Transitions from first substance use to substance use disorders in adolescence: is early onset associated with a rapid escalation?

Drug Alcohol Depend. 2009 Jan 1;99(1-3):68-78. doi: 10.1016/j.drugalcdep.2008.06.014. Epub 2008 Sep 2.


Background: Early substance use (SU) in adolescence is known to be associated with an elevated risk of developing substance use disorders (SUD); it remains unclear though whether early SU is associated with more rapid transitions to SUD.

Objective: To examine the risk and speed of transition from first SU (alcohol, nicotine, cannabis) to SUD as a function of age of first use.

Methods: N=3021 community subjects aged 14-24 years at baseline were followed-up prospectively over 10-years. SU and SUD were assessed using the DSM-IV/M-CIDI.

Results: (1) The conditional probability of substance-specific SU-SUD transition was the greatest for nicotine (36.0%) and the least for cannabis (18.3% for abuse, 6.2% for dependence) with alcohol in between (25.3% for abuse; 11.2% for dependence). (2) In addition to confirming early SU as a risk factor for SUD we find: (3) higher age of onset of any SU to be associated with faster transitions to SUD, except for cannabis dependence. (4) Transitions from first cannabis use (CU) to cannabis use disorders (CUD) occurred faster than for alcohol and nicotine. (5) Use of other substances co-occurred with risk and speed of transitions to specific SUDs.

Conclusion: Type of substance and concurrent use of other drugs are of importance for the association between age of first use and the speed of transitions to substance use disorders. Given that further research will identify moderators and mediators affecting these differential associations, these findings may have important implications for designing early and targeted interventions to prevent disorder progression.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Age of Onset
  • Alcohol Drinking / epidemiology
  • Disease Progression
  • Germany / epidemiology
  • Humans
  • Illicit Drugs
  • Longitudinal Studies
  • Marijuana Smoking / epidemiology
  • Marijuana Smoking / psychology
  • Prospective Studies
  • Psychiatric Status Rating Scales
  • Regression Analysis
  • Risk
  • Smoking / epidemiology
  • Substance-Related Disorders / diagnosis
  • Substance-Related Disorders / epidemiology*
  • Survival Analysis


  • Illicit Drugs