Differences between substance abuse clients in treatment with and without history of tobacco use

Introduction: Evidence from population studies reveals that the typical pattern of progression to regular use of substances consists of use of one or more gateway substances such as tobacco. However, the few studies among problematic drug users have documented significant deviations from this typical pattern of progression. Objective: To determine the prevalence of atypical progression patterns among people with substance use disorders. Design: A convenience sample of 1,179 clients participating in publicly-funded substance abuse treatment facilities in Tennessee provided retrospective self-reports six months after admission to treatment about their tobacco and substance use histories. Measures: Atypical progression was defined as those with substance use disorders that did not use tobacco. Methods: Likelihood of being a typical vs. atypical progressor was analyzed using multivariable logistic regression analysis, controlling for demographic and substance abuse behavioral factors. Results: Eighty-two percent of substance abuse treatment clients were characterized as typical progressors, with 18% characterized as atypical progressors. Being African American was associated with atypical progression. Having a middle or high school-educated compared to college-educated was associated with typical progression meaning having a history of tobacco use that may have led to problematic substances abuse. Age of onset of drug use was marginally associated with typical progression, with age 6-12 initiators being more likely than 18 or older initiators to follow the typical sequence. Conclusions : It is clear that there are certain segments of the population such as African Americans that may progress to problematic use of substances without necessarily using a gateway substance.