National Institute on Drug Abuse Highlights From the National Surveyu on Drug Alouse: 1979 walt a DOCUMENTS pt?" DEC L! 198 LIBRA UNIVERSITY OF CAI 0 | | | | WA U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration '' ''fam bd SEP Pui Highlights From the National Survey on Drug Abuse: 1979 bY Judith Droitcour, Miller and Ira FH. Cisin Social Research Group The George Washington University National Institute on Drug Abuse 5600 Fishers Lane Rockville, Maryland 20857 U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Public Health Service Alcohol, Drug Abuse, and Mental Health Administration '' OK ver Sat, SHU 272 7 PUBL This publication was written for the National Institute on Drug Abuse by the Social Research Group of The George Washington University, Washington, D.C., with the assistance of Response Analysis Corporation, Princeton, N.J., under Contract No. 271-78-3508. HV S82?S M492 “7 1474 tC) “~ | vuDpu ACKNOWLEDGMENTS Susan Somerville, research associate at the Social Research Group, made a significant contribution to this report in compiling the statistics and developing analyses. Joan Dunne Rittenhouse, Ph.D. served as project officer. li ''PREFACE This report summarizes and interprets the most recent findings of a continuing nationwide research effort sponsored by the National Institute on Drug Abuse. The 1979 National Survey is the sixth in a series of studies of the general population of the United States. These surveys provide extensive data on the use of a broad spectrum of legal and illegal substances and cover three major population groups: youth, young adults, and older adults. The purpose of reporting survey highlights is to inform drug abuse professionals and interested members of the general public about the nature and extent of drug abuse in this country today. The primary focus of this report is on those illicit drugs which have now been used by large numbers of young persons, i.e., marijuana, cocaine, and hallucinogens. In addition to providing 1979 preva- lence estimates and trend data across the last two decades, this report includes an overview of results selected from more complex analyses of National Survey data. As a special topic, the conse- quences of marijuana use are examined in terms of users' reports of their own experiences. The 1979 National Survey on Drug Abuse consists of personal inter- views with over 7,000 respondents aged 12 and older, randomly selected from the household population of the coterminus United States. These data provide the basis for prevalence estimates and other findings which contribute to an understanding of the picture of drug abuse in 1979. Population coverage, sample design, and other important research procedures are described in the Tech- nical Note near the end of this report. While same of the data presented here are based on special analyses carried out for the purposes of this report, many of the basic findings are drawn fran the more camprehensive report of prevalence estimates generated by the 1979 National Survey (Fishburne, Abelson & Cisin, 1980); much of the interpretive discussion is based on papers included in a forthcaming N.I.D.A. monograph (Rittenhouse, 1980). Five earlier similar surveys provide the basis for reporting trends across the decade of the seventies. For selected years as far back as 1960, trend data are approximated via the "reconstructed trend technique"' described in the Technical Note. The 1974, 1976 and 1977 studies were, like the present survey, undertaken jointly by the Social Research Group of The George Washington University and the Response Analysis Corporation, under the sponsorship of the National Institute on Drug Abuse. The 1971 and 1972 studies were conducted by the Response Analysis Corporation for the National Camission on Marijuana and Drug Abuse. The two measures of drug use prevalence most often utilized in this report are "lifetime experience" and "current use.'' The prevalence of lifetime experience with a particular drug is de- fined as the percentage of respondents who report having ever used that drug. The prevalence of current use refers to the percentage of respondents who report having used the drug during the month 218973 iii ''(30 days) prior to interview. These two measures are applied to a variety of substances, including marijuana/hashish (called simply "marijuana" in the text) and three "stronger" illicit drug classes—-cocaine, hallucinogens, and heroin. Lifetime experience data are also provided for the following drug-use classes: the recreational or non-medical use of psychotherapeutic drugs that are legally available only under a doctor's prescription; the use of inhalants for kicks or to get high; and, the consumption of alcohol and cigarettes, which represents legal adult behavior, but is generally prohibited for youth. The illicit drugs and drug classes covered in this report are described in the Glossary at the end of this volume. Two measures of drug use frequency--"lifetime frequency" and "'cur- rent frequency''—-are applied primarily to marijuana. The lifetime frequency of marijuana use refers to the total number of times a person has used marijuana over the course of his/her lifetime. Current frequency refers to the number of days on which the respond- ent used marijuana during the month (30 days) prior to interview. Survey results are generalizable to the population from which the sample was drawn. As in any sample survey, however, there is same degree of statistical uncertainty. For this reason, many of the tables in this report include ranges which surround estimates of drug use prevalence. For example, 35% of the young adults partici- pating in the 1979 survey report using marijuana during the month prior to the interview. The range surrounding this current use prevalence estimate is 33% to 38%. This range is referred to as the "95% confidence interval" because if corresponding ranges were calculated for all possible similar samples, the population value would be included in the range 95 out of 100 times. Thus, the reader can be 95% sure or confident that the range presented in- cludes the value which would be obtained in a complete census of the population group. Section 1 of this report provides 1979 prevalence estimates for a variety of substances and presents data on the frequency of mari- juana use; antecedents of illicit drug use and the process of drug use entry are also discussed. Section 2 summarizes recent trends and traces the changing drug abuse picture back into the decade of the sixties. Section 3 presents data on the perceived consequences of marijuana use, including respondent opinion regarding the posi- tive and negative effects of marijuana as well as marijuana users' reports of their experience with two negative consequences—-impaired driving ability and loss of motivation. Throughout this report, data are presented separately for three major population groups: youth aged 12 to 17; young adults aged 18 to 25; and older adults aged 26 or over. iv ''TABLE OF CONTENTS Section 1: DRUG ABUSE, 1979. . 2... 2. 2 ee ee ee Lifetime Experience . ...+..+ ++ -+e-+-e Current Experience. . 2. . 6. «+e ee ees Demographic Correlates. . 2... 6 + e+ se ee The Influence of the Family ......-. Section 2: TRENDS IN ILLICIT DRUG USE, 1960 THROUGH 1979 . Marijuana Trends. . ee & & Stronger Drug Trends: Cocaine and Hallucinogens .......-. Section 3: PERCEIVED CONSEQUENCES OF MARIJUANA USE . Reduced Driving Performance .... Loss of Motivation. . .....+e+-+-e-s General Perceptions: ''Good Effects''/ "Bad Effects" . Saw es REFERENCES. . 2. 6 ee ee ee ee ee ee we ee TECHNICAL NOTE. . 2. 2/6 ee ee ee ee GLOSSARY OF ILLICIT DRUG CLASSES. . . . . 26. e+ ess Page H ouour 13 13 16 19 20 22 31 34 ''''Section 1: DRUG ABUSE, 1979 The survey highlights presented in this section indicate that illicit drug use is an age related phenomenon, reflecting the present distribution of drug use opportunities. Most drug use histories are not limited to one- or two-time "experimental" use. Marijuana, the most widespread illicit substance, is typically the first and the most frequently used. The use of illicit drugs is linked to the use of legally obtainable substances, and the family continues to be an important influence on individual drug use be- havior fran the teens through the middle adult years. These and other findings are delineated in the following discussions of lifetime experience, current experience, demographic correlates and familial influences. Lifetime Experience The prevalence of lifetime experience with a particular drug refers to the percentage of a population group that has ever tried that drug. This subsection reports lifetime prevalence data for a variety of substances and also addresses (1) the process of entry into illicit drug use, i.e., caming to engage in this behavior for the first time, and (2) the lifetime frequency of use, that is, the extent to which the behavior is repeated. Opportunity is an important factor in the process of beginning J illicit drug use. Persons who have ever tried substances such as marijuana and cocaine are a subset of those who experienced the chance to try these drugs. Complex analyses of National Survey data (reported in detail by Somerville and Miller, 1980) reveal the outlines of the process of drug use entry. The typical poten- tial user does not ''seek out'' the chance to try an illicit drug. Rather, acquaintance with a user precedes the first opportunity experience--and most persons who experience a chance to try an J illicit drug do not take advantage of their first opportunity. Many who "pass up" their first chance to use a particular drug do, however, try it at a later time. These patterns apply for both marijuana and stronger drugs. ''The usual time lags across first acquaintance with a user, first opportunity, and first use suggest that many persons are hesitant to begin illicit drug use, but eventually overcome their inhibi- tions. Indeed, it seems reasonable to suppose that as a result of continuing contact with friends and/or acquaintances who use drugs, the potential user gradually comes to accept illicit drug use as a behavior which is "all right for himself." At the present time, the opportunity structure is strongly related to age. Young adults aged 18 to 25 are most likely to have experi- enced the chance to try an illicit drug. Opportunity experiences are also rather widespread among older teenagers and adults aged 26 to 34, but are considerably less common among younger teens and persons aged 35 or older. Use at the time of first opportunity is equally unlikely in all age groups, but the younger the person is at the time of the first opportunity experience, the more likely it is that he or she will eventually try the drug in question. While older persons may be less vulnerable to the influence of drug- using friends, it is possible that they simply are less likely to experience repeated opportunities for use. Thus, much of the difference in the lifetime prevalence levels observed for youth, young adults, and older adults is attributable to the present structure of opportunities for illicit drug use. As shown in Table 1, the "ever use" of illicit substances is most strongly concentrated among young adults aged 18 to 25. About two- thirds of all young adults have now tried marijuana and substantial numbers report experience with cocaine and hallucinogens such as LSD or "PCP". Since almost all persons with stronger-drug experience have also used marijuana and since many have tried both cocaine and hallucino- gens, the population of young adults may be divided into three lifetime-experience groups which are roughly equal in size: (1) those who have never used any illicit drug; (2) those who have used marijuana only; and (3) those who have used cocaine and/or hallucino- gens as wel] as marijuana. These categories of lifetime experience represent the chronological order of most drug-use histories. That is, young adult users typically report that marijuana was the first illicit substance used; of those who began with marijuana, about half report later trying cocaine and/or hallucinogens. For the majority of young adults, illicit drug use began during the teen years. As Table 1 indicates, close to one-third of all youth aged 12 to 17 have tried marijuana. However, teenage marijuana use is an age-dependent phenomenon. When youth aged 12-13, 14-15, and 16-17 are considered separately, the estimates for lifetime mari- juana experience are 8%, 32%, and 51% respectively. Although adults aged 26 or older have the lowest illicit drug use rates, it should be noted that lifetime prevalence rates are rather high among persons currently aged 26 to 34 (who were "young adults" during earlier years in the seventies); almost 50% of this age cohort report experience with marijuana, 14% have tried hallu- cinogens, and a similar number have used cocaine. ''Table 1. Prevalence of Lifetime Experience with Selected Illicit Drugs, in Three Major Age Groups: 1979 Pereent who ever used each drug or drug class DRUG/DRUG_CLASS MARIJUANA /HASH (95 percent confidence tnterval) COCAINE (95 percent confidence interval) HALLUCINOGENS (95 percent confidence interval) HEROIN (95 percent confidence interval) MAJOR AGE GRouPs® youth young adults older adults 31% (29% to 38%) Mh (4% to 7%) 7% (6% to 9%) 1% ( * to 1%) 68% (66% to 71%) 28% (25% to 30%) 25% (23% to 28%) No (3% to 5%) 20% (18% to 21%) 4% (4% to 5%) 5% (4% to 6%) 1% (1% to 2%) “Youth are aged 12 to 17 years; young adults are aged 18 to 25; older adults are 26 years of age or older. Othe logie of the 95 percent confidence interval ts explained in the preface to thts volume. In some cases, the upper or lower confidence limit may be the same as the sample estimate, because of rounding. ‘Less than one-half of one percent. ''Few persons in any age group report experience with heroin--a fact that may reflect the low true prevalence of this substance and/or respondent reluctance to report the use of this most stigmatized of all illicit substances. New techniques of interviewing and prevalence estimation are currently being developed for the pur- pose of reducing the ''respondent denial'' factor. One new approach, the "nominative technique,'' was included in the 1977 and 1979 National Surveys. This technique yielded higher heroin prevalence estimates than the direct-report figures shown here. Turning to the lifetime frequency of use, the relevant questions are: Once a person has tried an illicit drug, how likely is it that he or she will repeat this behavior? Are most of those who have tried illicit substances merely one- or two-time users? Or, is rather extensive experience a more likely outcome? Table 2 presents data on the lifetime frequency of marijuana use, i.e., the total number of times marijuana was used fron the re- spondent's first experience with this drug up to the interview date. Only about one-fourth of those youth who have tried marijuana report use on just one or two occasions; a similar number of 12 to 17 year olds say they have used marijuana 100 or more times. Among persons aged 18 to 25, use on 100 or more occasions is three times Table 2. Lifetime Frequency of Marijuana/Hashish Use, in Three Major Age Groups: 1979 Percent who have used martjuana/hashish 1 or 2 times, 3 to 99 times, 100 or more ttmes MAJOR AGE GROUPS® NUMBER OF TIMES USED IN LIFE youth young adults older adults 1 or 2 times 8% M 6% 3 to 99 times 15% 31% % 100 or more times 8% 28% Sh (total percent ever used) (31%) Nee (20%) “The unweighted numbers of survey respondents in each age group are as follows: 2,165 youth aged 12 to 17; 2,044 young adults aged 18 to 25; 3,015 older adults aged 26 or over. ''as likely as one- or two-time use. Even among older adults who have tried marijuana, use on just one or two occasions is not the most likely outcome. Experience with cocaine and hallucinogens is typically less extensive than experience with marijuana; how- ever, the substantial majority of young-adult cocaine and hallucino- gen users have used these drugs more than one or two times. Thus, "experimental'' one- or two-time use is not the norm for illicit drug use today. This is particularly true for marijuana, the most widespread illicit substance. Table 3 presents lifetime prevalence data on legally obtainable substances that may be subject to abuse. Like the illicit sub- stances discussed above, the "recreational" (or nonmedical) use of prescription type psychotherapeutic drugs is strongly related to age; the same is true for substances like glue, gasoline, "Locker Roan" odorizer, etc., which are inhaled for kicks or to get high. In contrast, lifetime experience with alcohol and ciga- rettes is about equally prevalent in all adult age groups. How- ever, there are strong interrelationships among all the substances examined in this report. For example, most of those who have used prescription—type pills for recreational purposes also report experience with marijuana. Current Experience The current prevalence of a particular drug refers to the percent- age who report use during the month prior to interview. As Table 4 shows, current marijuana use is rather cammon among both youth (17%) and young adults (35%); indeed, in these age groups, current users represent a little more than half of those who ever tried marijuana. Among young adults, current use of cocaine is also relatively widespread; current cocaine users represent about one- third of the young adults who ever tried this drug. Current use of other illicit drugs is less likely; e.g., only about one-sixth of the young adults who have tried hallucinogens report past-month experience. Almost all current stronger drug users are also cur- rent marijuana users. Current use of illicit drugs is clearly much less likely for older adults than for youth or young adults--even when rates for current use among those who ever tried the drug are compared. More con- plex analyses of National Survey data indicate that persons who began marijuana use during their teens or early twenties may discon- tinue use as they mature, marry, and have children; however, to the extent that repeated use has occurred, "quitting'' is a less likely outcome. Given the cammonness of current marijuana use, it is important to examine the frequency of current use, i.e., the number of days on which marijuana was used during the 30 days prior to the interview. Table 5 presents data on three current-frequency categories: use on 1 or 2 days during the past month, which represents occasional, or perhaps even sporadic, current marijuana use; use on 3 to 19 days, which includes various levels of "regular" marijuana use—- ''Table 3. Prevalence of Lifetime Experience with Legally Obtain- able Substances, in Three Major Age Groups: 1979 Percent who ever used each drug or drug class DRUG/DRUG_ CLASS NONMEDICAL Rx (95 percent confidence tnterval®) INHALANTS” (95 percent confidence interval) ALCOHOL (95 percent confidence tnterval) CIGARETTES (95 percent confidence interval) MAJOR AGE GROUPS* youth 7% (6% to 9%) 10% (8% to 12%) 70% (68% to 73%) 54% (52% to 57%) young adults 30% (27% to 32%) 1% (15% to 19%) 95% (94% to 96%) 83% (81% to 85%) older adults WM (8% to 11%) 4% (3% to 5%) 92% (90% to 93%) 83% (81% to 85%) “Youth are aged 12 to 17 years; young adults are aged 18 to 25; older adults are 26 years of age or older. b See the Glossary at the end of thts volume for definitions of "inhalants" and "nonmedical Rx." “The logte of the 95 percent confidence interval ts explained in the preface to thts volume. ''Table 4. Prevalence of Current Experience with Selected Illicit Drugs in Three Major Age Groups: 1979 Percent who used each drug or drug class durtng the month prior to interview DRUG/DRUG CLASS MARIJUANA /HASH (95 percent confidenge interval” ) CO CAINE (95 percent confidence interval) HALLUCINOGENS (95 percent confidence interval) HEROIN MAJOR AGE GrouPS* youth young adults older adults 1% (15% to 19%) 1% (1% to 2%) 2% (2% to 3%) 35% (33% to 38%) Ho (8% to 11%) % (3% to 6%) 6% (5% to 7%) 1% (1% to 1%) “Youth are aged 12 to 17 years; young adults are ages 18 to 25; older adults are aged 26 years and older. Pohe logie of the 95% confidence interval is explained in the pre- In some cases, the upper or lower confidence limit may be the same as the sample estimate, due to rounding. face to this volume. 4Less than one-half of one percent; confidence interval not provided. ''Table 5. Current Frequency of Marijuana/Hashish Use, in Three Major Age Groups: 1979 Percent who used martjuana/hashish on 1 or 2 days, 3 to 19 days, and 20 or more days during the month prior to intervtew MAJOR AGE GROUPS* DAYS USED IN PAST MONTH youth young adults older adults 1 or 2 days 6% M 3% 3 to 19 days TM% 16% Zo 20 or more 4% 11% 1% days (total percent eurrent users) (12%) (35%) (6%) a : . The unweighted numbers of survey respondents in each age group are as follows: 2,165 youth aged 12 to 17; 2,044 young adults aged 18 to 25; 3,015 older adults aged 26 years and older. but stops short of prolonged daily consumption; use on 20 or more days, which represents daily or near-daily use throughout the cur- rent month, Substantial numbers of current users fall into each of these three frequency-of-use categories. Among young adults, the most likely pattern is clearly "regular'' use that stops short of daily consump- tion. Yet 11% of all young adults (almost one-third of the current users) say they used marijuana on a daily or near-daily basis throughout the month prior to the interview. By contrast, 4% of youth aged 12 to 17 (about one-fourth of the current users) are daily or near-daily users. Among 16 to 17 year-olds, however, the rate for daily or near-daily use is 8%, representing between one- fourth and one-third of the current users in this age group--and thus approaching the level of this behavior among young adult cur- rent users. For older adults, such steady use is fairly rare; in this age group, the modal current use pattern is occasional (or perhaps sporadic) consumption. Because persons who try marijuana often consume it repeatedly and because use on a near-daily basis is not a rarity among current ''users, the consequences of marijuana use are of special concern, A later section of this report examines reduced driving perfor- mance and loss of motivation among marijuana users with various frequency-of-use histories. In contrast to the marijuana data presented here, current use of stronger drugs such as cocaine and hallucinogens usually represents use on only one or two days during the month prior to interview. The current use of certain legally obtainable substances is re- lated to the current use of illicit drugs. Young adults who report current use of prescription-type pills for recreational purposes are a subset of current marijuana users--and almost all current marijuana users also report past-month alcohol consumption. Among young adults, there appears to be a particularly close link between alcohol and marijuana use; within the relatively large group of young adults who report current use of both alcohol and marijuana, the number of days on which alcohol was used is cor- related with the number of days on which marijuana was used. While the data presented above define the general patterns of drug use in this country today, important questions concern the distri- bution of drug use behavior across various population subgroups. Has illicit drug use "spread" through most major demographic groups? Is use concentrated in same groups of young persons but relatively rare in others? What factors influence persons toward or away from drug use? These issues are pursued in the following subsections. Demographic Correlates Most demographic variables other than age are weakly related to drug use prevalence. Rates are somewhat lower for persons in the South than for other regions of the country--but the contrasts are not dramatic; e.g., 61% of young adults residing in the South report having tried marijuana in contrast to 71% or 72% of young adults residing in other regions. Similarly, rates are lower in sparsely populated rural areas than in other sections; e.g., 54% of the young adults residing in rural areas with populations of less than 2,500 report marijuana experience, in contrast to 73% of those who live in large metropolitan areas and 68% of those in moderate density areas. (See Harrell & Cisin, 1980, for a report on rural drug use.) Much smaller differences characterize various racial and socioeconamic groups. These patterns indicate that illicit drug use has spread through most major demographic groups of young persons. However, young men are more likely to be involved in illicit drug use than are young women. Although the lifetime prevalence dif- ferences are not particularly striking (61% of young women and 75% of young men report having used marijuana), young women who report marijuana use are more likely than young men to be one- or two- time users, while young males are more likely than their female counterparts to report use on 100 or more occasions. And, 45% of all young men report current marijuana use in contrast to only 26% of young women. Thus, a clear majority of the young men who ever S ''Jd tried marijuana report use during the month prior to interview; in contrast, less than half of the young women who have used mari- juana are current users. ‘ The Influence of the Family Analyses of National Survey data have highlighted the special ways v in which the family influences drug use behavior on the part of . teenagers, young adults, and older persons in their thirties and forties. As detailed in an earlier report (Miller & Rittenhouse, 1980), teenagers appear to be influenced by the example of older family members, Drug abuse behavior is more likely among those teens whose mothers smoke cigarettes and/or drink moderately than among youth whose mothers abstain. This general pattern holds for teen- age use of marijuana and stronger illicit drugs as well as for youthful alcohol and cigarette consumption. Interestingly, the mother-child link is not substance specific; for example, mothers' use of cigarettes is at least as strongly correlated with teenage alcohol use as it is with teenage cigarette use. Apparently, children learn general orientations towards or away from drug use in accordance with their mothers' substance-use behavior. Drug use is also more likely among teenagers whose older brothers or sisters use alcohol and/or illicit drugs—-and is less likely among those whose older siblings abstain. Analyses of the sibling- sibling behavior link point to drug specific effects, suggesting that teens may imitate specific behaviors which are engaged in by their older siblings. By contrast, the father's substance use does not appear to be related to their sons' and daughters' drug use. Among the other family-related factors which appear to have little or no influence on teenage drug use are: the family's socioeconamic status; the mother's current employment status; and the mother's current marital status (i.e., whether or not a father/stepfather lives in the hame). These facts argue against a general ''family situation" interpreta- tion of the mother-child and sibling-sibling links outlined above; instead, it appears that children learn drug use or abstention behavior fran certain older members of the family. While youth are regularly exposed to the influence of other family members, adults may or may not live within a family group. Young adults often spend a period of time "on their own'--the time when having left the parental hone, they have not yet begun to form ‘ families of their own. During this time young persons may live alone or (as is more often the case) may reside with "roommates" of the same or opposite sex. The prevalence of illicit drug use is very high in these groups: over 80% of the young adults who live alone have tried marijuana, as have almost 90% of those who live with friends, "roomates" or '"spouse-type'' partners. Cur- a rent marijuana use is reported by about 45% of the young adults who live alone and by 65% of those who live with roomates. Pre- 10 ''valence rates are also high for stronger drug use, especially among those who live with roommates; e.g., almost 25% of the 18- to 25- year-olds who live with roomates report current cocaine use. Ex- cessive alcohol use (i.e., consumption of five or more drinks on a Single occasion) is also more prevalent in these groups than among either young adults who still live with parents or those who reside with their spouses and/or children. Thus, during the young adult years, residence apart from family members appears to be conducive to substance abuse--and this tendency toward drug use may be further intensified by peer-group 7 living. But the importance of family residence is not limited to the 18 to 25 age group. Drug use prevalence levels are also very high among the relatively small numbers of 26- to 34-year- olds who are "cut off" fran immediate daily family influence. (About 10% of this age cohort live alone or with ''roonmates.") In the 26 to 34 age group, almost 70% of those who live alone have tried marijuana and over 30% are current users; almost 80% of those who live with roamates report experience with mari- juana, and about 55% report current use. Lifetime experience with stronger drugs is particularly widespread among 26- to 34- year-olds who live with roommates: 48% have tried cocaine and 44% have tried hallucinogens. Indeed, within the ''roonmates" group, there appears to be little difference in the behavior of 18- to 25-year-olds and 26- to 34-year-olds. In addition, among married persons in the 26 to 34 age group, the presence of children in the home is an influence; e.g., 62% of the married persons who have no children have tried mari- juana and 24% are current users; in comparison, about 40% of the married persons with children have tried this drug and only 10% are current users. The latter group (married persons with children) comprises more than half of the age 26 to 34 popu- lation. Even among persons aged 35 to 49, marital status and/or a lack of family members in the living group are related to illicit drug use. The large majority of persons aged 35 to 49 are married and live with their spouses; only 14% of such persons have ever tried marijuana and current use is rare indeed (3%). Among the relatively few persons aged 35 to 49 who either live alone or reside with friends (including never-married persons as well as formerly married persons with no children or other relatives in the home), 42% report experience with marijuana and 1% report current use. Among all divorced persons in this age group, 36% report having tried marijuana and 11% report current use; rates are somewhat lower among those divorced persons whose chil- dren reside with them and somewhat higher for those who live alone or with friends. : In sum, for adults in their twenties, thirties and forties, in- volvenent in family life tends to discourage the use of illicit JS drugs. The highest prevalence rates are observed for young persons living alone or with roommates. Marital status and the presence 11 ''of children in the home are also important factors. Among youth, family influence can either encourage or discourage drug use, as older family members ''set examples'' of substance use or abstention. 12 ''a ) ~ Section 2: TRENDS IN ILLICIT DRUG USE, 1960 to 1979 This discussion of trends in illicit drug use focuses on the changes in lifetime prevalence that have resulted from the expansion of drug use opportunities across the past two decades. In addition, recent trends in current prevalence (i.e., use during the month prior to interview) are examined briefly in relation to corresponding in- creases in lifetime prevalence. Limited opportunities represent a barrier to increases in drug use prevalence, while an expansion of opportunity creates the potential for a Similar level of increase in actual drug use. During the past two decades, increases in the numbers of persons who have used mari- juana, hallucinogens, and cocaine have reflected the proliferation of opportunities to use these substances. Trends in opportunity therefore constitute an important 'barameter" of future trends in drug use experience. Perhaps more importantly, by canparing trends in opportunity to trends in lifetime prevalence, two sources of change in prevalence can be distinguished: (1) change in the per- centage of the population that is exposed to drug use opportunity, and (2) change in the tendency to ''take advantage of" drug use oppor- tunity, i.e., trends in the likelihood of use, once an opportunity occurs. (For a detailed discussion of trends in opportunity, see Samerville & Miller, 1980.) Although the earliest surveys in this series were conducted in 1971 and 1972, "retrospective estimates" are presented for lifetime pre- valence and opportunity levels in years as far back as 1960. The technique of "reconstructing" trends based on retrospective data is described in the Technical Note near the end of this report. Data on levels of current use are necessarily limited to actual survey years. Marijuana Trends Opportunities for marijuana use were rare in the early sixties—- especially among youth. As Figure 1 shows, the consistent increase in youth marijuana opportunities which characterized the past two decades have culminated in the late seventies; today, about one half of all 12- to 17-year-olds report that they had the chance to try 13 ''Figure 1—Marijuana‘ Trends in opportu- nity and lifetime experience, youth and young adults outh 100% yo ~ = 80% 60% | — 40% . = =e / _ percent with wo opportunity om 20% oe od percent ever used 0% 1960* 1967* 1972 ’°76’77. 1979 oung adults 100% » g 80% + _ goes 60% ff percentwith opportunity 40% | — “ percent ever used 20%} 9% 1960* 1967* 1972 "76°77 1979 \ “Based on reconstructed data. Includes Hashish as well as Marijuana, except in 1972 14 ~~ YS © '' marijuana if they wanted to. Trends in the lifetime prevalence of teenage marijuana use have been somewhat less dramatic--due to the lack of substantial change in the likelihood that a teenager who experiences marijuana opportunity will actually try the drug. As Figure 1 shows, as of 1967, it is estimated that about 10% of all youth had experienced marijuana opportunity and that about 6% of this age group had tried this drug; thus in 1967, about three- fifths of the youth who were exposed to marijuana opportunity took advantage of the chance to try this drug. By 1977, about 50% of the 12- to 17-year-olds reported having had the chance to try mari- juana, and nearly 30% of this age cohort had used the drug; thus, again, about three-fifths of the "exposed" youth took advantage of the chance to use this drug. Some fluctuations have occurred, but overall there has been little change in the nature of teenage "re- sponses" to the opportunity situation, and trends in youthful mari- juana use are clearly attributable to the expansion of opportunity. Over the past twenty years, increases in both marijuana opportunity and lifetime experience have been most extensive for the 18 to 25 age group. Figure 1 illustrates the clearly parallel fashion in which the proliferation of marijuana experience has followed the expansion of opportunity for the young adult population. Indeed, the rate of change identified with each historical period is equally descriptive of opportunity trends and changes in the prevalence of lifetime experience: rather gradual increases occurred during the early sixties, sharp rises characterized the late sixties and early seventies, and more moderate levels of change have continued through the late seventies. The parallel nature of the trends in marijuana opportunity and use observed for the young adult population indicates that while much of the change in lifetime prevalence is attributable to increased levels of opportunity, there have also been substantial increases in the "tendency to try marijuana'' when an opportunity occurs. In the early sixties, about one-half to three-fifths of the young adults who were exposed to marijuana opportunity actually used the drug; in subsequent years, this proportion increased so that by 1979 about four-fifths of those reporting marijuana opportunity also said they had used the drug. Nevertheless, the increase in young adults' "tendency to use" marijuana when opportunity occurs is dwarfed by the magnitude of the trends in marijuana opportunity shown in Figure 1. Thus, it is clear that in recent years increases in opportunity have outstripped increases in the "tendency to try" marijuana given that one has the chance to do so--in the 18 to 25 age group as well as among youth. Marijuana trends are least dramatic for adults aged 26 or older. However, increases in both opportunity and lifetime prevalence have taken place even in this age group, and--unlike the situation for young adults--the most substantial increases in opportunity and use have occurred since 1972. Turning to recent trends in the current (i.e., past month) use of marijuana, in each survey conducted since 1972 about one half of 15 ''the youth who ever tried marijuana reported past-month use. Among adults, the patterns are rather similar: about half of the young- adult "ever users'' reported current use in both 1972 and 1979, as did one-third of the older adults who had ever tried the drug. In both adult groups, current prevalence lagged during the mid-seven- ties, but overall, trends in the level of current marijuana use have "kept pace'' with trends in lifetime prevalence. In sum, the expansion of marijuana opportunities has been the primary source of the increases in marijuana prevalence charted across the past two decades. Although the greatest rate of increase occurred during the late sixties and early seventies, marijuana opportunities are continuing to reach ever greater numbers of persons and the pre- valence of actual use is still increasing. Most recently, between the 1977 and 1979 surveys, significant increases in both the life- time prevalence and current use of marijuana were observed for young adults as well as older persons. These data suggest that on-going increases, rather than culmination at a saturation point, may charac- terize the early 1980's. At least this appears true for the adult population. The future for youth is less predictable. Youth mari- juana trends have slowed, at least temporarily, but in our opinion it is too early to predict a "leveling off" of teenage marijuana use. Notably, the 1979 study showed significant increases in both lifetime prevalence and current use among youth residing in non- metropolitan areas—-indicating that marijuana is gradually being extended to groups of youth who were "not reached" in previous years. ‘Stronger Drug''! Trends: Cocaine and Hallucinogens This discussion of "stronger drug"! trends focusses on opportunity and use of cocaine and hallucinogens in the young adult population. Although increases in the prevalence of cocaine and hallucinogens have been observed for youth as well as older adults, the use of these substances is clearly concentrated in the 18 to 25 age group. Data on heroin trends are not presented here. Although reports of heroin opportunity have increased since 1971, reports of actual use have remained at a low level. As previously noted, survey data on heroin use may be marred by ''respondent denial,"’ i.e., respondent failure to report the fact of use; new methods of prevalence esti- mation are therefore under development. In the young adult population, trends in the lifetime prevalence of cocaine and hallucinogens have paralleled trends in the opportunity to use these substances fran 1960 to the present time. As Figure 2 shows, the moderate cocaine trends which characterized the early years have been surpassed by the most recent increases in opportunity and use of this drug. In contrast, trends in hallucinogen opportu- nity and "ever use'' were most dramatic during the late sixties and early seventies—-parallelling the marijuana trends discussed above. The recent fluctuations in hallucinogen trends shown in Figure 2 apparently derive from the variety of substances included in this general drug class. (See the Glossary at the end of this report.) Clearly, hallucinogens were more prevalent than cocaine during the early seventies, but as of 1979 about the same number of young adults report having tried each kind of substance, 16 '' Figure 2—Stronger drugs: Trends in op- portunity and lifetime experi- ence, young adults only 7 cocaine ly - 40% “ 30% _ = ; oes percentwith __,.**" opportunity |. 20% ° o Ws ” percent ececsnsenscenee” ever used 0% 1960* 1967* 1972 ’76'77 1979 hallucinogens 50% - 40% fees 4 eo « i « 30% < percentwith ,’ opportunity Pa 20%|— - Fa io 3 ra percent 10% everused - *Based on reconstructed data. y 1967* 1972 ‘76°77 1979 Le ''Overall, the young adult opportunity and "ever use'' trends observed for stronger drugs show the same pattern as the previously discussed young adult marijuana trends: increases in opportunity have usually been followed by somewhat more gradual increases in the ''tendency to use" once an opportunity occurs. Current use of hallucinogens has been relatively unlikely in each survey year, but recent trends in the current use of cocaine are rather striking: in 1974, only 3% of all young adults reported uSing cocaine during the month prior to interview; little, if any, change in this figure was observed until the 1979 survey, when 9% of this age group reported past-month cocaine use. Comparing trends in lifetime prevalence to trends in the current use of cocaine, it is clear that the rate of increase in current use has recently exceeded the rate of increase for "ever use''; a higher pro- portion of those with lifetime cocaine experience reported current use in 1979 than in any previous survey year. In summary, increases in lifetime prevalence typically follow in- creases in opportunities for illicit drug use. Generally, trends in opportunities have surpassed increases in the tendency to use once an opportunity has occurred; this is particularly true for youth, where increases in lifetime prevalence of marijuana use have been almost wholly due to the expansion of opportunities to use this drug. Trends in current prevalence have differed according to the drug in question. Current use of hallucinogens has remained relatively unlikely; trends in the current use of marijuana have kept pace with continuing increases in "ever use;'' and trends in the current use of cocaine have recently outstripped increases in lifetime experience with this drug. Finally, the trend patterns reported here do not appear to indicate that a point of saturation has been reached--at least not for the adult population. Continuing increases in the use of illicit drugs raise many ques- tions of considerable concern; perhaps the most important of these regard the consequences of illicit drug use. The following section examines selected consequences of marijuana use in terms of user reports of their own experiences, as well as respondent beliefs regarding the effects of marijuana use. 18 '' Section 3: PERCEIVED CONSEQUENCES OF MARIJUANA USE Marijuana, like alcohol and other drugs, may carry risks for a wide range of adverse effects. While studies of alcohol ebuse have identified the negative outcomes associated with various levels of alcohol consumption, marijuana has only recently came into wide- spread use and much less is known about the negative consequences that may result. The scattered evidence that does exist is gener- ally inconclusive, but suggests that marijuana users may experience adverse physiological, psychological, and even biological effects. Negative social consequences may also derive from the use of this drug. (Rittenhouse, 1979.) The current picture of drug abuse and the continuing trends out- lined in previous sections of this report point to the need for in- formation on the consequences of marijuana use: large numbers of young persons have used marijuana, and the typical pattern is not one- or two-time "experimental" use. Many young adults report cur- rent consumption on a regular or even near-daily basis. Moreover, recent trends observed for both marijuana and stronger drugs suggest that the high levels of prevalence reported in 1979 may rise even higher in the coming years. For these reasons, the consequences of marijuana use were chosen as one of two new lines of research pursued in the 1979 National Survey on Drug Abuse. While there are a number of drug effects that can be measured only in the laboratory, surveys can provide valuable data on those psychological changes, instances of reduced performance, and/or social consequences that are substantial enough to be per- ceived by the user himself or herself. Experience with consequences of this nature can be reported by marijuana users in a survey inter- 1, "split sample'' design, coupled with the use of alternative forms, was used in order to allow research in two special-topic areas with- out increasing respondent burden. More than one-half of the respon- dents to the 1979.National Survey were designated for questioning on marijuana consequences; the remainder of the sample answered spe- cial questions which allow alternative estimates of heroin preva- lence. 19 ''view. In addition, certain kinds of drug-use effects may be ob- servable by other persons, and users may relay their experiences to friends; thus, surveys can glean additional data by tapping respondents' knowledge about the experiences of other persons known to them. Such data represent respondents' perceptions of their own experiences or their friends' experiences. It should also be noted that respondents' answers in a survey interview depend upon the way in which they interpret the specific question(s) posed, and that survey data on drug use consequences are not controlled for factors such as precise dosage level, quality of substance, concurrent use of other substances, or user characteristics. Yet information pro- vided by survey respondents reflects "real life'' occurrences rather than the artificial circumstances which characterize con- trolled laboratory studies. Based on exploratory, development work conducted by the Institute for Research in Social Behavior and SRI International, under con- tract to the National Institute on Drug Abuse (see Rittenhouse, 1979), two potential consequences of marijuana use were selected for study in the National Survey on Drug Abuse: decreased driving performance and loss of motivation. This section presents marijuana users' reports of their own exper- iences with reduced ability behind the wheel and with lowered levels of motivation, as well as respondent reports of other per- sons' experiences with these consequences of marijuana use. Respon- dent beliefs are also examined. These data are presented separately A for four "marijuana gxperience"’ groups within the young adult and older adult samples: (1) those respondents who have used marijuana on 100 or more occasions; (2) those who have less experience with the drug, but have used more than one or two times; (3) those reporting use on only one or two occasions; and (4) those who say they have never tried the drug. In addition to focusing on decreased driving performance and loss of motivation, this section summarizes respondents' own descrip- tions of the "good effects" and "bad effects" of marijuana use. These data, which are based on "open-ended''/''free answer'' questions, provide a general picture of prevailing perceptions of marijuana and its effects. Reduced Driving Performance The negative impact of marijuana use on driving performance is de- fined here in terms of an acute short-term effect: "Getting really high shortly before driving'' would ''cause a person to drive less well than he or she usually does." Table 6 shows the percentage 2No youth were designated for the consequences form of the 1979 questionnaire, in part because some consequences questions are not relevant to youth; e.g., the majority of youth aged 12 to 17 are not old enough to drive. ''Table 6. Marijuana Consequences: Perceived Effect on Driving Performance, by Lifetime Frequency of Marijuana Use Beltef: Getting really high on martjuana would cause a person to drive less well youNG ADULTS* b LIFETIME PERCENT HOLDING THIS BELIEF BASED ON: (total FREQUENCY percent OF MARI- own another's some other holding JUANA USE experience experience basis beltef) 100+ times 50% 8% 2% (60%) 3-99 times 42% 21% 12% (74%) 1-2 times 21% 44% 19% (84%) never -- 41% AM (83%) OLDER ADULTS © LIFETIME PERCENT HOLDING THIS BELIEF BASED ON: (total FREQUENCY percent OF MARI- own another's some other holding JUANA USE experience experience basis belief) 100+ times 60% Sh M (67%) 3-99 times 43% 22% 17% (81%) 1-2 times 18% 22% 4T% (87%) never -- 18% 66% (84%) "the uneighted numbers of young adult respondents in each lifetime frequency are as follows: 452 (used 100+ times); 477 (used 3-99 times); 164 (used 1-2 times); and 575 (never used). oThe three basis-of-belief categories are hierarchical: "Ou expertence" includes all respondents who both hold the belief and say that they themselves "drove less well shortly after getting really high." The category "another's expertence" includes those who hold the belief and know someone who experienced the consequence--but say they never experienced it themselves. The last cate- gory ("some other basis") includes respondents who hold the beltef, but neither report personal experience nor say it happened to someone they know. “The unweighted monbers of older adult respondents in each lifetime frequency are as follows: 136 (used 100+ times); 253 (used 3-99 times); 153 (used 1-2 times); and 1,889 (never used). al ''of respondents who hold this belief based on personal experience ("it happened to me"), as well as the percentage who, though lacking personal experience, base their belief on the knowledge of another person's experience ("it happened to someone I know"''), and the per- centage who hold this belief based on some other source of knowledge. Based on their own personal experience, large numbers of marijuana users believe that "getting really high" impairs driving performance. Notably, half of the young adults who used marijuana on at least 100 occasions report that they drove less well while high on this drug. The same is true of the majority of older adults who used the drug 100 or more times. Substantial numbers of less experienced marijuana users also report experiencing lowered performance when driving while high. Among those users who never experienced this consequence themselves, the majority base their belief on the fact that it happened to sameone they know. Many nonusers also claim to know persons who experienced this consequence. Overall, a sub- stantial majority of young adults and older persons believe that "getting really high'' results in decreased driving ability. Although the prevalence of this belief is somewhat lower among persons who have used marijuana 100 or more times, 60% of the young adults in this group and a larger majority of the older "most experienced" users agree that marijuana use impairs driving performance. The number of adults who believe that marijuana has a negative effect on driving is about the same as the number who believe that four or five alcohol drinks would impair driving performance. Loss of Motivation The adverse effect which marijuana may have on motivation is de- fined as follows: steady or daily marijuana use would ''cause a hard-working person to stop caring and not try as hard."' Steady or daily use is defined as including both (1) heavy, continual use, i.e., "smoking marijuana every day and at night...being almost always high" and (2) somewhat more moderate daily use, that is, "smoking a little marijuana every night and enough more on week- ends to stay high."' (It should be noted that the answers given clearly depend upon respondent interpretation of the phrase ''stop caring and not try as hard,'' because the duration and severity of motivation loss was not further specified in the questionnaire. ) Table 7 shows that 30% of the young adults and about 25% of the older persons who have used marijuana on at least 100 occasions report that at one time they themselves stopped caring and did not try_as hard because of steady or daily marijuana use. Fairly sub- stantial numbers of somewhat less experienced marijuana users (i.e., those who used more than just one or two times, but less than 100 times) also report having personally experienced the "amotiva- tional syndrome,'' but larger numbers base their belief on the experience of sameone known to then. Overall, about half of the young adults who have used marijuana at least 100 times--and a clear majority of all other groups—-believe that steady marijuana use would cause "a hard-working person to 22 '' Table 7. Marijuana Consequences: Perceived Effect on Motivation, by Lifetime Frequency of Marijuana Use Beltef: Steady or datly use” would cause a hard-working person to stop caring and not try as hard YOUNG ADULTS b LIFETIME PERCENT HOLDING THIS BELIEF BASED ON: (total FREQUENCY percent OF MARI- own another's some other holding JUANA USE experience experience basis beltef) 100+ times 30% 13% 6% (48%) 3-99 times 19% 33% 1% (69%) 1-2 times -- 59% 22% (81%) never -- 43% 38% (82%) OLDER ADULTS LIFETIME PERCENT HOLDING THIS BELIEF BASED ON: (total FREQUENCY percent OF MARI- own another's some other holding JUANA USE experience experience basis belief) 100+ times 26% 1% 15% (60%) 3-99 times 14% 35% 25% (74%) 1-2 times —- 53% 32% (85%) never -- 21% 60% (81%) "Steady use was operationally defined as "smoking marijuana every day and on weekends" and being "almost always high," while datly use consists of "smoking a little marijuana every night and enough more on weekends to stay high." Pohe three basis of belief categories are hierarchical: “Own expertence" includes all respondents who both hold the belief and say that at one time they themselves "stopped caring and did not try as hard" because of steady or daily use. The category "another's experience" includes those who hold the belief and know someone who experienced the consequence--but say they never experienced it themselves. The "other basis" category includes respondents who hold the belief but neither report personal experience nor say it happened to someone they know. Thus, the percentages presented in this table add across, except for small differences due to rounding. The unweighted numbers of respondents in each marijuana frequency group are the same as those reported tn Table 6. ''stop caring and not try as hard.'' Since about half of those not counted as holding this belief gave a qualified answer or said they lacked sufficient knowledge to respond, the number of persons actually disagreeing with the majority view is lower than might be deduced from viewing Table 7. Clearly, the majority of adults believe that marijuana use tempo-— rarily impairs driving ability and that steady or daily use results in a loss of motivation. Many of the marijuana users who hold these opinions report personal experience with these negative con- sequences; many other persons base their beliefs on having known someone who experienced these effects. Reports of personal ex- perience with both kinds of consequences are related to the number of times marijuana has been used, with reduced driving performance and loss of motivation being most frequently reported by those who have used marijuana on 100 or more occasions; thus, although only two specific consequences were examined here, the general implica- tion is that the likelihood of experiencing a negative consequence increases as the drug is used again and again. Finally, it should be noted that, while Tables 6 and 7 present data separately for various ''marijuana-experience" groups, 28% of all young adults report having driven less well as a result of getting . high and 14% of this entire population age group report that at one time they "stopped caring" and "didn't try as hard'' because of steady or daily marijuana use. General Perceptions: "Good Effects''/''Bad Effects" The perceived consequences of marijuana use described above can be viewed in terms of respondents' more general perceptions of mari- juana and its effects. Before being asked about driving performance and motivation, respondents were given a chance to tell interviewers what positive (''good") effects they associate with marijuana and what negative ("bad") effects they attribute to the use of this drug. Responses to these open-ended or free answer questions are summarized in terms of six "positive effects" categories and six (loosely corresponding) 'negative effects'' categories, as shown in Tables 8 and 9. Table 8 presents the percentage of respondents mentioning each kind of positive effect. Table 9 presents corres- ponding data on the perceived negative effects of marijuana use. These data are presented separately for those who have tried mari- juana and for those who have never used the drug. As Table 8 shows, "positive mood" (e.g., "get high," worries for- gotten, "laugh,'"' etc.) is the most frequently mentioned type of "good effect.'' Although more frequently cited by users than non- users, 42% of the young adults who never tried marijuana mentioned this effect as did about one-third of the older adult non-users. Table 9 shows that much smaller numbers of persons attribute "nega- tive mood" effects to marijuana use. Marijuana users cite "relaxation" as a positive effect almost as 24 '' frequently as they mention 'positive mood.'' Non-users are not nearly as aware of this kind of effect. Users' perception of the relaxation benefit, however, appears to be "balanced" by their perception of somewhat similar negative effects-—-including slowed reflexes, memory loss, impairment of the ability to think logically, etc.; indeed, "loss of acumen'' is the kind of negative effect most frequently mentioned by marijuana users. Perceived good effects other than "positive mood" and "relaxation" include heightened awareness, increased self-confidence, the belief that marijuana is better than (or not as bad as) alcohol, and know- ledge of various medical uses. But these positive effects were not very frequently mentioned; indeed, users mentioning them are outnumbered by those who cite loosely corresponding "bad effects." For instance, only 12% of all young adult users mentioned that marijuana "heightens awareness,"' while 17% of this group noted bad effects such as paranoia, hallucinations, or other "psychotic symptoms.'"'" Similarly, the number noting the medical uses of marijuana is smaller than the fairly substantial number who mention negative health effects. Thus, marijuana users see the drug as pranoting a "positive mood," i.e., aS giving an enjoyable feeling and allowing worries to be forgotten; this appears to be the chief benefit associated with the use of the drug. Users also perceive marijuana as having a relaxing effect, but many of these users simultaneously perceive the drug as reducing cognitive abilities. Marijuana users are also aware that use of this drug may be bad for one's health. In general, marijuana users appear to have mentioned negative effects of this drug as frequently as the non-users did. Few persons mentioned apathy or loss of motivation, effects which were included in the "negative mood" category. Although "loss of acumen" (including slowed reflexes) was the most frequently cited negative effect, few persons mentioned reduced driving ability, which was included in the "reduced performance'' category. Reduced performance (in driving, on the job, as a parent, etc.) was the least frequently cited category of negative effects; this is true for both users and non-users, young adults and older persons. When specifically asked by interviewers, of course, a clear majority were of the opinion that marijuana use does reduce driving ability and that steady use does result in a loss of motivation. Indeed, large numbers of marijuana users had experienced these negative consequences themselves—-and the majority of young adults had at least known someone to whom this had happened. Overall, the general public conceives of the positive and negative effects of marijuana in terms of "inmediate'' or direct psychological, physio-— logical, and/or biological changes-—-rather than in terms of the social ramifications or consequences these effects may produce. In other words, when people think of marijuana effects, they think first in terms of the more direct effects on the user's psyche or body. The more serious—-and socially significant--ramifications of these effects for the performance of social roles and for the well being of others in the user's environment are not as readily identified by members of the general public. 25 ''Table 8. Marijuana Consequences: Perception of Positive Effects Among Marijuana Users and Non-users Percent menttoning each kind of positive effect MARIJUANA USERS? NON-USERS© CATEGORIES OF a young older young older POSITIVE EFFECTS adults adults adults adults POSITIVE MOOD 54% 42% AM 31% (htgh, worrtes forgotten, Laughter) RELAXATION 43% 43% 16% 12% (relax, unwind; sedative, tranquilizer effects) SELF CONFIDENCE 8% 8% 4% So (feeling accepted, secure in soctal sttuattons) HEIGHTENED AWARENESS 12% 17% % 3% (sharper percepttons , sensattons; appettte/sex effects) BETTER THAN ALCOHOL 7% 6% 3% 1% (no hang- over, ete.) MEDICAL USES 12% 20% 13% 18% (treating glaucoma, cancer) @since many respondents mentioned more than one positive effect of marijuana, the positive effects categories are not mutually exclusive. Pohe unweighted nwnbers of young-adult and older-adult respondents who have used marijuana are: 1,336 (young adults) and 700 (older adults). “The unweighted numbers of young-adult and older-adult respondents who have never used marijuana are: 708 (young adults) and 2,315 (older adults). 26 '' Table 9. Marijuana Consequences: Perception of Negative Effects Among Marijuana Users and Non-users Percent mentioning each kind of negative effect MARIJUANA users” NON-USERS© CATEGORIES OF young older young older NEGATIVE EFFECTS® adults adults adults adults NEGATIVE MOOD 16% 13% 11% 11% (trrttabiltty, apathy, trresponstbiltty, depression) LOSS OF ACUMEN 41% 32% 29% 26% (slowed reflexes, memory loss, impatred logic) REDUCED PERFORMANCE 6% M 2% 4% (on job, as parent, drives less well) PSYCHOTIC SYMPTOMS 1% 20% 24% 25% (paranoia, hatluetna- tions, ete.) ADDICTION, OTHER DRUGS 18% 26% 2A% 29% (habtt-forming, leads to stronger drugs) BAD FOR HEALTH 34% 31% 29% 28% (major health problems; tem- porary physt- eal effects) * Since many respondents mentioned more than one negative effect of martjuana, the negative effects categories are not mutually exclusive. bone unwetghted numbers of young-adult and older adult respondents who have used marijuana are: 1,336 (young adults) and 700 (older adults). rhe unweighted nuwnbers of young-adult and older-adult respondents who have never used marijuana are: 708 (young adults) and 2,315 (older adults). 27 ''Further information is needed on marijuana users' experiences in performing a variety of social roles-—-worker, parent, homemaker , and so forth. At the present time, we do not know whether or in what ways the loss of motivation which can result from daily mari- juana use actually affects social interaction, role performance, and family relationships. Similarly, we do not know to what extent reduced driving performance may have implications for a lowered level of performance and productivity in other skilled behaviors or camnplex tasks. Consequences that involve decreased performance often carry nega- tive implications for other persons in the drug user's environment as well as for the individual who uses the drug. As with the con- sequences of alcohol use, the effects of marijuana on the individual user are but a small part of the potential consequences. From a social perspective, consequences that affect the well-being of other persons are of primary concern. If family relationships suffer, if motivation and performance are lower in school and on the job, if fellow employees or motorists are endangered, then the implications for the society as a whole dwarf those inmediate effects that are limited to users alone. 28 '' REFERENCES Fishburne, P.M., Abelson, H.I., and Cisin, I.H. National Survey on Drug Abuse: Main Findings 1979. Washington, D.C.: Superin- tendent of Documents, U.S. Government Printing Office, 1980. Harrell, A.V., and Cisin, I.H. Drugs in Rural America: A Special Report fron the 1979 National Survey on Drug Abuse. Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office, in press. Miller, J.D., and Rittenhouse, J.D. "Social Learning and Drug Use in Family Dyads,"" in J.D. Rittenhouse (ed.) National Survey on Drug Abuse During the Seventies: A Social Analysis. Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office, 1980. Somerville, S.N., and Miller, J.D. "Opportunity and Decision: An Analysis of Drug Use Entry," in J.D. Rittenhouse (ed.), National Survey on Drug Abuse During the Seventies: A Social Analysis. Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office, 1980. Rittenhouse, J.D. (ed.) Consequences of Alcohol & Marijuana Use. Washington, D.C.: Superintendent of Documents, U.S. Government Printing Office, 1979. DHEW Publication No. (ADM) 80-920. 29 '''' TECHNICAL NOTE This Technical Note provides summary information on the methods and procedures used in the 1979 National Survey on Drug Abuse (including coverage of the population, sample selection, inter- viewing experience, data weights) and the reconstruction of 1960's trend data for this report. Coverage of the Population The results of any survey are limited to the population fran which the sample was drawn. In the current series of studies, the term "general population'' has been used to refer to persons aged 12 and older living in households in the contiguous United States (exclud- ing Hawaii and Alaska). Restriction to the household population obviously excludes certain portions of the total population: a) per- sons living in military installations, dormitories and some other group quarters; b) persons in institutions such as hospitals and jails; c) homeless persons—-those with no fixed address. Clearly, the excluded portions of the total population may differ considerably fran one another and fram the household population in many ways, perhaps including drug use patterns. The Sample of Youth, Young Adults, and Older Adults A national area probability sample designated sample locations, households, and specific individuals; at no point was selection left to the discretion of the interviewer. There were several steps in the design of this stratified randan sample. After dividing the contiguous United States into primary geographic areas (each area consisting of a county or group of counties with a minimum population of 50,000 in 1970), 103 primary areas were drawn using stratification procedures designed to insure representativeness on a number of variables. Eight additional primary areas were then selected in order to augment the number of rural areas to be included in the sample. From within these 111 primary areas, 500 smaller areas (each containing approximately 2,500 persons) were then randomly drawn. In each smaller area, one or more "segments" of ten to twenty-five housing units was then randanly selected, and housing units to be included in the sample were listed by specific address. Except for the intentional over- sampling of rural areas, the probability procedures used for the selection of locations and housing units were such that each housing unit in the contiguous United States had, overall, an equal chance of selection. Advance letters were mailed to selected households, announcing the survey and urging cooperation. Interviewers then called at each household to list residents for purposes of random selection. The individuals in each household were listed by age group, so that youth, young adults, and older adults could be sampled separately and with varying probabilities of selection. At most, one youth and one adult were selected per household. Because previous studies 31 ''had established that younger persons had more experience with illicit drugs, youth and young adults were oversampled. Because younger persons and rural residents were oversampled, sur- vey results have been weighted to reflect the actual age and rural/ nonrural distribution of the population. Interviewing Experience Interviewers visited selected households to conduct confidential interviews with respondents. Interviews were completed with 86% of the youth, 84% of the young adults, and 80% of the older adults originally selected for the sample. In all, 2,165 youth, 2,044 young adults, and 3,015 older persons were interviewed. Because many people are frequently away from hone, interviewers often had to make several visits in order to obtain a single interview; in no case was a ''similar person'' substituted for a randomly selected individual who could not be interviewed. The data collection period spanned August, 1979, through January, 1980, with most of the interviews being conducted during the fall of 1979. Throughout this study, every possible precaution was taken to pro- tect the privacy of the respondent, to insure the confidentiality of the data, and to maximize the validity of answers to sensitive questions. For example, interviewers never knew respondents ' answers to questions concerning illegal drug use. Respondents in- dicated their answers to such questions by circling numbers on answer sheets; each respondent then sealed his or her answer sheets in an envelope which was immediately mailed to the central office. No names were used on these answer sheets. Codes identifying households were kept in locked files at a separate location and were destroyed following verification of interviews. Data Weights Prior to tabulation, the data were weighted to compensate for the oversampling of persons in the younger age groups and in rural areas; each person's relative weight was based on the inverse of his or her chance of selection, as specified in the sampling plan. In addition, weights were used to compensate for differences in canpletion rates among various interviewing locations and dif- ferent demographic subgroups. These weights insure that the tabu- lations reflect the demographic distribution of the population. Fuller details of the methods used in the 1979 National Survey are provided in: Fishburne, P.M., Abelson, H.I., and Cisin, I.H. National Survey on Drug Abuse: Main Findings 1979, Washington, D.C. Superintendent of Documents, U.S. Government Printing Office, 1980. Reconstruction of 1960's Trend Data for this Report In this report, reconstructed data were used to extend trend infor- mation beyond that provided by existing prior surveys. Reconstructe estimates of drug use prevalence during the 1960's were based on: 32 '' 1) the respondent's age in 1979, and 2) the age at which the re- spondent reported having begun drug use. For instance, if a respondent was 30 years old at the time of the 1979 survey and reported that he or she first used marijuana at age 22, then in 1967 this person was 18 years old and had not yet used marijuana. Such a respondent would be considered a young adult non-user in 1967 in the reconstructed data. Similarly, 1960's trends in drug use opportunity are based on respondents' reports of their age at the time of their first chance to try an illicit drug. Reconstructed estimates are necessarily imperfect replicas of past reality: the accuracy of the respondent's retrospective report may be in doubt, and a degree of error is thereby added; however, even though some persons may incorrectly recall their exact age at the time they first used a drug, it is unlikely that bias is thereby introduced, for there appears to be no reason why persons would consistently underestimate or overestimate their age at first use. A very small number of respondents (less than 1%) were necessarily excluded because they were unable to give their age at first opportunity or first use. On the other hand, the household population surveyed in 1979 is not identical to the population which would have been surveyed if actual studies had been conducted during the 1960's. Obviously, older persons who have died since 1960 or 1967.could not be inter- viewed in the 1979 study. Furthermore, in 1960 and 1967 the house- hold population did not include some of the people who were surveyed in 1979: For example, a number of respondents who are now in their thirties may have been living in college dormitories or military installations in 1967; the same logic applies to reconstructed estimates for 1960. A special analysis indicated that factors such as these may introduce bias into reconstructed estimates--but the bias is probably not more than a few percentage points. In pre- senting a view of drug use trends, the importance of a bias of a few percentage points varies according to the magnitude of the estimate in a particular year. In relative terms, 4% is double 2%, but 32% is only slightly more than 30%. 33 ''GLOSSARY OF ILLICIT DRUGS AND DRUG CLASSES This section defines the drug classifications used in this report and provides some general information on the nature of certain illicit substances. It should be noted that the effect of any substance varies according to many factors, including dosage, quality, user characteristics, and other conditions of use. Marijuana/hashish. Marijuana and hashish are both derived from the same plant (Cannabis sativa), although hashish is stronger than marijuana. In the 1979 survey, a single set of questions was used for marijuana and hashish; e.g., "How old were you when you first had a chance to try marijuana or hashish if you wanted to?"' Cocaine. This drug, which is derived from the leaves of the coca bush, is usually classified as a stimulant, since it is often used to produce alertness as well as euphoria. Hallucinogens. Some hallucinogens are derived from plants (for example, mescaline is derived from the peyote cactus); other hallucinogens, such as LSD, are synthetic substances. These various kinds of substances are usually grouped together be- cause they are typically used to temporarily alter the state of consciousness, e.g., to produce illusions. In the 1979 survey, respondents were introduced to the series of questions on hallucinogens by the following interviewer statement: ''The next questions are about LSD and other hallu- cinogens such as phencyclidine or PCP, mescaline, peyote, psilocybin, and DMT."" Earlier survey questionnaires included similar, but not identical descriptions. Heroin. Heroin is derived from opium. While many opiates, e.g., morphine, are used for medical purposes (i.e., to relieve pain and induce sleep), heroin is not legally available for medical use in the United States. Nonmedical Rx. This drug class includes the "recreational" or non- medical use of stimulants, sedatives, tranquilizers, and/or analgesics that are legally obtainable only under a doctor's prescription. Reference: MacLeod, A., McMillen, J., Marcus, C., and Hanmond, J. Questions and Answers about Drug Abuse. (Prepared in cooperation with the Special Action Office for Drug Abuse Prevention, Execu- tive Office of the President). Washington, D.C.: U.S. Govern- ment Printing Office, 1975. '' '' DEPARTMENT OF HEALTH AND HUMAN SERVICES PUBLIC HEALTH SERVICE POSTAGE AND FEES PAID ce ogee os sie) EER U.S. DEPARTMENT OF H.H.S. ALCOHOL, DRUG ABUSE, AND oo MENTAL HEALTH ADMINISTRATION THIRD CLASS 5600 FISHERS LANE BULK RATE ROCKVILLE, MARYLAND 20857 OFFICIAL BUSINESS Penalty for private use, $300 NOTICE OF MAILING CHANGE CL) Check here if you wish to discontinue receiving this type of publication. L) Check here if your address has changed and you wish to continue receiving this type of publication. (Be sure to furnish your complete address including zip code.) 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