Eric A Woodcock1, Leslie H Lundahl1, Jonathan J K Stoltman2, Mark K Greenwald3. 1. Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA; Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA. 2. Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA. 3. Department of Psychiatry and Behavioral Neurosciences, School of Medicine, Wayne State University, Detroit, MI 48201, USA; Translational Neuroscience Program, Wayne State University, Detroit, MI 48201, USA; Department of Pharmacy Practice, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University, Detroit, MI 48201, USA. Electronic address: mgreen@med.wayne.edu.
Abstract
BACKGROUND: The present study retrospectively evaluated the chronology and predictors of substance use progression in current heroin-using individuals. METHODS: Out-of-treatment heroin users (urinalysis-verified; N=562) were screened for laboratory-based research studies using questionnaires and urinalysis. Comprehensive substance use histories were collected. Between- and within-substance use progression was analyzed using stepwise linear regression models. RESULTS: The strongest predictor of onset of regular heroin use was age at initial heroin use, accounting for 71.8% of variance. The strongest between-substance predictors of regular heroin use were ages at regular alcohol and tobacco use, accounting for 8.1% of variance. Earlier onset of regular heroin use (≤20 years) vs. older onset (≥30 years) was associated with a more rapid progression from initial to regular use, longer duration of heroin use, more lifetime use-related negative consequences, and greater likelihood of injecting heroin. The majority of participants (79.7%) reported substance use progression consistent with the gateway hypothesis. Gateway-inconsistent individuals were more likely to be African-American and to report younger age at initial use, longer duration of heroin use, and more frequent past-month heroin use. CONCLUSIONS: Our findings demonstrate the predictive validity and clinical relevance of evaluating substance use chronology and the gateway hypothesis pattern of progression.
BACKGROUND: The present study retrospectively evaluated the chronology and predictors of substance use progression in current heroin-using individuals. METHODS: Out-of-treatment heroin users (urinalysis-verified; N=562) were screened for laboratory-based research studies using questionnaires and urinalysis. Comprehensive substance use histories were collected. Between- and within-substance use progression was analyzed using stepwise linear regression models. RESULTS: The strongest predictor of onset of regular heroin use was age at initial heroin use, accounting for 71.8% of variance. The strongest between-substance predictors of regular heroin use were ages at regular alcohol and tobacco use, accounting for 8.1% of variance. Earlier onset of regular heroin use (≤20 years) vs. older onset (≥30 years) was associated with a more rapid progression from initial to regular use, longer duration of heroin use, more lifetime use-related negative consequences, and greater likelihood of injecting heroin. The majority of participants (79.7%) reported substance use progression consistent with the gateway hypothesis. Gateway-inconsistent individuals were more likely to be African-American and to report younger age at initial use, longer duration of heroin use, and more frequent past-month heroin use. CONCLUSIONS: Our findings demonstrate the predictive validity and clinical relevance of evaluating substance use chronology and the gateway hypothesis pattern of progression.
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