Probability and predictors of transition from first use to dependence on nicotine, alcohol, cannabis, and cocaine: results of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC).
Level 3 - non-randomized controlled study
Nationally representative longitudinal survey cohort analysis using survival models.
PubMed 21145178 · doi:10.1016/j.drugalcdep.2010.11.004
What was done
Discrete-time survival analyses were conducted on data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). The study examined lifetime users of nicotine (n=15,918), alcohol (n=28,907), cannabis (n=7,389), and cocaine (n=2,259) to calculate general and racial-ethnic cumulative probabilities and timelines of transitioning from first use to dependence, as well as shared predictors of dependence.
What was found
The estimated cumulative lifetime probability of transitioning to dependence was 67.5% for nicotine, 22.7% for alcohol, 20.9% for cocaine, and 8.9% for cannabis. Half of all dependence transitions occurred within approximately 27 years for nicotine, 13 years for alcohol, 5 years for cannabis, and 4 years for cocaine after initial use. Transition probabilities varied significantly by racial-ethnic background, and common predictors—including psychiatric comorbidities and minority status—were shared across the four substances.
Why it matters
This study provides comparative epidemiological benchmarks for substance dependence risk, highlighting that while nicotine has the highest overall conversion rate, cannabis and cocaine lead to dependence considerably faster after initial use.
Limits
The abstract relies on self-reported substance use and retrospective recall of the age of first use and dependence onset, introducing potential recall and reporting bias. Specific quantitative effect sizes, odds ratios for individual predictors, and confidence intervals are omitted from the abstract.
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