a change in the nature of drug use-fewer adolescents may be

proceeding from the stage of marijuana use to the use of other drugs.

A final area of discussion concerned sex differences in drug use.

It was hypothesized that drugs are used (or abused) to cope with life

crises. The types of drugs used my depend upon availability for a

particular age group and the sex of users within the age group.

Survey data indicate men use more illicit drugs than women during

adolescence, but that more women use more psychoactive prescription

drugs than men during adulthood. However, men use more alcohol in

adulthood.

The discussion clearly brought out the need for consideration of a

broad range of factors--age group, availability of drugs, cohort

effects, patterns of drug use, sex differences, and types of drugs

(illicit drugs, prescribed drugs, and alcohol)--for a fuller understanding of the epidemiology of drug use among adolescents.

118
New Directions for Research

More information is needed about drug abuse among special adolescent

population groups that are typically excluded from national survey

frames. Some of these groups, such as high school dropouts, young

members of the armed forces, and residents of college dorms, my be

of particular interest since they may be characterized by higher

levels of involvement with drugs than their same age peers who are

more routinely studied. Most population groups are included in sane

national surveys of drug use, but the problem is that the number of

respondents may not be large enough for reliable estimates in small

population groups. A remedy for this problem might involve pooling

data from several survey years or oversampling for these special

population groups.

119
Discussion

Personality and Sociodemographic Factors in Adolescent Drug Use

. . . Kelin E. Gersick

Three major directions were suggested for future research concerning

personality factors underlying drug use:

Incorporation of a developmental perspective;

The need to understand the role of personality factors and drug

use in context; and

The need to understand drug use as it relates to other deviant

behavior.

The role of personality factors in drug use had little predictive

value. Previous research has primarily involved cross-sectional

studies of the relation between static personality traits and drug use,

and such research cannot directly address questions concerning antecedents and results or reciprocal influences between drug taking and

personality. Longitudinal, developmental studies of personality and

drug use, including drugs besides marijuana, were suggested as a more

effective means for achieving an understanding of the dynamic interplay between personality development and drug-taking behavior.

Another criticism of previous personality research was the failure to

place behavior in context. Consideration of the historical context

may reveal conformity for predicting abstention from drug use in the

past, but abuse in the present. The nature of the immediate social

context, such as the peer group, may lead to differential influence

of conformity on drug taking depending own dominant group values

(e.g., conformity to the values within a Christian youth group may

lead away from use of illicit drugs). Thus, the reviewers felt the

study of personality in isolation from context had less predictive

and explanatory value. More "ecological" research was recommended.

The final observation was the need to study drug use as it relates to

other deviant behaviors. It was felt that the factors that characterize

drug use might also characterize such behaviors as early premarital sex,

juvenile delinquency, and other deviant activities. Thus a common

predisposition might yield a tendency to engage in a variety of

deviant behaviors. In addition, involvement in one deviant activity

might be related to involvement in another. however, possible predispositions to deviant activity must also be studied in context--

what is deviant within one peer group may not be so within another,

even if the society at large views the activity as deviant.

In summary, the reviewers suggested studying personality development

and drug-taking behavior as it occurs within specific contexts and

as it relates to other deviant activities.

120
New Directions for Research

1. More attention should be given to the role of developmental

factors in drug abuse. Variables such as chronological age or

school grade fail to capture the quality of development within

the child. The stage of development my be more important than

standard factors in determining the nature of a child's behavior

or the meaning of a situation to the child. Research that can

identify adaptive and maladaptive phasing of different kinds of

stages-drug use, cognitive development, moral development,

social skills--would be particularly useful.

2. An anthropological approach should be used to detail the characteristics of particular social environments and points in time.

Context is extremely important in the consideration of psychosocial behaviors such as drug use. Thus, we require more specific

data on differences within racial and ethnic categories and

between neighborhoods, and greater attention to cohort effects

and rapidly changing cultural events.

3. Researchers who make an effort to reach "hard to get" populations

(e.g., 8- to ll-year-olds) and use innovative data-gathering

techniques should be rewarded. For example, one experimenter

trained children to collect data through interviews.

4. Some research should be conducted on the correlates (e.g., religiosity) of non-use of drugs in high-risk areas.

121
Discussion

From Family to Peer: Transitions of Influence Among Drug-Using Youth

. . . Thomas J. Glynn

The discussion of family and peer influences centered around:

A model for conceptualizing the dimensions of parent and peer

influences; and

The nature of the influences of parents and peers.

A model for characterizing parent and peer influences consisted of

behavior, attitudes or values, and the quality of the relationship.

Behavior was seen as influencing the child through modeling, attitudes

as affecting the child's thinking or decision making, and the quality

of the relationship as affecting psychodynamic processes within the

child. The reviewers recommended that the investigator in any study

make clear which influence is under investigation. Modeling of

parental drinking has been related to alcohol use among adolescents,

whereas the quality of the parent-child relationship seems to affect

drug taking.

The reviewers discussed parent and peer influences as being complex

and interlocked--an "either/or" model was seen as too simplistic.

Neither parents nor peers totally influence the adolescent in all

areas, although the influence of one may be more powerful with respect

to specific areas. Howwever, it is likely that both will have sane

influence in most areas. For example, although the influence of

peers may dominate concerning marijuana use, the quality of the

relationship with parents may exert some influence.

Two aspects of parent and peer influence were explored in depth: the

social context and the nature and quality of parent and peer relationships. The advent of the "youth culture" confirms the feeling of many

parents: certain aspects of adolescent behavior are largely under

the influence of autonomous social systems (e.g., adolescent dating)

and are not under the control of parents; The embeddedness of deviant

activities within such autonomous social systems must be understood

if such activities are to be brought under control. The suggestion

was that parents must organize to "get around" or gain control of

such a system if the behavior in question is to be influenced.

Peer relationships were described as short-term and relatively casual

when compared to the long-term and deeper relationships children have

with their parents. Thus, there was sane speculation that peer relationships exert influence primarily through modeling, whereas parentchild relationships not only influence behavior through modeling, but

also exert deeper influences on the development of the child's character and values. There was mention, however, of the intensity and

importance of a peer relationship while it lasts. One study showed

the best friend, not parents, to exert an influence on marijuana use.

122
Since peer relationships are relatively brief, in many cases, shortterm longitudinal studies of concurrent parent-child and peer relationships were suggested as a means for investigating this littleexplored area.

New Directions for Research

1. Age of first drug experience is getting lower with each epidemiological report. How will relative family and peer influence change

as age of first drug use lowers? Since data now suggest that

parental modeling is the most important predictor for adolescent

initiation into alcohol use, and peer modeling for marijuana use,

will the strength of these influences change as they are applied

to younger children or will the same patterns be followed, only

earlier?

2. Does initiation into drug use lead the adolescent to association

with drug-using peers or does association with drug-using peers

lead to drug use? This classic question, although posed in an

"either/or" fashion, will have many qualifiers when addressed by

research (e.g., a finding might be "association with drug-using

peers is related to initiation of use, but parental influence

determines the extent of that use"). Nevertheless, this question

has thus far resulted in data that support both positions and is

clearly in need of further research.

123
Discussion

The Delinquency and Drug Use Relationship Among Adolescents:

A Critical Overview

. . . Richard R. Clayton

The nature of the causal relationship between delinquency and drug

use predominated in this discussion. The primary question was the

direction of causality-does delinquency lead to drug use or the

reverse? Such a question should be considered within a broad theoretical context of deviance.

The primary research suggestion was that a "microscopic" look be

taken at the interrelationships between daily drug taking and engagement in delinquent activities. It was hypothesized that when drugs

are being taken on a daily basis, there is more of a tendency to

become involved in crime than when the same person is not taking

drugs on a daily basis. An important recommendation was that the

person's degree of involvement in drug and crimes be considered in

such an investigation.

New Directions for Research

1. The causal nature of the delinquency-drug relationship needs

investigation. Extant data sources ought to be reanalyzed using

the criteria of causality articulated by Hirschi and Selvin

(association, time-order of occurrence, and testing for spuriousness), the elaboration and techniques of Lazarsfeld, Hyman,

and Rosenberg at the nonparametric level, and Blalock, Heise,

and Duncan at the parametric level.

2. More attention should be given to the intersection of drug using

and delinquent episodes, studied intensively over time in longi3.

4.

5.

tudinal studies of adolescents moving toward young adulthood. A

promising approach might be a modification of the crime days

concept (i.e., "drug days") developed by Ball et al.

Considerably more research is needed on the utility of the concept of deterrence, particularly perceived certainty of detection

and sanction, found in the work of Erickson and Gibbs, as it

relates to delinquent and drug-using behaviors among youth.

The effects of changes in the age structure on present and projected future rates of both drug use and delinquency have been

virtually ignored, except for Zimring's "Bright" paper commissioned by the National Institute of Juvenile Justice and Delinquency Prevention (1975), and Toby's succinct piece in the New

York Times (1977).

The National Institute on Drug Abuse should encourage efforts to

integrate theories of delinquency and deviance with theories

about drug abuse.

124
Discussion

Adolescents and Drug Abuse: Biomedical Consequences

. . . Sidney Cohen

A traditional hypothesis discussed was the possible physiological

predisposition of sane individuals to drug abuse. However, most

heavy drug abusers take drugs to make themselves "feel better"

(e.g., to allay depression or a lack of feeling). The perceived

effects of drugs (i.e., how they make people "feel better") are

poorly understood. Recent research on "receptors" may, however,

cast new light on the effects of drugs and the reasons for certain drug actions.

One interesting hypothesis was offered during the discussion that

illustrates the inseparability of the physiological and psychological

aspects of drug taking. Many heavy drug or alcohol users report a

"big bang" when they are "high" or "intoxicated." This psychological

state is described as something that cannot be well understood by

those who have not experienced it. There was a "hunch" that there

may be a physiological reason for experiencing such states. Further

work is needed in this area of investigation.

New Directions for Research

1. Research is needed comparing the effects of drugs on the young

and adults. Virtually all of the research concerning drug

effects uses adult subjects, animal or human. It is known

that reactivity to drugs varies with age and stage of development; however, little is known about the nature of this reactivity, physiologically and psychologically. Some drugs may

have an adverse effect on children and not on adults (e.g.,

adolescents may experience the "amotivational syndrome" with

heavy marijuana use, whereas this condition is less frequent

among adult users).

2. There is little research concerning the long-term effects of

marijuana use. It is very probably carcinogenic: coal tars

from marijuana produce cancer on rodent skin similar to that

produced by cigarette tars. Marijuana may have harmful effects

on the hormonal systems, and the "amotivational syndrome" may

accompany heavy marijuana use. More research is needed to

understand the physiological and psychological effects of

marijuana use.

3. Little is known about the subsequent life experience of former

abusers of "fad" drugs, such as "speed freaks." Why did they

start? Why did they stop? What have been the long-term consequences of their drug abuse experience? A retrospective or

followup study of former "speed freaks" might yield valuable

insight for prevention and treatment.

125
GENERAL RESEARCH SUGGESTIONS

There was general agreement that research should involve younger

cohorts in longitudinal studies of development and should examine

drug use in context. Such studies are enormously complex, and discussion centered about problems of analyzing data from large-scale,

longitudinal investigations.

There are methodological problems with such studies. Little consistency exists in design when longitudinal studies are contrasted,

so problems in comparability appear. One specific methodological

problem with longitudinal studies is determining the proper time

intervals for followup.

A mare practical problem with longitudinal studies is the lack of

time to analyze the mass of data. If adequate time is not taken,

the results are little more than descriptive. It was suggested that

the National Institute on Drug Abuse provide additional resources

and funding to assist in the design and data analysis of the largescale studies that are required for the effective investigation of

drug abuse among adolescents.

REFERENCES

Toby, Jackson. A Prospect of Less Crime in the 1980's. New York

Times, October 26, 1977.

Zimring, Frank. Dealing with Youth Crime--National Needs and Federal Priorities. Paper prepared for the Coordinating Council on

Juvenile Justice and Delinquency Prevention. September 1975.

AUTHOR

Robert Russell, Ph.D.

Consultant

5415 Connecticut Avenue, N.W.

Washington, D.C. 20015

126
Participants

RAUS Review Conference on Drug Abuse and the American Adolescent

National Institute on Drug Abuse

Rockville, Maryland

September 8, 1980

REVIEWERS

Denise B. Kandel, Ph.D., Chair

College of Physicians

and Surgeons

Columbia University

New York, New York

Judith D. Miller, M.A.

Social Research Group

The George Washington University

Washington, D.C.

Kelin E. Gersick, Ph.D.

Yale University Medical School

New Raven, Connecticut

Thomas J. Glynn, Ph.D.

National Institute on Drug

Abuse

Rockville, Maryland

Richard R. Clayton, Ph.D.

University of Kentucky

Lexington, Kentucky

Sidney Cohen, M.D.

UCLA School of Medicine

Los Angeles, California

SUMMARIZATION

Robert Russell, Ph.D.

Consultant

Washington, D.C.

MODERATOR

Dan J. Lettieri, Ph.D.

National Institute on Drug

Abuse

Rockville, Maryland

RAUS COORDINATOR

Jacqueline P. Ludford, M.S.

National Institute on Drug

Abuse

Rockville, Maryland

NIDA STAFF

Brenda Alford, M.S.W.

Jack Durell, M.D.

James A. Ferguson, D.V.M.

Thomas J. Glynn, Ph.D.

Dan J. Lettieri, Ph.D.

Jacqueline P. Ludford, M.S.

Robert C. Petersen, Ph.D.

Richard Phillipson, M.D.

Marvin Snyder, Ph.D.

Eleanor Waldrop

127
monograph series

While limited supplies last, single copies of the monographs may

be obtained free of charge from the National Clearinghouse for

Drug Abuse Information (NCDAI). Please contact NCDAI also for

information about availability of coming issues and other

publications of the National Institute on Drug Abuse relevant to

drug abuse research.

Additional copies may be purchased from the U.S. Government

Printing Office (GPO) and/or the National Technical Information

Service (NTIS) as indicated. NTIS prices are for paper copy.

Microfiche copies, at $3.50, are also available from NTIS.

Prices from either source are subject to change.

Addresses are:

NCDAI

National Clearinghouse for Drug Abuse Information

Room 1OA-53

5600 Fishers Lane

Rockville, Maryland 20857

GPO NTIS

Superintendent of Documents National Technical Information

U.S. Government Printing Office Service

Washington, D.C. 20402 U.S. Department of Commerce

Springfield, Virginia 22161

1 FINDINGS OF DRUG ABUSE RESEARCH. Not available from NCDAI.

Vol. 1: GPO out of stock NTIS PB #272 867/AS $27.50

Vol. 2: GPO out of stock NTIS PB #272 868/AS $27.50

2 OPERATIONAL DEFINITIONS IN SOCIO-BEHAVIORAL DRUG USE RESEARCH

1975. Jack Elinson, Ph.D., and David Nurco, Ph.D., eds. Not

available from NCDAI.

GPO out of stock NTIS PB #246 338/AS $14

3 AMINERGIC HYPOTHESES OF BEHAVIOR: REALITY OR CLICHE? Bruce J.

Bernard, Ph.D., ed.

GPO Stock #017-024-00486-3 $2.25 NTIS PB #246 68J/AS $14

128
4 NARCOTIC ANTAGONISTS: THE SEARCH FOR LONG-ACTING PREPARATIONS,

Robert Willette, Ph.D., ea.

GPO Stock #017-024-00488-O $1.10 NTIS PB #247 096/AS $6.50

5 YOUNG MEN AND DRUGS: A NATIONWIDE SURVEY. John A. O'Donnell,

Ph.D., et al. Not available from NCDAI.

GPO Stock #017-024-00511-8 $2.25 NTIS PB #247 446/AS $14

6 EFFECTS OF LABELING THE "DRUG ABUSER": AN INQUIRY. Jay R.

Williams, Ph.D.

GPO Stock #O17-024-00512-6 $1.05 NTIS PB #249 092/AS $6.50

7 CANNABINOID ASSAYS IN HUMANS. Robert Willette, Ph.D., ed.

GPO Stock #017-024-00510-0 $1.95 NTIS PB #251 905/AS $12.50

8 Rx: 3x/WEEK LAAM - ALTERNATIVE TO METHADONE. Jack Blaine, M.D.,

and Pierre Renault, M.D., eds.

Not available from GPO NTIS PB #253 763/AS $12.50

9 NARCOTIC ANTAGONISTS: NALTREXONE PROGRESS REPORT. Demetrios

Julius, M.D., and Pierre Renault, M.D., eds.

GPO Stock $O17-024-00521-5 $2.55 NTIS PB #255 833/AS $15.50

10 EPIDEMIOLOGY OF DRUG ABUSE: CURRENT ISSUES. Louise G. Richards,

Ph.D., and Louise B. Blevens, eds. Examines methodological issues

in surveys and data collection. Not available from NCDAI.

GPO Stock #O17-024-00571-1 $2.60 NTIS PB #266 691/AS $20

11 DRUGS AND DRIVING. Robert Willette, Ph.D., ed. Reviews

research on effects of drugs on psychomotor performance, focusing

on measures of impairment by different drugs at various levels.

Not available from NCDAI.

GPO Stock #017-024-00576-2 $1.70 NTIS PB #269 602/AS $14

12 PSYCHODYNAMICS OF DRUG DEPENDENCE. Jack D. Blaine, M.D., and

Demetrios A. Julius, M.D., eds. Theoretical and clinical papers

concerned with the intrapsychic determinants of drug addiction.

GPO Stock #017-024-00642-4 $2.75 NTIS PB #276 084/AS $15.50

13 COCAINE: 1977. Robert C. Petersen, Ph.D., and Richard C.

Stillman, M.D., eds. Reports the extent and limits of current

knowledge about cocaine, its use and misuse.

GPO Stock #017-024-00592-4 $3 NTIS PB #269 175/AS $17

14 MARIHUANA RESEARCH FINDINGS: 1976. Robert C. Petersen, Ph.D..

ed. Technical papers on which the 6th Marihuana and Health report

to Congress was based.

GPO Stock #O17-024-00622-0 $3 NTIS PB #271 279/AS $20

15 REVIEW OF INHALANTS: EUPHORIA TO DYSFUNCTION. Charles Wm.

Sharp, Ph.D., and Mary Lee Brehm, Ph.D., eds. Review of inhalant

abuse, including an extensive bibliography.

GPO Stock #O17-024-00650-5 $4.25 NTIS PB #275 798/AS $26

129
16 THE EPIDEMIOLOGY OF HEROIN AND OTHER NARCOTICS. Joan Dunne

Rittenhouse, Ph.D., ed. Task Force report on research

technologies and implications for studying heroin-narcotic use.

GPO Stock #017-024-00690-4 $3.50 NTIS PB #276 357/AS $18.50

17 RESEARCH ON SMOKING BEHAVIOR. Murray E. Jarvik, M.D., Ph.D.,

et al., eds. Includes epidemiology, etiology, consequences of

use, and approaches to behavioral change. From a NIDA-supported

UCLA conference.

GPO Stock #017-024-00694-7 $4.50 NTIS PB #276 353/AS $27.50

18 BEHAVIORAL TOLERANCE: RESEARCH AND TREATMENT IMPLICATIONS.

Norman A. Krasnegor, Ph.D., ed. Theoretical and empirical studies

of nonpharmacologic factors in development of drug tolerance.

GPO Stock #017-024-00699-8 $2.75 NTIS PB #276 337/AS $14

19 THE INTERNATIONAL CHALLENGE OF DRUG ABUSE. Robert C. Petersen,

Ph.D., ed. Papers from the VI World Congress of Psychiatry which

deal with drug issues of particular interest worldwide.

GPO Stock #017-024-00822-2 $4.50 NTIS PB #293 807/AS $26

20 SELF-ADMINISTRATION OF ABUSED SUBSTANCES: METHODS FOR STUDY.

Norman A. Krasnegor, Ph.D., ed. Techniques used to study basic

processes underlying abuse of drugs, ethanol, food, and tobacco.

GPO Stock #017-024-00794-3 $3.75 NTIS PB #288 471/AS $20

21 PHENCYCLIDINE (PCP) ABUSE: AN APPRAISAL. Robert C. Petersen,

Ph.D., and Richard C. Stillman, M.D., eds. Pioneering volume for

clinicians and researchers assessing what is known about the

problem of PCP abuse.

GPO Stock 1017-024-00785-4 $4.25 NTIS PB #288 472/AS $23

22 QUASAR: QUANTITATIVE STRUCTURE ACTIVITY RELATIONSHIPS OF

ANALGESICS, NARCOTIC ANTAGONISTS, AND HALLUCINOGENS. Gene

Barnett, Ph.D.; Milan Trsic, Ph.D.; and Robert Willette, Ph.D.;

eds. Reports from an interdisciplinary conference on the

molecular nature of drug-receptor interactions. Not available

from NCDAI.

GPO Stock #017-024-00786-2 $5.25 NTIS PB #292 265/AS $33.50

23 CIGARETTE SMOKING AS A DEPENDENCE PROCESS. Norman A.

Krasnegor, Ph.D., ed. Discusses factors involved in the onset,

maintenance, and cessation of the cigarette smoking habit.

Includes an agenda for future research.

GPO Stock #017-024-00895-8 $4.50 NTIS PB #297 721/AS $17

24 SYNTHETIC ESTIMATES FOR SMALL AREAS: STATISTICAL WORKSHOP

PAPERS AND DISCUSSION. Joseph Steinberg, ed. Papers from a workshop cosponsored by NIDA and the National Center for Health Statistics on a class of statistical approaches that yield needed

estimates of data for States and local areas. Not available from

NCDAI.

GPO Stock #017-024-00911-3 $5 NTIS PB #299 009/AS $21.50

130
25 BEHAVIORAL ANALYSIS AND TREATMENT OF SUBSTANCE ABUSE. Norman

A. Krasnegor, Ph.D., ed. Papers present commonalities and

implications for treatment of dependency on drugs, ethanol, food,

and tobacco.

GPO Stock #017-024-00939-3 $4.50 NTIS PB #80-112428 $20

26 THE BEHAVIORAL ASPECTS OF SMOKING. Norman A. Krasnegor, Ph.D.,

ed. Reprint of the behavioral section of the 1979 Report of the

Surgeon General on Smoking and Health; introduction by editor,

GPO Stock #017-024-00947-4 $4.25 NTIS PB #80-118755 $15.50

27 PROBLEMS OF DRUG DEPENDENCE, 1979: PROCEEDINGS OF THE 41ST

ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG

DEPENDENCE, INC. Louis S. Harris, Ph.D., ed. Not available from

NCDAI.

GPO Stock #017-024-00981-4 $8 NTIS PB 180-175482 $35

28 NARCOTIC ANTAGONISTS: NALTREXONE PHARMACOCHEMISTRY AND

SUSTAINED-RELEASE PREPARATIONS. Robert Willette, Ph.D., and

Gene Barnett, Ph.D., eds. Papers report research on sustainedrelease and long-acting devices for use with the narcotic antagonist naltrexone.

GPO Stock #017-024-01081-2 $6.00 NTIS PB #81-238875 $21.50

29 DRUG ABUSE DEATHS IN NINE CITIES: A SURVEY REPORT. Louis A.

Gottschalk, M.D., et al. Epidemiologic study providing data on

drug-involved deaths and procedures for their investigations.

Not available from NCDAI.

GPO Stock #017-024-00982-2 $4.25 NTIS PB #80-178882 $15.50

30 THEORIES ON DRUG ABUSE: SELECTED CONTEMPORARY PERSPECTIVES.

Dan J. Lettieri, Ph.D.; Mollie Sayers; and Helen Wallenstein

Pearson, eds. Volume presents summaries of the major contemporary theories of drug abuse by each of 43 leading theorists.

GPO Stock #017-024-00997-1 $8.50 Not available from NTIS

31 MARIJUANA RESEARCH FINDINGS: 1980. Robert C. Petersen, Ph.D.,

ed. The text of the 8th Marijuana and Health report to Congress

and the background scientific papers on which this summary report

was based.

GPO Stock 1017-024-01010-3 $5 NTIS PB #80-215171 $18.50

32 GC/MS ASSAYS FOR ABUSED DRUGS IN BODY FLUIDS. Rodger L. Foltz,

Ph.D.; Allison F. Fentiman, Jr., Ph.D.; and Ruth B. Foltz. A

collection of methods for the quantitative analysis of several

important drugs of abuse by the technique of gas chromatographymass spectrometry.

GPO Stock #017-024-01015-4 $5 NTIS PB #81-133246 $17

34 PROBLEMS OF DRUG DEPENDENCE, 1980: PROCEEDINGS OF THE 42ND

ANNUAL SCIENTIFIC MEETING, THE COMMITTEE ON PROBLEMS OF DRUG

DEPENDENCE, INC. Louis S. Harris, Ph.D., ed. Comprehensive

assemblage of ongoing research on drug abuse, addiction, and new

compounds.

GPO Stock #017-024-01061-8 $7 NTIS PB #81-194847 $32

131
35 DEMOGRAPHIC TRENDS AND DRUG ABUSE, 1980-1995. Louise G.

Richards, Ph.D., ed. Estimates of probable extent and nature of

nonmedical drug use, 1980-1995, based on age structure and other

characteristics of U.S. population.

GPO Stock #017-024-01087-1 $4

36 NEW APPROACHES TO TREATMENT OF CHRONIC PAIN: A REVIEW OF MULTIDISCIPLINARY PAIN CLINICS AND PAIN CENTERS. Lorenz K.Y. Ng, M.D.,

ed. A sharing of ideas among active practitioners in the treatment of pain.

GPO Stock #017-024-01082-1 $4.75 NTIS PB #81 240913 $17

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