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

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Abstract
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.