Psychological Reports. 1979, 44, 1099-1106. @ Psychological Reports 1979

MULTIPLE-DRUG USE AMONG HIGH SCHOOL STUDENTS' MARTHA J. EISTERHOLD, PATRICK MURPHY, WILLIAM BENEKE, AND GARY SCOTT Lincoln University Summary.-A survey of tobacco, alcohol and marijuana use was completed by 309 high school students in a rural midwestern county. Frequencies of use of these drugs were similar to data obtained in urban coastal populations. Significant multi-drug-use patterns were identified. Most drug use began at ages 14 or 15 and occurred in social situations implicating social factors as primary determinants of adolescents' drug use.

The frequency of drug use among high school students, particularly for marijuana, has continued to receive wide publicity. Unfortunately, all too often, public estimates of drug use, alarming statements regarding drug effects, or naive hypotheses about the reasons for students' drug use have been based on inadequate information, misinformation, or emotion. There is a clear need for additional sources of information. Studies of drug use done elsewhere have shown that 52% of high school students have tried marijuana and around 32% currently use it. Thirty-two percent use tobacco cigarettes daily and 72% currently use alcohol (Gould, Berberian, Kasl, Thompson, & Kleber, 1977). Research also has indicated parental use of drugs is significantly related to the development of problems by adolescents (Annis, 1974; Goodwin, Davis, & Robins, 1975; Hemminke, 1974; Lawrence & Roellman, 1974). It also has been shown that polydrug use is a common occurrence (Gould, et al., 1977; Hemrninke, 1974; Single, Kandel, & Faust, 1974). Three hypotheses regarding multiple-drug use have been asserted. The "stepping-stone" hypothesis suggests that use of "soft" drugs, e.g., marijuana, in itself leads to use of "hard" drugs such as heroin. This hypothesis usually refers to the progressive development of drug use, from marijuana to heroin, but several authors have applied the stepping-stone hypothesis to other drugs (Blum, Braunstein, & Stone, 1969; Single, et al., 1974). A second explanation postulates a "drug-user personality'' which predisposes individuals to use drugs. In this conceptualization, the specific drugs used would depend upon their accessibility as well as upon other social factors. Finally, the "drug-pusher" model, emphasizes accessibility and accounts for multiple-drug use by postulating a single source from which several illicit drugs are obtained. Evidence relevant to all three formulations is largely circumstantial. N o 'Research supported by NSF Minority Institution Science Improvement Grant 2x542050112 and USDA-CSRS Grant 701-15-03D awarded to Lincoln University. The authors wish to acknowledge the assistance of Phyllis Von Der Bruegge in typing and proofreading the final draft of this manuscript. Address reprint requests to William M. Beneke, Department of Education and Psychology, Lincoln University, Jefferson City, MO 65101.

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chemical or biological basis for the stepping-stone hypothesis has been forthcoming. Evidence from surveys (Gould, et al., 1977), as well as in-depth study of marijuana users in Jamaica (Rubins & Comitas, 1976), cast serious doubt on the concept of a causative progression in drug usage. The hypothesis concerning drug-user's personality, while capable of explaining varied patterns of multiple use, has not led to the specification of a personality profile predictive of multiple use, and the drug pusher model cannot explain use of multiple drugs which are obviously not obtained from a common source. The present study examined the use of chree common drugs: tobacco, alcohol, and marijuana, among high school students. It was hypothesized that positive relationships would be found between subjects' and parental drug use and that significant patterns of multiple-drug use could be identified. It also was hypothesized that data on age at first experience with drugs would not show a unitary progression of drug use in which use of any single drug consistently preceded the use of another drug.

The subjects were 309 adolescents recruited from four high schools in Cole County, Missouri. Cole County is essentially a rural Missouri county with a population of about 46,000. It includes Jefferson City, the state capital, with a population of approximately 32,000. Questionnaire The questionnaire had 32 multiple-choice items based on an earlier form developed by Ferraro and Billings ( 1974) for use with college students. Eight items dealt with demographic data on the subject and his family. The remaining 24 items concerned the use of tobacco, marijuana, and alcohol. Questions about alcohol use were further divided into "beer and wine" and "hard liquor" use. In each of the four drug categories, subjects indicated frequency of drug use, the age at which the drug was first used and parental use of the drug. Additional items for beer and wine, liquor, and marijuana dealt with situational factors relevant to drug use and asked respondents to predict their future use of these drugs. Finally, chree questions dealt with reasons for marijuana use or non-use. Procedure The questionnaire was administered by two undergraduate psychology majors or, in one instance, by a sociology teacher. While one might question data obtained by the teacher, this individual had good rapport with the students and previously had administered several other questionnaires as part of his classes. Thus, any bias introduced by teacher-administration of the questionnaire should be minimal. Explanation of the purposes of the questionnaire was given both orally and in writing prior to the survey.

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On the day the survey was conducted, the researchers again explained the purpose of the study and the procedures for completing the questionnaire. Questionnaires were then completed anonymously in a classroom setting and returned to the researchers. Data from the questionnaires were coded and keypunched for computer analysis. RESULTS

Demographic Data Data from the eight demographic questions are summarized in Table 1. The majority of subjects were white Catholics, active or barely active in their religion, and 16 to 17 yr. of age. Most were juniors or seniors in high school. A surprising 37.6% were unable to place their parents' income into the broad categories of the questionnaire. Of those who could, 138 (44.6%) had annual parental incomes of $15,000 or more. The preponderance of Catholic subjects in the sample represents the strong Roman Catholic influence in the community as well as inclusion of a large Catholic high school as one of the four schools participating in the survey. TABLE 1

DEMOGRAPHIC CHARACTERISTICS BY PERCENTAGE FOR 309 SUBJECTS COMPLETINGSURVEY Characteristics Sex Male Female Age (yr.) 13-14 15

Year in School 68

9

Parents' Income

%

Characteristics

%

Ethnic Background White Other Subjects' Religion Jewish Catholic Lutheran Baptist Other Protestant Other None Religious Activity Very Active Active Barely Active Inactive N o Affiliation

>25 Unknown

Frequency of D ~ u gUse Of the high school students surveyed, 60.2% did not smoke tobacco cigarettes. Regular users, reporting use of 1 or more cigarettes per day, comprised

M. J. EISTERHOLD, ET AL.

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24.6% of the sample. Only 13.7% of the sample did not use beer or wine, and an additional 24.8% reported drinking less than once per month. The remainder of the sample fell into the 1 to 4 times per month (33.5%) and 1 to 4 times per week (24.8%) categories, while 10 students ( 3.3% of the sample) reported drinking beer and wine daily. Hard liquor was consumed somewhat less frequently, with 28.3% reporting that they had never consumed hard liquor, and another 28% drinking less than once per month. The more frequent users were predominantly in categories 1 to 4 times per month (31.6% ) and 1 to 4 times per week ( 10.7% ), though four respondents (1.3%) reported drinking hard liquor daily. Reported cumulative frequency of marijuana use followed a different pattern. A majority (59.1%) of the sample had never used this drug. The next most common reported frequency, more than 30 times total, was reported by 61 respondents (19.8%) while the remaining 21.1% of the sample were distributed relatively evenly across the intermediate frequencies. The pattern of current marijuana use tended to parallel the use of tobacco and alcohol. Two hundred-twenty-six respondents, including 44 who had formerly used marijuana, were not current users. Only eight subjects (2.6%) currently used marijuana on a daily basis. The remaining 24.3% were evenly divided among the four intermediate frequency categories.

Maltiple-drug Use Statistically significant direct relationships were found for each of the six possible two-way comparisons of frequency of drug use, as shown in Table 2. TABLE 2

CHI-SQUARED VALUES AND CONTINGENCY COEFFICIENTS FOR COMPARISONS OF DRUGUSE FREQUENCY D~STRIBUTION Drugs

Note.-All

XI

Tobacco-Beer and Wine 76.4 Tobacco-Hard Liquor 89.5 Tobacc-Mari juana 155.0 Beer and Wine-Hard Liquor 305.9 Beer and WineMarijuana 98.5 Hard Liquor-Mari juana 95.6 chi-squared values exceeded fl < .0001.

df

Contingency Coefficient

16 16 20 16 20 20

0.446 0.475 0.579 0.706 0.493 0.488

Degrees of freedom for chi squared values differ as columns and rows with zero frequencies were combined with the adjacent column/row in computer analysis. Table 3 groups respondents by combinations of drug categories they reported using. Only 11.4% had never used the drugs in the survey; 14 1% reported using drugs in only one category (primarily beer and/or wine) ; 26.5% reported use of drugs in two categories (most often beer and wine, and hard liquor);

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MULTIPLE-DRUG USE AMONG STUDENTS

19.9% reported drug use in three categories (primarily the two alcohol categories plus either tobacco or marijuana), and the remaining 28.1 % reported use of all drugs in the survey. Since the beer and wine category appeared closely associated with hard liquor in frequency of use as well as chemistry, we combined these two into a single category, alcohol. With this change, single category users became the largest group (37.3%) followed by users of all (29.4%), two (21.9%) and no categories of drugs. TABLE 3

FREQUENCIES OF PAITERNS OP DRUGUSE Drug Combinations N o Drugs One Drug Tobacco Beer & Wine Hard Liquor Marijuana Two Drugs Beer & Wine and Hard Liquor Tobacco and Beer & Wine Tobacco and Hard Liquor Tobacco and Marijuana Beer & Wine and Marijuana Hard Liquor and Marijuana Three Drugs Tobacco and Beer & Wine and Hard Liquor Beer & Wine and Hard Liquor and Marijuana Tobacco and Beer & Wine and Marijuana Tobacco and Hard Liquor and Marijuana All ( 4 ) Drugs

N

%

35

11.4 14.1 0.3 12.1 1.3 0.3 26.5

43 1 37 4 1 81 71 6 0 0

23.2

4

2.0 0 0 1.3

0 61 26 31 3 1 86

19.9 8.5 10.1 1.O 0.3 28.1

0

Age of First Use To evaluate the stepping-stone hypothesis in the context of these drugs, the ages at which the various categories of drugs were initially used were compared for subjects who reported using any of the six possible drug pairs. In all but two cases, the largest category of respondents indicated that they first used both drug categories at the same age interval. The two exceptions indicated that tobacco use tended to precede the use of both hard liquor and marijuana, though in both cases there were substantial numbers of subjects who began use of both categories at the same time. The modal age of first use for each drug was 14 or 15 yr. of age, suggesting that social factors present at this age, rather than a stepping-stone hypothesis, better explain these data.

M. J. EISTERHOLD, ET AL.

Parelzts' Use Parental use of tobacco cigarettes was not significantly related to the students' use. At least one parent smoked cigarettes in 61% of the sample. Parents' use of beer or wine was significantly related to the students' use ( x 2 = 42.1, df = 20, p < .005). Only 16% of the subjects reported that neither parent drank beer or wine. Parents' use of beer or wine was significantly related to the students' use ( x 2 = 50.6, df = 16, p < .005). Seventy-one percent of the students reported at least one parent who drinks hard liquor. Parents' use of marijuana was significantly related to students' use ( x 2 = 75.16, df = 20, p < .005), but only 2% of the students reported a parent who used marijuana. Other Predictors of Drug U J ~ Religious activity was not significantly related to the frequency of beer or wine use but did have a significant relationship with both hard liquor use ( x 2 = 39.3, df = 16, p < .005) and marijuana use = 54.7, df = 20, P < .005 ) . The data indicate that the majority of students who use alcohol or marijuana do so in social situations Of the 83.9% of the sample who reported having used beer or wine, 44% most frequently drank when with one to three friends and 49.3% when ac a party. Of the 71% reported using hard liquor, 37.7% drank most frequently when with one to three friends and 50.3% when at a party. Fifty-two percent of the 42.6% who reported ever using marijuana did so at the suggestion of a friend who provided them with the drug. Of those who currently use marijuana 69% do so most frequently when with one to three friends. The primary reason given for first using marijuana (given by 62.2% of the sample who reported ever having used marijuana) was out of curiosity about the experience. The primary reason cited for never having used marijuana (53.7%) was not having a desire to do so.

(x3

DISCUSSION These results are comparable with results obtained in other studies. Over three-fourths of the subjects use alcohol (combining both beer and wine, and hard liquor), while Gould, et al. (1977) also reported that three-fourths of the subjects in their sample used liquor. Other results similar to Gould's include the current use of marijuana and the use of tobacco cigarettes. In both Gould's study and the present one, about one-third of the sample currently use marijuana; about one-third of Gould's sample smoke cigarettes regularly while onefourth are regular smokers in this study. The results in both studies indicate chat the use of these drugs is prevalent among high school students. Students using one drug were likely to be using other drugs as well. Significant positive relationships were found between frequency of use of all pos-

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sible drug pairs. Dividing students into those who had used each drug and those who had not, indicated that nearly 75% of the students sampled used at least two drugs surveyed and about 28% had experienced all of the drugs surveyed. Collapsing beer and wine, and hard liquor categories into the single category, alcohol, did not markedly alter this finding, as slightly more than half of the sample still used some combination of drugs. Data on age-at-first-use-of-drugs showed no consistent patterns, when any two drugs were compared. This research as well as Gould, et al.'s ( 1977) question the stepping-stone hypothesis. The most frequently reported age category for the initial use of each drug in our survey was 14 or 15 yr. of age, suggesting the social context of drug use as a primary factor. Reported current use of beer and wine, hard liquor and marijuana in the context of small groups of friends and at parties further strengthens the argument for the importance of social determinants of drug use, though this result is not difficult to explain on the basis of a drug-user personality concept. The "pusher" hypothesis does not seem relevant to this research since the drugs included in this survey are obtainable from a variety of sources. Parental drug use also appeared to be related to student use. As predicted, parental drug use was significantly related to the use of marijuana, beer or wine, and hard liquor. Tobacco cigarettes were a notable exception. Parental drug use may have value as a predictor for identifying potential drug users. Lutherans, Catholics, and those holding no formal religious affiliation were more likely to be heavier users. The relationship between religious activity and marijuana use was also statistically significant. This is comparable with Ferraro and Billings' (1974) significant findings in their marijuana-use survey between the two variables. This study yielded significant correlations between religious activity and hard liquor use; the more religiously active a student reported himself, the less likely he was to use hard liquor. The same results were found with marijuana use. Insignificant correlations were found between beer or wine frequency and religious activity. This may be accounted for by the greater social and religious acceptance of beer and wine than hard liquor. These results have implications for programs (such as drug education) aimed at reducing the drug-dependence of our youth. Rather than targeting these programs for "high risk" youth or more "dangerous" drugs, what appears to be needed is a broad program for the general youth population aimed at all drugs. If such a program is to have a focus, it should concentrate on the situational factors. Stripping drug use of its glamour and value for peer acceptance may ultimately prove to be a feasible approach. The authors find it interesting that the results of this survey, conducted in a small midwestern community, parallel SO closely those conducted in coastal

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population centers. Noting the time lag between collection of data and publication, it may be that a current survey of coastal urban regions would show an even greater frequency of drug use in these areas. Nevertheless, the problem of drug use is not limited by geography or population density. It is a problem of national scope and affects us all. REFERENCES ANNIS,

H.M. Patterns of intra-familial drug use. British Journal o f Addiction, 1974, 69, 361-369.

BLUM,R. H., BRAUNSTEIN, L., & STONE.A. Normal drug use: an exploratory study o f

patterns and correlates. In J. 0. Cole & J. R. Whittenborn (Eds.), Drug abuse: social nnd prychopharmacological arpects. Springfield, IL: Thomas, 1969. Pp. 59-92. .. FERRARO, D. P., & BILLINGS, D. K. Illicit drug use by college students: three-year trends. International Journal o f the Addictions, 1974, 9, 879-883. GOODWIN, D. W.. DAVIS, D. M., & ROBINS, L. N. Drinking a m ~ dabundant illicit drugs: the Viet Nnm case. Archives o f General Psychiatry, 1975, 32, 230-233. GOULD,L. C., BERBERIAN, R. M., KASL,S. V., THOMPSON, W. D., & KLEBER, H. D. Sequential patterns of multiple-drug use among high school students. Archiver o f General Psychiatry. 1977, 34, 216-222. HEMMINKI, E. Tobacco, alcohol, medicines and illegal drug taking. Adolescence, 1974, 9, 421-422. LAWRENCE, T. S.. & RELLMAN,J. A. Correlates of student drug use in a suburban high school. Prvchiatrv. .. 1974.. 37.. 129-136. RUBINS, V., & COMITAS, L. Ganja in Jamaica: the effects o f marijuana. Garden City. N. Y.: Doubleday, 1976. SINGLE, E., KANDEL, D.. & FAUST, R . Patterns of multiple drug use in high school. Journal o f Health and Social Behavior, 1974, 15, 344-352.

Accepted May 21, 1979.

Multiple-drug use among high school students.

Psychological Reports. 1979, 44, 1099-1106. @ Psychological Reports 1979 MULTIPLE-DRUG USE AMONG HIGH SCHOOL STUDENTS' MARTHA J. EISTERHOLD, PATRICK...
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