Research Article: A Qualitative Study of the Context of Child and Adolescent Substance Use Initiation and Patterns of Use in the First Year for Early and Later Initiators

Date Published: January 25, 2017

Publisher: Public Library of Science

Author(s): Sharon Kingston, Maya Rose, Julian Cohen-Serrins, Emily Knight, Ruth Jepson.


Individuals who initiate substance use before high school are at higher risk of negative outcomes. Eighty-six young adults between the ages of 18 and 28 participated in semi-structured qualitative interviews focused on the circumstances surrounding participants’ first use of substances and their pattern of use in the year following initiation in order to investigate similarities and differences between early versus later initiators. Initiation and use among early initiators were more likely to be encouraged by poor parental monitoring or active facilitation of use by parents. Early initiators were more likely to report risky patterns of use such as daily use and using alone. The data suggest that interventions targeting this population should focus on improving parental monitoring and decreasing positive parental attitudes toward adolescent substance use and efforts to increase identification and intervention by middle school staff to reach youth from high-risk families.

Partial Text

Individuals who begin using psychoactive substances at an early age, typically defined as prior to age 13 or 14 [1,2] are at greater risk of negative psychosocial, educational and mental health outcomes than individuals who initiate substance use at a later age. These early initiators typically begin their substance use with alcohol, tobacco and marijuana and experience more pronounced individual and family risk factors for substance abuse and dependence than later initiators [3–8]. Despite a relatively robust literature on the negative outcomes related to early substance use initiation and the risk factors associated with early initiation there is a paucity of research on whether the context of initiation and the early trajectory of use differs between early versus later initiators.

Forty-two percent (n = 36) were coded as early initiators, 31% (n = 11) of these initiated substance use as elementary school students (11 years old or younger) and 69% (n = 25) initiated as middle school students (age 12 to 14). Fifty-eight percent (n = 50) initiated in high school or later with 14% (n = 7) of later initiators initiating after high school graduation (age 18 and older) and the remainder initiating as high school students (age 14 to 18).

The interviews with young adults revealed differences between early and later initiators in initiation contexts and the pattern of use in the first year. Early users, as expected, describe much more problematic attitudes toward substance use, more negative patterns of use in the first year and less attachment to prosocial goals [6]. The interviews with early initiators indicate that they are often initiating substance use in home environments where they are not being closely monitored by adults. This lack of monitoring allows them to use substances in their own home or backyard and to steal substances from their homes. In some cases, adults are actively facilitating use. These results help explain why substance use by parents is correlated with early initiation [5,6,33]. Further, the presence of substances in the home increases availability, parental intoxication interferes with the ability to recognize use in their children or monitor their activities and positive attitudes towards substance use leads some parents to actively facilitate their child’s use.




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