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Sequences of Substance Use Among American Indian Adolescents

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ABSTRACT

Objective

To determine whether the predominant pattern of the sequence of use of different classes of substances among a large sample of American Indian (AI) adolescents is consistent with Stage Theory [i.e., (1) alcohol, (2) marijuana, (3) other illicit drugs, and (4) cocaine].

Method

Data came from surveys completed by 1,562 AI high school students in 1993. Pairwise comparisons of age of first use for alcohol, marijuana, inhalants, cocaine, and other illicit drugs were examined, as were the prevalence rates of specific sequences of substance use.

Results

Thirty-five percent of the AI youths who had used both alcohol and marijuana reported using alcohol first. Seventy-five percent of youths who had used three or more substances reported a sequence of first use that was inconsistent with Stage Theory. However, a general pattern of using alcohol, marijuana, and/or inhalants prior to the use of cocaine and other illicit drugs was observed. Sequences of first use varied by gender, age of first substance use, community, and number of classes of substances used.

Conclusions

To enhance the validity of Stage Theory for AI adolescents, the authors recommend its revision to include alcohol, marijuana, and inhalants as initiating substances.

Section snippets

METHOD

Data for this study were collected in a school-based survey of the use of alcohol and other substances as well as potential risk and protective factors for such use among AI high school students (Mitchell et al., 1999, Novins and Mitchell, 1998). Data consisted of paper-and-pencil questionnaire responses from students in grades 9 through 12 at seven predominantly AI high schools in four rural AI communities west of the Mississippi River. In working with AI communities, protection of the

Prevalence and Age of First Use

The lifetime prevalence of use and mean age of first use for each of the five classes of substances are summarized in Table 1. Alcohol had the highest prevalence of use (73.5%); cocaine, the lowest (10.3%). Inhalants had the lowest mean age of first use (12.6 years old), followed by marijuana (13.0 years old), and then alcohol (13.3 years old). The mean age of first use of any class of substance was 12.4 years old, lower than the mean age of first use for any of the individual classes of

DISCUSSION

These results call into question the applicability of Stage Theory, at least in its current form, to the progression of use of different substance classes among AI adolescents. For example, Stage Theory suggests that among the five classes of substances studied here, alcohol should be the first substance used. However, among users of both alcohol and marijuana, 34.9% reported using alcohol prior to marijuana and 35.1% reported using marijuana prior to alcohol. The findings were similar among AI

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    This research was supported in part by NIDA grant R01-DA10039 (Dr. Mitchell), NIAAA grant R01-AA08474 (Drs. Manson and Beals), NIMH grant R01-MH42473 (Dr. Manson), and NIMH grant K20-MH01253 (Dr. Novins). The authors gratefully acknowledge the contribution of Drs. Mark Plunkett, Spero Manson, and Anna Barón.

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