Andrew Golub

Variation in youthful risks of progression from alcohol and tobacco to marijuana and to hard drugs across generations

OBJECTIVES Much research has documented that youthful substance use typically follows a sequence starting with use of alcohol or tobacco or both and potentially proceeding to marijuana and then hard drug use. This study explicitly examined the probabilities of progression through each stage and their covariates. METHODS A secondary analysis of data from the National Household Survey on Drug Abuse (1979-1997) was conducted with particular sensitivity to the nature of substance use progression, sampling procedures, and reliability of self-report data. RESULTS Progression to marijuana and hard drug use was uncommon among persons born before World War II. The stages phenomenon essentially emerged with the baby boom and rose to a peak among persons born around 1960. Subsequently, progression risks at each stage declined. Progression risks were also higher among younger initiators of alcohol, tobacco, or marijuana use. CONCLUSIONS The recent increase in youthful marijuana use has been offset by lower rates of progression to hard drug use among youths born in the 1970s. Dire predictions of future hard drug abuse by youths who came of age in the 1990s may be greatly overstated.

The Growth in Marijuana Use Among American Youths During the 1990s and the Extent of Blunt Smoking

Abstract Marijuana use among American youths and young adults increased substantially during the 1990s. This paper reviews that trend using data collected 1979–2003 by the National Survey on Drug Use and Health (NSDUH). The data suggest that the increase in marijuana use started first among persons age 12–20. Among 18–20 year-olds, the increase started earlier among whites and blacks than Hispanics, among males before females, and surprisingly in areas that are not part of an MSA as opposed to those with a population in excess of a million. Much of the increase in marijuana use could have been attributable to the growing popularity of blunts. Starting in 2000, the NSDUH explicitly asked youths age 12–17 (but not older respondents) about smoking blunts. Of the 9% of youths who reported past-30-day use of marijuana 2000–03, more than half reported smoking blunts. On the other hand, the data also indicate that blunts have not fully supplanted other ways that youths consume marijuana. Blunts were more common among youths that were black, older, male, and from metropolitan areas. Many blunt smokers reported they had not used marijuana, which suggests that they did not define smoking blunts as marijuana use. Even fewer reported that they had used cigars, suggesting they did not define smoking blunts as cigar use.

Careers in Crack, Drug Use, Drug Distribution, and Nondrug Criminality

The Careers in Crack Project examined the impact of crack cocaine on the lives of users and sellers of crack, heroin, and cocaine powder recruited in Manhattan in 1988-1989 (N = 1,003). This article summarizes findings that place in context and even debunk several myths about use of crack and the crack culture, presents insights into the crack epidemic and its impact on individuals, evaluates the vigorous public policy attempts to control use of crack, and suggests potentially more effective alternatives.

Cohort Changes in Illegal Drug Use among Arrestees in Manhattan: From the Heroin Injection Generation to the Blunts Generation

This paper identifies three inner-city cohorts differing by birth year and preferred drugs that routinely passed through Manhattans criminal justice system from 1987 through 1997: The Heroin Injection Generation born 1945-54, the Cocaine/Crack Generation born 1955-69, and the Blunts (marijuana plus tobacco) Generation born since 1970. The future prospects for the Blunts Generation may be modestly enhanced by their continued avoidance of cocaine, crack, and heroin--despite the fact that many of them are being reared in severely distressed households and are developing few skills for legal jobs.

Response Reliability and the Study of Adolescent Substance Use Progression

Studies of adolescent substance use progression typically infer a sequence of initiation from self-reported ages at first use of alcohol, tobacco, marijuana, and hard drugs. This paper examines the reliability of this procedure for a sample of 892 New Jersey youths interviewed on two occasions separated by three years. Individual responses on the second occasion differed substantially from those provided on the first. However, the inferred sequences were consistent as long as 1) first use of alcohol and/or tobacco was considered a single stage, and 2) cases in which individuals initiated the use of two substances in the same year were considered as ambiguous regarding order. The sequences reported were also consistent with the gateway theory that suggests alcohol/tobacco precedes any possible use of marijuana and hard drugs.

Projecting and Monitoring the Life Course of the Marijuana/Blunts Generation:

Since the 1990s, marijuana has been the drug of choice among American youths, especially those that tend to sustain arrests. Previous birth cohorts had greater use of crack, powder cocaine, or heroin. This paper summarizes prior research that strongly suggests drug eras tend to follow a regular course. These insights then serve as the basis for projecting trends in marijuana use both for the general population nationwide and for Manhattan arrestees. To the extent that current trends persist, the prospects for the “Marijuana/Blunts Generation” (born 1970 and later) may be relatively good. These young persons may successfully avoid “hard drugs” as well as the attendant health, social, and legal problems for their entire life, but they may experience higher levels of smoking-related ailments. The conclusion presents issues for continued drug surveillance and ethnographic research to more accurately understand the Marijuana/Blunts Era and to provide an indicator of future changes as they occur.

On Correcting Biases in Self-Reports of Age at First Substance Use with Repeated Cross-Section Analysis

Household survey data on age at first use of alcohol, tobacco, marijuana,and hard drugs can be biased due to sample selection and inaccuraterecall. One potential concern is attrition, whereby individuals who getinvolved with substance use at an early age become increasingly less likelyto be surveyed in successive years. A comparison of data from the NationalHousehold Survey on Drug Abuse (NHSDA) with data from a longitudinal studysuggested that attrition might have caused substantially less bias thandid “forward telescoping,” the inflating of age at first useover time. The evidence of forward telescoping was particularly pronouncedwith respect to age at first use of alcohol. This paper presents a procedurefor correcting the distribution of age at first use for forward telescoping(but not attrition) by viewing a portion of the NHSDA data collected insuccessive years as constituting a cohort study. Results are presented fromapplying this procedure with NHSDA data collected from 1982 to 1995 forrespondents born 1968–1973. The findings suggest that preventionprograms need to be introduced at an earlier age than would be indicatedby “uncorrected” retrospective data. Other implications are alsohighlighted.

Quality-of-life policing Do offenders get the message?

In the 1990s, the New York City Police Department expanded its focus on reducing behaviors that detract from the overall quality of life (QOL) in the city. Many have credited this effort for the decline in the citys overall crime rate. They often cite the fixing broken windows argument, which maintains that reducing disorder sets off a chain of events leading to less crime. However, systematic research has not yet documented this chain of events. Looks at one of the first linkages, whether QOL policing sends a message to offenders not to engage in disorderly behaviors in public locales. The project interviewed 539 New York City arrestees in 1999. Almost all of them were aware that police were targeting various disorderly behaviors. Among those that engaged in disorderly behaviors, about half reported that they had stopped or cut back in the past six months. They reported a police presence was the most important factor behind their behavioral changes. These findings support the idea that QOL policing has a deterrent effect.

Unmet Need for Treatment of Substance Use Disorders and Serious Psychological Distress Among Veterans: A Nationwide Analysis Using the NSDUH

Many veterans returning from Afghanistan and Iraq experience serious mental health (MH) concerns including substance use disorders (SUD), post-traumatic stress disorder, traumatic brain injury, depression, or serious psychological distress (SPD). This article uses data from the 2004 to 2010 National Survey on Drug Use and Health to examine the prevalence of unmet MH needs among veterans aged 21 to 34 in the general population. The prevalence of untreated SUD among veterans (16%) was twice as high as untreated SPD (8%), a nonspecific diagnosis of serious MH concerns. Surprisingly, similar rates of untreated SUD and SPD were found among a nonveteran comparison sample matched on gender and age. These findings suggest that reducing unmet need for MH treatment for veterans in the general population may require improving outreach to all Americans and creating greater acceptance for MH treatment. The need for further analyses of reasons for not obtaining treatment is discussed.

Studying Crack Abusers: Strategies for Recruiting the Right Tail of an Ill-defined Population

This study attempts to better understand a limited segment of the drug-abusing population, especially individuals who repeatedly use crack and other drugs. This article addresses the methodological strategies and underlying paradigms informing the recruitment of hard-to-reach and ill-defined subpopulations of crack abusers and noncrack drug abusers. Subjects were recruited from diverse social contexts: streets or communities where most drug users do their business, arrested persons who were released, jail inmates, probationers and parolees, prison inmates, and treatment settings. A systematic comparison of subject attributes across recruitment locales and with other, similar target groups is presented. The utility and external comparability of the recruitment techniques are supported by the findings.