Mark Zoccolillo, MD, McGill University

Summary:

Recalling that adolescence is the time of first exposure to illegal drugs for most who will ever use drugs, the author observes that most studies to date have examined patterns of use, prevalence rates, or symptoms of abuse. Few however have focused on problem use. Problem use is defined here as attending school, driving or playing sports while intoxicated. Studying problem use in adolescents is justified by several factors: (1) studies of alcohol use in adolescence find high rates of problem use; (2) interventions for problem use may differ from those targeting dependence; (3) understanding problem use will help clarify the steps in the development of dependence; and (4) criteria to diagnose dependence have been largely based on adult samples.

This study examines problem use in a province-wide (Québec) sample of adolescents aged 14-17. From a pool of 4,648 subjects representative of all regions of Québec and urban/rural settings, 2,863 subjects were selected for assessment and 63 % (1,808) participated (870 boys and 929 girls). A section of a larger questionnaire dealt with "cigarettes, drugs and alcohol" (70 questions). The questionnaire’s objectives were to: (1) examine illegal drugs and alcohol use separately; (2) obtain lifetime and 60month prevalence rates of problem use (more than 5 times); and (3) determine whether users had ever used drugs or alcohol frequently enough to be at risk of physiological dependence.

The results show:

1. Prevalence : 80% of boys and 82% of girls had ever drank alcohol, and 62% more than 5 times; while 44% of boys and 50% of girls had used drugs, 32% of each group using drugs more than five times. Most frequent drug used was marijuana (44% and 50%), hallucinogens (19% and 20%), with the other drugs recording rates between less than 1% and 6%.
2. Alcohol problem use: For those who drank alcohol more than 5 times, 29% of boys and 47% of girls had none of the problem uses listed. But 30% of boys and 25% of girls had at least one problem, 22% of boys and 16% of girls had two, 10% of boys and 5% of girls had three. The most frequent problem uses for boys were: drinking before playing sports (45%), drinking in the morning (34%), drunk while at school (16%) and driving under the influence (15%). For girls, the most frequent problems were: playing sports (27%); drinking in the morning (26%); drunk while at school (13%) and arguments with parents about alcohol (10%).
3. Drug problem use: For drug problems, only 6% of boys and 15% of girls had none of the problems listed while 10% of boys and 18% of girls had one, 16% of each group had two, and 20% of boys and 16% of girls had three. 79% of boys and 69% of girls had been at school while drugged, 75% of boys and 53% of girls had played sports while drugged, 68% of boys and 56% of girls had used drugs in the morning; 28% of boys and 27% of girls had arguments with parents because of drugs.

According to the author, the data suggest that "normative use" of drugs is in fact problem use: (1) almost all adolescents who reported using drugs more than 5 times reported problem use; (2) about a third have used drugs more than 5 times; (3) most are 15 or 16 and have only begun using drugs recently. Even though alcohol use is more frequent, problem use of alcohol is less frequent than for drugs. It also appears that marijuana is a significant source of problems in this population. The author observes that this data is comparable to similar surveys conducted in Ontario and in the USA.