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Denise B. Kandel, PhD; Mark Davies, MPH

Arch Gen Psychiatry. 1996;53(1):71-80.

Abstract
Background
When it appeared in the 1980s, crack was thought to represent a completely new pathway of entry into drug use. Our objective was to identify the distinguishing characteristics of adolescents who have reached different stages of drug use, in particular the highest state represented by crack.

Methods
Adolescents (N=7611) representative of students in grades 7 to 12 from 53 New York state schools were classified in the following six mutually exclusive, cumulative categories of drug use: nonusers; alcohol and/or cigarette users only; marijuana users only; users of illicit drugs other than marijuana but neither cocaine nor crack; cocaine but not crack users; and crack users. The groups were compared in level of psychosocial functioning.

Results
Students who use illicit drugs show deficits in school performance, quality of family relationships, and health and increased psychological symptoms. Compared with nonusers, they are more delinquent and more actively involved with their peers and live in social environments in which the perceived use of drugs by other adolescents and parents is more extensive. Delinquency and extent of perceived drug use consistently increase with each higher stage of use. Crack users exhibit the lowest level of psychosocial functioning of any drug-using group.

Conclusions
There are stage-specific characteristics and common characteristics (delinquent participation, peer drug use) throughout the developmental sequence of drug use. Despite declines over the last two decades in the prevalence of the use of different drugs, young people who use drugs display characteristics over historical time similar to those of young drug users 20 years ago.

Author Affiliations
From the Department of Psychiatry and School of Public Health, Columbia University (Dr Kandel), and the New York State Office of Mental Health (Dr Kandel and Mr Davies), New York, NY.

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