Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
AM. J. DRUG ALCOHOL ABUSE, 4(1), pp. 65-76 (1977)
Alcohol and Marijuana Consumption among Undergraduate Polydrug Users
MARK HOCHHAUSER, Ph.D. Assistant Professor Department of Psychology West Virginia State College Institute, West Virginia 251 12
ABSTRACT
Of 365 undergraduates surveyed, 42% admitted to polydrug use. The rank order of drugs used was: alcohol, maxijuana, tobacco, hallucinogens, barbiturates, amphetamines, cocaine, opiates, and inhalants. Forty-four percent used one drug combination, 25% used 2 to 3 combinations, 17% used 4 to 7 combinations, with 14% using 8 to 14 combinations. Nealry 85% used alcohol plus marijuana, with nearly one-third combining alcohol or marijuana with barbiturates, hallucinogens, or amphetamines. Alcohol appeared to be the fust drug used; however, it was not abandoned when marijuana use began-both drugs were simply used concurrently, and new drugs were incorporated into the existing patterns of drug use. Interpretations of polydrug use are limited by difficulties in assessing drug use, as well as inconsistencies in the chemical composition of illicit drugs.
INTRODUCTION The polydrug phenomenon (i.e., the use of drugs in combination) has been only recently identified [ 1-41, yet it has created an assortment of methodological issues for drug-abuse researchers. Although some research exists documenting the physiological and psychological effects of combining licit drugs [S-71, virtually no evidence exists describing either the particular patterns of illicit polydrug consumption or the behavioral consequences of such consumption. 65
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
66
HOCHHAUSER
Essential information is unavailable in at least two areas: (1) the age at which drug use begins, and (2) the specific drug combinations that are used by various age groups. This knowledge is vital, as a particular drug, or combination of drugs, may generate significantly different effects, depending on the physiological and psychological maturity of the drug user [8,9] , especially when such drugs are absorbed over lengthy periods of time. The purpose of this survey was to focus on the frequency and duration of drug use, with particular emphasis on patterns of polydrug consumption. At this point some comments must be directed to the apparent conflicts in the identification of those individuals who abuse more than one drug. As originally defined [ 101 ,“polydrug abuse” was the tendency to use more than one drug; more recently, however, the National Institute on Drug Abuse (NIDA) has defined polydrug use as the use and abuse of all nonnarcotic drugs. Furthermore, the term “multidrug abuse,” i.e., the nonmedical use of more than one drug [ 1 1, 121, has also been utilized by some researchers. Multidrug abuse does not refer to the progression of drugs typically observed in most drug abusers; however, it does include multiple drug abuse based upon the primary dependence of alcohol and narcotics, whereas polydrug abuse concerns primary dependence upon drugs other than alcohol, heroin, or methadone. In an effort to resolve the controversy between polydrug abuse vs multidrug abuse, Kaufman [3] has suggested substitution of the term “multiple drug abuse” for the sometimes conflicting and confusing terminology of polydrug or multidrug abuse. In this classification, four types of multiple drug abusers are recognized: Type I includes narcotics abuse with the abuse of other psychoactive drugs and alcohol; Type I1 encompasses those on methadone maintenance who abuse other drugs and alcoho1;Type I11 is comprised of those who abuse alcohol and other drugs, and Type IV involves the abuse of nonnarcotic psychoactive drugs. Although an individual may be classified as a multiple drug abuser, this label provides only a relatively gross indication of the particular pattern of drugs used, and virtually no information as to the physiological and psychological effects of such drug combinations. For example, an individual may consume several drugs at the same time, during the same day, or the same week: although the individual might be identified as a multiple drug abuser in each case, this would provide in itself little information regarding the physiological and psychological effects of such drug use. For example, there is some evidence suggesting that traces of some drugs (e.g., marijuana) remain in the body as long as 8 days after ingestion [ 131 ,thus providing multiple drug effects as a consequence of drugs taken several days apart. A complete understanding of multiple drug use must therefore be based not only on the particular patterns of those drugs used, but on the temporal relationships between the drugs, insofar as the temporal interval between each drug consumed will affect the physiological and psychological processes of the user.
ALCOHOL AND MARIJUANA CONSUMPTION AMONG POLYDRUC USERS
61
METHOD
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
Subjects Three hundred and sixty-five undergraduates at West Virginia State College, representing approximately 9% of the student population, voluntarily reported on their patterns of drug use. Students were voluntarily recruited en masse in several large undergraduate classes, as well as individually in several dormitories. Procedure A 25-item multiple choice questionnaire assessed sex, residence (dormitory resident or commuter), frequency of drug use (monthly, weekly, or daily), duration of drug use (less than 1 year, 1 to 2 years, or more than 2 years), and drug consumption patterns of those students identified as alcohol, tobacco, marijuana, polydrug, and nonpolydrug users. Nine individual categories were surveyed: alcohol, tobacco, marijuana, barbiturates, hallucinogens, amphetamines, cocaine, opiates, and inhalants. In addition, 15 combinations of the above drugs were evaluated; each combination was obtained by linking alcohol or marijuana with each of the other drugs (except tobacco). For statistical purposes it was decided that any student who admitted using one or more combinations of drugs at the same time would be classified as a polydrug user. To ensure that the subject clearly understood the drug categorization, a minimum of six common terms accompanied each specific drug category. For example, barbiturates were described as: downers, barbs, blue devils, yellow jackets, goof balls, downs, and phennies. Furthermore, in an attempt to accurately survey total drug use, assessment of amphetamines and barbiturates included those taken by prescription. Each student was provided with a questionnaire and an answer sheet (I.B.M. Form I.T.S. 1000 A 155) and instructed t o review the material. In an effort to eliminate, or at least diminish, deceptive responses (since completion of this survey required admission of possibly illegal acts), every effort was made to insure the anonymity of the subject. Subjects were apprised of their right to return the questionnaire, unanswered, if they so desired. The number of subjects who declined to participate in the survey was not recorded. For those electing to participate in the survey, all data were recorded on the objective answer sheet, from which it was subsequently transcribed to punched cards. Furthermore, no biographical data were requested which could identify the subject.
RESULTS Table 1 compares the percentage of subjects using each drug category as a function of sex, residence, age, and specific drug used. The nine original
44
65
15
Total (N= 365)
54
63 100 69 69
100 93 92 88
52 50 69 60 48
45
18
57 64 100 84
40 58 37 35 6
69 41
52 55
87 72
71 79 77 80 61
50 39
63 44
83 65
h g users Alcohol (n = 319) Tobaca, (n = 242) Marijuana (n = 210) Polydrug (n = 152) Nonpolydrug (n = 213)
Under 20 (n = 147) 21-25 (n = 114) 26-30 (PI = 52) = 20) 31-35 (PI Over 35 (n = 31)
Age
Males (n = 200) Females (n = 165) Residence Dormitory (n = 54) Commuter (n = 311)
sex
Secondary
Tertiary
24 30 38 41 6 21
27 21 35 40 8 22
21 29 15 10 3
20 21
17 23 25 25 12 10 16
17
23 19
34
21
8
26 31 39 39
21 28 17 20 0
15 32
24 17
11 12 15 20
2 10
4 14
11 16 4 5 0
15 9
12 8
17 19 26 28
13 26 4 5 0
22 13
17 12
7
2
7 10 9 13
0
5 12 2 15
0 6
5
9
Alcohol Tobacco Marijuana Barbiturates Hallucinogens Amphetamines Cocaine Opiates Inhalants
PrimiUY
Table 1. Percentage of Subjects Using Each Drug
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
ALCOHOL AND MARIJUANA CONSUMPTION AMONG POLYDRUG USERS
69
categories were divided into three general classifications; primary drugs (i.e., those substances-alcohol, tobacco, and marijuana-that were used by 50% or more of the sample), secondary drugs (i.e., those substances-barbiturates, hallucinogens, and amphetamines-that were used by about 25 to 50% of the sample), and tertiary drugs (i.e., those substances-cocaine, opiates, and inhalants-that were used by less than 25%’ of the sample). For each of the nine drug categories, males reported greater use than did females (sign test, p < .05); the differential was about 16%with the primary drugs and about 5% with the secondary and tertiary drugs. Residence differences were not as apparent as were sex differences: dormitory residents reported more use of the primary drugs (alcohol and marijuana) and tertiary drugs, while commuters exceeded in the use of tobacco and secondary drugs. Age differences generally portrayed a decreasing use of drugs with increasing age, with the 21 to 25 year old group reporting the most extensive drug use. Nearly 75% of the subjects under 25 years of age reported using alcohol, about 50% used tobacco and marijuana, approximately 25% used secondary drugs and cocaine, while only about 11% acknowledged use of opiates or inhalants. Age groups 26 to 30 and 31 to 35 reported the greatest use of alcohol and tobacco (many of these older students are parttime students and veterans): about 35% of these subjects used marijuana, the secondary and tertiary drugs being reported by about 10%of these groups. Subjects beyond the age of 35 reported the least use of drugs, although about 50% used alcohol and tobacco, less than 20%used barbiturates, with no other drug use reported. Additional comparisons were made of alcohol, tobacco, marijuana, polydrug users (those subjects reporting use of at least one drug combination), and nonpolydrug users (those subjects who did not report use of a single drug combination). About 90% of the alcohol and tobacco users used alcohol or tobacco, 60%used marijuana, and about 28%used secondary drugs, with 13% using tertiary drugs. Marijuana and polydrug users revealed the greatest total use of drugs by all groups surveyed: marijuana use was reported by about 92% of these subjects, alcohol and tobacco by 80%, secondary drug use by 39%, cocaine use by 27%, and opiate and inhalants by 14%. Due to the magnitude of the polydrug phenomenon and the relatively large percentage (42%) of students who acknowledged multiple drug use, we selectively focused on patterns of drug use among polydrug subjects and compared them with nonpolydrug users. Chi-square analyses between polydrug and nonpolydrug subjects revealed that polydrug users were primarily male (x2 = 8.55, df = 1, p < .Ol),
70
HOCHHAUSER
Table 2. Frequency of Drug Use: Polydrug (P) and Nonpolydrug (NP) Users
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
Monthly
Weekly
Daily
%P
%NP
%P
%NP
%P
%NP
Primary Alcohol Tobacco Marijuana
31 21 35
48 16 12
46 31 32
15 18
5 16 16
3 10 1
Secondary Hallucinogens Amphetamines Barbiturates
38 35 31
6 6
3 3 2
AM. J. DRUG ALCOHOL ABUSE, 4(1), pp. 65-76 (1977)
Alcohol and Marijuana Consumption among Undergraduate Polydrug Users
MARK HOCHHAUSER, Ph.D. Assistant Professor Department of Psychology West Virginia State College Institute, West Virginia 251 12
ABSTRACT
Of 365 undergraduates surveyed, 42% admitted to polydrug use. The rank order of drugs used was: alcohol, maxijuana, tobacco, hallucinogens, barbiturates, amphetamines, cocaine, opiates, and inhalants. Forty-four percent used one drug combination, 25% used 2 to 3 combinations, 17% used 4 to 7 combinations, with 14% using 8 to 14 combinations. Nealry 85% used alcohol plus marijuana, with nearly one-third combining alcohol or marijuana with barbiturates, hallucinogens, or amphetamines. Alcohol appeared to be the fust drug used; however, it was not abandoned when marijuana use began-both drugs were simply used concurrently, and new drugs were incorporated into the existing patterns of drug use. Interpretations of polydrug use are limited by difficulties in assessing drug use, as well as inconsistencies in the chemical composition of illicit drugs.
INTRODUCTION The polydrug phenomenon (i.e., the use of drugs in combination) has been only recently identified [ 1-41, yet it has created an assortment of methodological issues for drug-abuse researchers. Although some research exists documenting the physiological and psychological effects of combining licit drugs [S-71, virtually no evidence exists describing either the particular patterns of illicit polydrug consumption or the behavioral consequences of such consumption. 65
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
66
HOCHHAUSER
Essential information is unavailable in at least two areas: (1) the age at which drug use begins, and (2) the specific drug combinations that are used by various age groups. This knowledge is vital, as a particular drug, or combination of drugs, may generate significantly different effects, depending on the physiological and psychological maturity of the drug user [8,9] , especially when such drugs are absorbed over lengthy periods of time. The purpose of this survey was to focus on the frequency and duration of drug use, with particular emphasis on patterns of polydrug consumption. At this point some comments must be directed to the apparent conflicts in the identification of those individuals who abuse more than one drug. As originally defined [ 101 ,“polydrug abuse” was the tendency to use more than one drug; more recently, however, the National Institute on Drug Abuse (NIDA) has defined polydrug use as the use and abuse of all nonnarcotic drugs. Furthermore, the term “multidrug abuse,” i.e., the nonmedical use of more than one drug [ 1 1, 121, has also been utilized by some researchers. Multidrug abuse does not refer to the progression of drugs typically observed in most drug abusers; however, it does include multiple drug abuse based upon the primary dependence of alcohol and narcotics, whereas polydrug abuse concerns primary dependence upon drugs other than alcohol, heroin, or methadone. In an effort to resolve the controversy between polydrug abuse vs multidrug abuse, Kaufman [3] has suggested substitution of the term “multiple drug abuse” for the sometimes conflicting and confusing terminology of polydrug or multidrug abuse. In this classification, four types of multiple drug abusers are recognized: Type I includes narcotics abuse with the abuse of other psychoactive drugs and alcohol; Type I1 encompasses those on methadone maintenance who abuse other drugs and alcoho1;Type I11 is comprised of those who abuse alcohol and other drugs, and Type IV involves the abuse of nonnarcotic psychoactive drugs. Although an individual may be classified as a multiple drug abuser, this label provides only a relatively gross indication of the particular pattern of drugs used, and virtually no information as to the physiological and psychological effects of such drug combinations. For example, an individual may consume several drugs at the same time, during the same day, or the same week: although the individual might be identified as a multiple drug abuser in each case, this would provide in itself little information regarding the physiological and psychological effects of such drug use. For example, there is some evidence suggesting that traces of some drugs (e.g., marijuana) remain in the body as long as 8 days after ingestion [ 131 ,thus providing multiple drug effects as a consequence of drugs taken several days apart. A complete understanding of multiple drug use must therefore be based not only on the particular patterns of those drugs used, but on the temporal relationships between the drugs, insofar as the temporal interval between each drug consumed will affect the physiological and psychological processes of the user.
ALCOHOL AND MARIJUANA CONSUMPTION AMONG POLYDRUC USERS
61
METHOD
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
Subjects Three hundred and sixty-five undergraduates at West Virginia State College, representing approximately 9% of the student population, voluntarily reported on their patterns of drug use. Students were voluntarily recruited en masse in several large undergraduate classes, as well as individually in several dormitories. Procedure A 25-item multiple choice questionnaire assessed sex, residence (dormitory resident or commuter), frequency of drug use (monthly, weekly, or daily), duration of drug use (less than 1 year, 1 to 2 years, or more than 2 years), and drug consumption patterns of those students identified as alcohol, tobacco, marijuana, polydrug, and nonpolydrug users. Nine individual categories were surveyed: alcohol, tobacco, marijuana, barbiturates, hallucinogens, amphetamines, cocaine, opiates, and inhalants. In addition, 15 combinations of the above drugs were evaluated; each combination was obtained by linking alcohol or marijuana with each of the other drugs (except tobacco). For statistical purposes it was decided that any student who admitted using one or more combinations of drugs at the same time would be classified as a polydrug user. To ensure that the subject clearly understood the drug categorization, a minimum of six common terms accompanied each specific drug category. For example, barbiturates were described as: downers, barbs, blue devils, yellow jackets, goof balls, downs, and phennies. Furthermore, in an attempt to accurately survey total drug use, assessment of amphetamines and barbiturates included those taken by prescription. Each student was provided with a questionnaire and an answer sheet (I.B.M. Form I.T.S. 1000 A 155) and instructed t o review the material. In an effort to eliminate, or at least diminish, deceptive responses (since completion of this survey required admission of possibly illegal acts), every effort was made to insure the anonymity of the subject. Subjects were apprised of their right to return the questionnaire, unanswered, if they so desired. The number of subjects who declined to participate in the survey was not recorded. For those electing to participate in the survey, all data were recorded on the objective answer sheet, from which it was subsequently transcribed to punched cards. Furthermore, no biographical data were requested which could identify the subject.
RESULTS Table 1 compares the percentage of subjects using each drug category as a function of sex, residence, age, and specific drug used. The nine original
44
65
15
Total (N= 365)
54
63 100 69 69
100 93 92 88
52 50 69 60 48
45
18
57 64 100 84
40 58 37 35 6
69 41
52 55
87 72
71 79 77 80 61
50 39
63 44
83 65
h g users Alcohol (n = 319) Tobaca, (n = 242) Marijuana (n = 210) Polydrug (n = 152) Nonpolydrug (n = 213)
Under 20 (n = 147) 21-25 (n = 114) 26-30 (PI = 52) = 20) 31-35 (PI Over 35 (n = 31)
Age
Males (n = 200) Females (n = 165) Residence Dormitory (n = 54) Commuter (n = 311)
sex
Secondary
Tertiary
24 30 38 41 6 21
27 21 35 40 8 22
21 29 15 10 3
20 21
17 23 25 25 12 10 16
17
23 19
34
21
8
26 31 39 39
21 28 17 20 0
15 32
24 17
11 12 15 20
2 10
4 14
11 16 4 5 0
15 9
12 8
17 19 26 28
13 26 4 5 0
22 13
17 12
7
2
7 10 9 13
0
5 12 2 15
0 6
5
9
Alcohol Tobacco Marijuana Barbiturates Hallucinogens Amphetamines Cocaine Opiates Inhalants
PrimiUY
Table 1. Percentage of Subjects Using Each Drug
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
ALCOHOL AND MARIJUANA CONSUMPTION AMONG POLYDRUG USERS
69
categories were divided into three general classifications; primary drugs (i.e., those substances-alcohol, tobacco, and marijuana-that were used by 50% or more of the sample), secondary drugs (i.e., those substances-barbiturates, hallucinogens, and amphetamines-that were used by about 25 to 50% of the sample), and tertiary drugs (i.e., those substances-cocaine, opiates, and inhalants-that were used by less than 25%’ of the sample). For each of the nine drug categories, males reported greater use than did females (sign test, p < .05); the differential was about 16%with the primary drugs and about 5% with the secondary and tertiary drugs. Residence differences were not as apparent as were sex differences: dormitory residents reported more use of the primary drugs (alcohol and marijuana) and tertiary drugs, while commuters exceeded in the use of tobacco and secondary drugs. Age differences generally portrayed a decreasing use of drugs with increasing age, with the 21 to 25 year old group reporting the most extensive drug use. Nearly 75% of the subjects under 25 years of age reported using alcohol, about 50% used tobacco and marijuana, approximately 25% used secondary drugs and cocaine, while only about 11% acknowledged use of opiates or inhalants. Age groups 26 to 30 and 31 to 35 reported the greatest use of alcohol and tobacco (many of these older students are parttime students and veterans): about 35% of these subjects used marijuana, the secondary and tertiary drugs being reported by about 10%of these groups. Subjects beyond the age of 35 reported the least use of drugs, although about 50% used alcohol and tobacco, less than 20%used barbiturates, with no other drug use reported. Additional comparisons were made of alcohol, tobacco, marijuana, polydrug users (those subjects reporting use of at least one drug combination), and nonpolydrug users (those subjects who did not report use of a single drug combination). About 90% of the alcohol and tobacco users used alcohol or tobacco, 60%used marijuana, and about 28%used secondary drugs, with 13% using tertiary drugs. Marijuana and polydrug users revealed the greatest total use of drugs by all groups surveyed: marijuana use was reported by about 92% of these subjects, alcohol and tobacco by 80%, secondary drug use by 39%, cocaine use by 27%, and opiate and inhalants by 14%. Due to the magnitude of the polydrug phenomenon and the relatively large percentage (42%) of students who acknowledged multiple drug use, we selectively focused on patterns of drug use among polydrug subjects and compared them with nonpolydrug users. Chi-square analyses between polydrug and nonpolydrug subjects revealed that polydrug users were primarily male (x2 = 8.55, df = 1, p < .Ol),
70
HOCHHAUSER
Table 2. Frequency of Drug Use: Polydrug (P) and Nonpolydrug (NP) Users
Am J Drug Alcohol Abuse Downloaded from informahealthcare.com by Chulalongkorn University on 12/31/14 For personal use only.
Monthly
Weekly
Daily
%P
%NP
%P
%NP
%P
%NP
Primary Alcohol Tobacco Marijuana
31 21 35
48 16 12
46 31 32
15 18
5 16 16
3 10 1
Secondary Hallucinogens Amphetamines Barbiturates
38 35 31
6 6
3 3 2
