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Ecstasy and Gateway Drugs: Initiating the Use of Ecstasy and Other Drugs

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Official websites use. Share sensitive information only on official, secure websites. The main purposes of this study are to examine if, and to what extent, ecstasy use serves as a gateway to the use of hard drugs such as cocaine, heroin, and methamphetamine and to compare the age of onset of alcohol and marijuana use and subsequent use of cocaine, heroin, and methamphetamine among young adult ecstasy users. Face-to-face surveys were conducted with young adult ecstasy users in Atlanta, Georgia. Subjects were solicited using the community identification process, including targeted sampling and guided recruitment. Data analysis involved discrete-time, event history analysis. Results suggest that the age of onset of ecstasy use influences the initiation of cocaine and methamphetamine for our sample of active ecstasy users. In addition, alcohol and marijuana use precedes the initiation of cocaine and methamphetamine, but only marijuana influences the initiation of heroin. The sequential progression of drug use proposed in the gateway literature is not immutable. Researchers must take into account the changing popularity of drugs over time, such as the emergence of ecstasy use, when identifying patterns of drug use onset. The nature of the developmental progression of drug use trajectories remains a hotly debated topic, often focusing on the validity of the gateway theory 1. This theory assumes that the use of specific drugs is related to a sequential pattern of initiation, although the causal mechanisms that drive this sequential trajectory are often unclear 2. Other scholars have provided further support for the gateway theory as it pertains to other drug pathways 7 — Studies guided by the gateway theory are not without critics. One critique is that such studies are often derived from population-based samples, which are known to exhibit low prevalence of hard drug use 12 , 16 — When examining findings from targeted samples of drug users, results show that hard drug users often do not initiate their trajectory with alcohol use, but with marijuana 18 — A second critique of studies based on the gateway theory is that most are limited to adolescents. There is little evidence that adolescents who initiate the use of hard drugs necessarily become regular users 16 , A final critique of the theory is that there is substantial ambiguity over how research findings should be interpreted, with similar findings leading to divergent conclusions 2. Despite critiques of research guided by gateway theory, the theory is used to set policies and develop educational campaigns that emphasize alcohol and tobacco abstinence to prevent future use of and addiction to hard drugs 19 , Drug researchers have critiqued such policies for failing to consider the complex underlying causal mechanisms that lead to both hard drug use and subsequent addiction 2 , Further, such policies inadequately recognize the impact of local drug markets, which to a large extent determine what drugs are available and how they are used 17 , Finally, policies typically do not respond to period and cohort effects in drug use initiation 20 , As the drug scene evolves, gateway drugs may change as well In this paper we focus on ecstasy 3,4-Methylenedioxymethamphetamine or MDMA and whether it serves as a gateway in the path to other drug use within a sample of young adult ecstasy users. We do not argue that ecstasy use may physiologically cause more serious drug use, however the social context of ecstasy use may set the stage for the subsequent use of other drugs. Within the social context of drug use, ecstasy is largely perceived to be a safe drug, with roughly one-half of adults age 19 to 30 years old seeing little risk in ecstasy In addition, there is a relatively high prevalence of ecstasy use. Among individuals between the ages of 18 and 25, Between September and April , a cross-sectional survey was conducted of active ecstasy users between the ages of 18 and 25 in Atlanta, Georgia. To be eligible, respondents had to have used ecstasy at least three times in the past 90 days on separate occasions , not be in drug treatment or another institutional setting, and not be intoxicated or otherwise cognitively impaired at the time of interview. Initial participant recruitment involved the community identification CID process, a mapping method to record epidemiological indicators of the prevalence of ecstasy use, expert opinions, and ethnographic information from local researchers 28 — It is important to note that this sample is not generalizable to the general population or even to a population of active ecstasy users. As has been done in similar studies 30 , we concentrated on a specific sample of ecstasy users to reinforce the internal validity of our data. Our subsequent results must be interpreted taking into account the specificity of our sample. Further, since all of our respondents use ecstasy, we cannot establish causality as we may have been able to had our sample included non-users. However, this sample is important in its own right, despite these weaknesses, because drug use trajectories of active ecstasy users may differ from those of experimental or non-users Using a short form, potential respondents were initially screened in the setting where they were actively recruited such as at clubs and near college dorms. In addition, we actively solicited respondents via referrals. We limited referral chains to two referrals per chain. Further, we limited the number of respondents from any one setting to eight in order to avoid saturation. Passive recruitment, involving the posting of flyers in locales with heavier concentrations of young adults, was also utilized. Passively recruited respondents were initially screened, when they called the phone number listed on the flyers, using the same short form as actively recruited respondents. Prior to each interview, a follow-up screening with a detailed focus on ecstasy use was conducted. Questions were asked about the local price of ecstasy, the local ecstasy taxonomy, and the ecstasy high. Very few individuals failed the second screening. Individuals who passed both screenings were provided with information on the nature of the study, including details about informed consent and other confidentiality procedures. Data collection involved an interviewer-administered computerized survey. The interviews took place at a mutually convenient location such as one of the project offices or a local coffee shop. The average length of time to complete the survey was two hours. We use logistic regression of discrete-time models 31 — 32 , to examine the effects of the timing of the onset of ecstasy use on the onset of cocaine, heroin, and methamphetamine use. Discrete-time event history analysis is the most appropriate approach to studying processes in which individuals change from one state to another e. Discrete-time event history models require a unique type of data. The data used in these analyses were collected as a cross-sectional dataset in which each case represents a single individual. To estimate these models using discrete-time analysis, the original data were transformed into a person-year dataset in which each case represents a separate observation of each individual for each year in which they were at risk of having used a given drug. Admittedly using years as a unit of time is a rough interval, however it is often used in social research due to a lack of more discrete measures and to avoid recall problems endemic of retrospectively collected data For each person-year case, a dummy variable, indicating whether or not the individual used a drug in that year, was added, along with a dichotomous event indicator to specify whether the event of interest occurred at the time of the last observation or the case was censored. This event indicator was regressed using logistic regression on the predictor variables and the series of dummy variables in each person-year. Every respondent within our sample either experienced the onset of a given drug or was censored at the time of the survey, within a very small number of possible years. Hence there are many cases that are tied i. The presence of ties leads to bias in continuous-time models but not discrete-time models We chose to use discrete-time models in lieu of continuous-time models for two reasons. First discrete-time models can approximate continuous-time models The transition from never using a given drug to having used that drug can occur at any finite point in time. Using retrospective data, however, limits the ability of the respondent to recall the precise timing of their transition from one state to another. The data used in this study were collected so that the respondents indicated their age when they first used a given drug. We, therefore, use discrete-time event history analysis to model a phenomenon that is in reality continuous, but that is measured discretely. Second, continuous-time models assume that an event does not happen at precisely the same time for multiple subjects. This equation predicts the conditional log-odds that a given event using a certain drug will occur in a given time period, j. In interpreting the coefficients from discrete-time survival models, the estimated percentage change in the hazard rate of having experienced a given event for a positive change in each covariate is calculated as: The three dependent variables in this analysis are the risk of using cocaine , methamphetamine , and heroin i. The dependent variable in each model is coded 0 for each year in which a respondent is at risk of using a drug and is censored for those years that the respondent is no longer at risk because the event has already occurred i. Our key independent variable is a time-dependent measure of ecstasy use. We also include measures of the timing of first alcohol use and marijuana use. We integrate time-varying independent variables into our models via the method of episode splitting Episode splitting is used when covariates change their value at some discrete point in time, such as over the course of a given year as is the case here. We have integrated episode splitting by substituting each original episode with a set of sub-episodes that split whenever the respondent experienced the onset of one of the independent variables. Hence, in our analyses, each time-varying independent variable is coded categorically as onset having occurred or not having occurred, as was the dependent variable Beyond time-dependent covariates, we include a static measure of self-control to assess differences in propensity for drug use see Table 1. We measured low self-control with a modified version of Grasmick et al. We also include a number of demographic characteristics as control variables. We conducted diagnostic analyses of our data, with special attention to issues of multicollinearity. The highest variance inflation factor in our models is 1. The onsets of alcohol and marijuana use occur at earlier ages than the onset of any other substance use among our respondents Table 2. Moreover, in this sample the onset of marijuana use precedes the onset of alcohol use by almost one year. Further, a larger proportion of our respondents reports never having used alcohol 5. Although all respondents are active ecstasy users, the age of onset of ecstasy use occurs quite late in the drug use queue. On average, the respondents report using cocaine Methamphetamine has the oldest age of onset at Univariate Kaplan-Meier survival curves for each of the drug use variables show the probability of not experiencing the onset of a given behavior at a given age Figure 1. As expected from the results presented above, the probability of not initiating alcohol and marijuana use appear lower at younger ages than the probability of not using any hard drug, including ecstasy. At that age, the use of all other drugs is just emerging. This trend is followed by cocaine and methamphetamine at approximate ages of 19 and 22, respectively. Our multivariate analyses indicate that the estimated risk of using cocaine is influenced by a number of factors Table 3. Of greatest interest to this study, however, is the use of ecstasy and the so-called gateway substances, alcohol and marijuana. As would be expected from the gateway literature, later onset of alcohol and marijuana is associated with later onset of cocaine use in our sample. These results are expected from the literature and from the survival curves presented in Figure 1. However, neither clearly indicated that delaying the onset of ecstasy use might also influence the onset of cocaine use among our respondents. That appears to be the case in these multivariate analyses. While the effect is not of the same magnitude as the effects of alcohol and marijuana, ecstasy appears to hold a position in the sequential progression of cocaine use. Alcohol, marijuana, and ecstasy onset have similar effects on the onset of methamphetamine use Table 4. As was the case for the initiation of cocaine use, the initiation of methamphetamine use appears to be influenced by ecstasy. Alcohol, marijuana, and ecstasy use do not have the same effects on heroin use as they did on cocaine and methamphetamine use among our respondents Table 5. In fact, only marijuana use has a significant effect on heroin use. Neither the onset of ecstasy use or the onset of alcohol use has a significant effect on the onset of heroin use. We explored this proposition by using discrete-time hazard models to examine how the timing of initial onset of ecstasy use influenced the onset of other hard drugs in a unique sample of active ecstasy users. And to our knowledge no other research has specifically examined the effects of the age of onset of ecstasy use on the age of onset of other hard drugs. Therefore our findings regarding ecstasy are revealing. The analyses indicate that ecstasy may have an influence on the use of other hard drugs, specifically cocaine and methamphetamine. While those in our sample of active ecstasy users tend to initiate ecstasy at a later age than many other substances, once key variables are controlled for, it appears that initiating ecstasy at a later age may lower the risk of initiating the use of cocaine and methamphetamine, although not heroin. There are a number of reasons to expect that ecstasy use may trigger the initiation of other hard drug use. While not without risk, ecstasy tends to be perceived by drug users as less risky than other hard drugs Because perception of risk influences drug use 43 , individuals may be more likely to try ecstasy. In the early years of ecstasy, use tended to be restricted to a rave-scene that was purist in nature with participants restricting the use of drugs to ecstasy However, in recent years, ecstasy use has expanded far beyond this specific drug culture The expanded use of ecstasy may have lessened its potential protection against the use of other, more stigmatized, hard drugs. Further, the current use of ecstasy in a poly-drug culture may have increased the exposure of ecstasy users to other hard drugs Users may begin to use ecstasy because they perceive it as having less risk than other hard drugs. However the initiation of ecstasy use may also be an initiation into a poly-drug culture where the availability of other hard drugs is greater and the use such drugs is normalized. In other words, individuals begin to use ecstasy because they perceive it to be low-risk, but they then put themselves at risk of using other drugs because they have now entered an environment where poly-drug use is common, and an environment where ecstasy may be adulterated with a variety of other substances unbeknownst to the user. It is important to note that our research simply establishes the existence of temporal trajectories from ecstasy use to the use of other drugs. Our research cannot explicate the causal mechanisms by which this occurs. The ideas we present as to how ecstasy may operate as a gateway to the use of other drugs are offered simply for discussion. We leave to other research the task of identifying the causal mechanisms that underpin this drug sequence. We also leave to other research the task of exploring how ecstasy operates as part of the temporal progression of drug use within other populations. Our research is based upon a unique sample of young adult, active ecstasy users. For this reason our results cannot be generalized to other drug users or to the population in general. Ecstasy may not operate in the same way in the general population where there are a greater number of people who may have experimented with ecstasy, but would not be considered active ecstasy users. Finally, our sample was restricted to those ages 25 or younger. It may be that some of our respondents initiated the use of certain drugs at some later point in life outside the bounds of this study. In summary, this research suggests that the sequential progression of drug use proposed in the gateway literature is not immutable. As different drugs rise and fall in popularity, it is important to revisit the patterns of initiation of substance use. Policy and prevention efforts based on drug sequences identified in the literature of the past may be misidentifying the typical progression of those initiating drug use in the contemporary context. Hence the initiator role of ecstasy and more recent entries into youth drug cultures, such as methamphetamine, must be investigated further. The views presented in this paper are those of the authors and do not represent those of the funding agency. We thank Miriam W. Boeri for the coordination of the data collection and all the field staff and the participants who made this study possible. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. As a library, NLM provides access to scientific literature. Ann Epidemiol. Published in final edited form as: Ann Epidemiol. Issue date Jan. PMC Copyright notice. The publisher's version of this article is available at Ann Epidemiol. Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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