The aim of the study was to analyse the initiation process into illicit drug use focusing on three endpoints which can be seen as stages in the drug career: being offered drugs, using cannabis and using intravenous drugs. Questionnaire data were available on 23482 men, aged 18–20 years, conscripted for military service in 1969–70. The association between family background, social conditions, other licit drug use, emotional control and the three endpoints were analysed. Although many conscripts tried cannabis, a smaller number continued with intravenous drug abuse. These were in general characterised by poor emotional control and a history of social maladjustment, and early onset of use. Our findings give further evidence for social maladjustment as a causative factor for illicit drug use and for the role of cannabis as a stepping stone to heavy drug abuse.
1. Chein, J., Gerard, D., Lee R, Rosenfield, E.Narcotics, delinquency and social policy: the road to H. London: Basic Books, 1964.
2.
2. Vaillant, B.The natural history of urban narcotic drug addiction – some determinants. In: Steinberg H, ed. The scientific basis of drug dependence. London: Churchill, 1969.
3.
3. Hammer, T., Vaglum, P., Initiation, continuation or discontinuation of cannabis use in the general population. Br J Addict1990; 85: 899–909.
4.
4. Hammer, T., Vaglum, P., Users and nonusers within a high risk milieu of cannabis use. A general population study. Int J Addict1991; 26: 595–604.
5.
5. Stenbacka, M., Allebeck, P., Romelsjö A., Do cannabis abusers differ from intravenous drug abusers: the role of social and behavioural risk factors. Br J Addict1992; 87: 259–66.
6.
6. Stenbacka, M., Allebeck, P., Romelsjö A, Brandt, L., Intravenous drug abuse in young men: risk factors assessed in a longitudinal perspective. Scand J Soc Med1992; 20: 94–101.
7.
7. Robins, L. N., Sturdy childhood predictors of adult antisocial behaviour: replications from longitudinal studies. Psychol Med1978; 8: 611–22.
8.
8. Stenbacka, M., Initiation into intravenous drug abuse. Acta Psychiatr Scand1990; 81: 459–62.
9.
9. Segal, B., Adolescent initiation into drug-taking behaviour: comparisons over a 5-year interval. Int J Addict1991; 26: 267–79.
10.
10. Kandel, D. B., Logan, J. A., Patterns of drug use from adolescence to young adulthood: I. Periods of risk for initiation, continued use, and discontinuation.. Am J Public Health1984; 74: 660–6.
11.
11. Plant, M. A., Reeves, C. E., The group dynamics of becoming a drug taker. Interpersonal Development1973; 4: 99–106.
12.
12. Plant, M. A.Drugtakers in an English town. London: Tavistock Publications, 1975.
13.
13. Gibbons, C. G., Brown, B. S., Greene, M. H., DuPont, R. L., Initiation into heroin use. Int J Addict1981; 16: 935–9.
14.
14. Bejerot, N.Drug abuse and drug policy. An epidemiological and methodological study of drug abuse of the intravenous type in the Stockholm arrest population, 1965–1970, in relation to changes in drug policy. Acta Psychiatr Scand1975; Suppl 256.
15.
15. Kandel, D. B., Epidemiological and psychological perspectives on adolescent drug use. J Am Acad Child Psychiatry1982; 21: 328–46.
16.
16. Kandel, D. B., Faust, R., Sequency and stages in patterns of adolescent drug use. Arch Gen Psychiatry1975; 32: 923–32.
17.
17. O'Donnell JA, Clayton RR., The stepping-stone hypothesis – marijuana, heroin, and causality. Chem Depend1982; 4: 229–41.
18.
18. DeAlarcon, R., The spread of heroin abuse in a community. Bull Narc1969; 21: 17–23.
19.
19. Jonas, S.Heroin utilization – a communicable disease?N Y State J Med, 1972; 1292–9.
20.
20. Allebeck, P., Allgulander, C., Fisher, L. D., Predictors of completed suicide in a cohort of 50,465 young men: role of personality and deviant behaviour. Br Med J1988; 297: 176–8.
21.
21. Allebeck, P., Allgulander, C., Suicide among young men: psychiatric illness, deviant behaviour and substance abuse. Acta Psychiatr Scand1990; 81: 565–70.
22.
22. Andreasson, S.Misuse of alcohol and cannabis among young men. A longitudinal study of health effects. Huddinge: Karolinska Institutet, 1990 (Thesis).
23.
23. Rothman, K.Modern epidemiology. Boston: Little Brown & Co, 1986.
24.
24. Benson, G., Holmberg, B., Validity of questionnaires in population studies on drug use. Acta Psychiatr Scand1985; 71: 9–18.
25.
25. Torstensson, M.Drug abusers in a metropolitan cohort. Stockholm: Dept of Sociology, 1987. (Project Metropolitan, Research Report No 25, 1987).
26.
26. Schwartz, R. H., Luxenberg, M. G., Hoffman, N. G.“Crack” use by American middle-class adolescent polydrug abusers. J Pediatr1990; 118: 150–5.
27.
27. Siegel, R. K., Cocaine and the priviliged class: a review of historical and contemporary images. Adv Alcohol Subst Abuse1984; 4: 37–49.
28.
28. Raveis, V. H., Kandel, D. B., Changes in drug behavior from the middle to the late twenties: initiation, persistence, and cessation of use. Am J Public Health1987; 77: 607–11.
29.
29. Yamaguchi, K., Kandel, D. B., Patterns of drug use from adolescence to young adulthood: III. Predictors of progression. Am J Public Health1984; 74: 673–80.
30.
30. Tomas, J. M., Vlahov, D., Anthony, J. C., Association between intravenous drug abuse and early misbehavior. Drug Alcohol Depend1990; 25: 79–89.
31.
31. Meyer, R. E.Who can say no to illicit drug use?Arch Gen Psychiatry1989; 46: 189–90.
32.
32. Stein, J. A., Newcomb, M. D., Bentler, P. M., An 8-year study of multiple influences on drug use and drug use consequences. J Pers Soc Psychol1987; 53: 1094–105.
33.
33. O'Malley PM, Bachman JG, Johnston LD.Period, age, and cohort effects on substance use among young Americans: a decade of change, 1976–86. Am J Public Health1988; 78: 1315–21.
34.
34. Fleming, J. P., Kellam, S. G., Brown, C. H., Early predictors of age at first use of alcohol, marijuana, and cigarettes. Drug Alcohol Depend1982; 9: 285–303.
35.
35. Kandel, D. B., Simcha-Fagan O, Davies, M., Risk factors for delinquency and illicit drug use from adolescence to young adulthood. J Drug Issues1986; 16: 67–90.
