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Articles   |    
Transitions in Illicit Drug Use Status Over 3 Years: A Prospective Analysis of a General Population Sample
Wilson M. Compton, M.D., M.P.E.; Deborah A. Dawson, Ph.D.; Kevin P. Conway, Ph.D.; Marc Brodsky, M.S.; Bridget F. Grant, Ph.D.
Am J Psychiatry 2013;170:660-670. doi:10.1176/appi.ajp.2012.12060737
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All authors report no financial relationships with commercial interests.

The study on which this paper is based, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), is sponsored by NIAAA, with supplemental support from NIDA. This research was supported in part by NIAAA’s Intramural Program.

The views and opinions expressed in this paper are those of the authors and should not be construed to represent the views of any of the sponsoring organizations or agencies or the U.S. government.

From the Division of Epidemiology, Services and Prevention Research, National Institute on Drug Abuse (NIDA), Bethesda, Md.; the Laboratory of Epidemiology and Biometry, National Institute on Alcohol Abuse and Alcoholism (NIAAA), Bethesda; and Kelly Government Services, Bethesda.

Address correspondence to Dr. Compton (wcompton@nida.nih.gov).

Copyright © 2013 by the American Psychiatric Association

Received June 03, 2012; Revised August 26, 2012; Accepted October 09, 2012.

Abstract

Objective  The authors examined 3-year transitions among nonuse, asymptomatic use, and problem use of illicit drugs for U.S. adults in the general household population.

Method  Data were from the nationally representative National Epidemiologic Survey on Alcohol and Related Conditions, a study of 34,653 adults interviewed twice, 3 years apart. Respondents were categorized on three mutually exclusive categories of baseline drug status: past-year nonusers (N=32,675), past-year asymptomatic drug users (N=861), and past-year symptomatic drug users (N=1,117). Symptomatic drug use, or problem use, was defined as presence of one or more symptoms that operationalize DSM-IV drug abuse and dependence criteria. The authors assessed sociodemographic, health, substance use, and psychiatric covariates for association with 3-year transitions to different status categories.

Results  Among baseline nonusers, 95.4% continued to be nonusers at follow-up, 2.1% became asymptomatic users, and 2.5% developed problem use. Among baseline asymptomatic users, 66.6% had stopped using drugs at follow-up, 14.3% continued to be asymptomatic users, and 19.1% had developed problem use. Nearly half (49.0%) of those with problem use at baseline had stopped using drugs at follow-up, 10.9% had transitioned to asymptomatic use, and 40.1% continued to have problem use. Younger age, male sex, white race, and not being married were associated with progression from nonuse to use or problem use, as were alcohol and tobacco use and disorders, major depression, and schizotypal, borderline, and narcissistic personality disorders. Panic disorder and avoidant personality disorder were associated with less progression.

Conclusions  Transitions in drug use status are common. The finding that alcohol and tobacco variables and co-occurring psychopathology are important correlates of transitions suggests the value of addressing all co-occurring disorders and substance use in patient assessments and treatment planning, both to prevent adverse transitions and to promote positive transitions.

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FIGURE 1. Modeling Approach to Transitions in Drug Use Status From Baseline to 3-Year Follow-Up Among U.S. Adults Age 18 and Oldera

a Predictors based on reduced multinomial regression models (from Table 3).

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TABLE 1.Wave 2 Past-Year Drug Status as a Function of Wave 1 Past-Year Drug Status Among U.S. Adults
Anchor for Jump
TABLE 2.Wave 1 Background, Health, Substance-Related, and Psychiatric Characteristics for Individuals With Wave 1–Wave 2 Transitions in Drug Status
Anchor for Jump
TABLE 3.Correlates of Wave 1–Wave 2 Transitions in Drug Status, Based on Reduced Multinomial Regression Modelsa
Table Footer Note

a Reduced models contain only variables that were significant at p<0.05 level or whose inclusion was necessary to maintain the proper referent for categorical variables. “NS” denotes variables with p values ≥0.05 that were included in the reduced model because they were significant for at least one of the two outcomes or to maintain the appropriate referent category for multicategorical variables. A dash (—) denotes variables that were not included in the reduced model.

Table Footer Note

b Referent: private health insurance.

Table Footer Note

c Referent: nonsmoker.

Table Footer Note

d Referent: nondrinker.

Table Footer Note

e Referent: used less addictive drugs.

Table Footer Note

p<0.01. *p<0.005.

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