Delineating prototypical patterns of substance use initiations over time.

Abstract

The purpose of this paper is to discover patterns of drug use initiations over time through a multiple event process survival mixture model (MEPSUM model), a novel approach for substance use and prevention research. The MEPSUM model combines survival analysis and mixture modeling-specifically latent class analysis-to examine individual differences in the timing of initiation and cumulative risk of substance use over time, and is applied to cross-sectional survey data on drug initiations. Data are drawn from the 2009 National Survey on Drug Use and Health. The survey includes responses from 55 772 individuals (52.05% female). The age of first use of nine different types of substances are examined, including alcohol, tobacco, cocaine and non-medical use of prescription drugs. It is argued that six patterns parsimoniously describe the population's risk of initiating different substances over time, described colloquially as general abstainers; early, late and progressive soft drug users; and early and late hard drug users. Both gender and ethnicity significantly predict the patterns, with Caucasians and males having a higher risk for the hard drug-using patterns. The MEPSUM model produced stable results in this application, as the patterns are validated in a split-sample design. The MEPSUM model provides a statistical framework from which to evaluate patterns of risk for drug initiations over time and predict substance use trajectories relevant to public health interventions. The patterns that result from the model can be used as outcomes for subsequent investigations of etiological and mediating mechanisms.