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Multiple and Substitute Addictions Involving Prescription Drugs Misuse Among 12th Graders: Gateway Theory Revisited With Market Basket Analysis

Jayawardene, Wasantha Parakrama MD; YoussefAgha, Ahmed Hassan PhD

doi: 10.1097/ADM.0000000000000012
Original Research

Objectives: This study aimed to identify the sequential patterns of drug use initiation, which included prescription drugs misuse (PDM), among 12th-grade students in Indiana. The study also tested the suitability of the data mining method Market Basket Analysis (MBA) to detect common drug use initiation sequences in large-scale surveys.

Methods: Data from 2007 to 2009 Annual Surveys of Alcohol, Tobacco, and Other Drug Use by Indiana Children and Adolescents were used for this study. A close-ended, self-administered questionnaire was used to ask adolescents about the use of 21 substance categories and the age of first use. “Support%” and “confidence%” statistics of Market Basket Analysis detected multiple and substitute addictions, respectively.

Results: The lifetime prevalence of using any addictive substance was 73.3%, and it has been decreasing during past few years. Although the lifetime prevalence of PDM was 19.2%, it has been increasing. Males and whites were more likely to use drugs and engage in multiple addictions. Market Basket Analysis identified common drug use initiation sequences that involved 11 drugs. High levels of support existed for associations among alcohol, cigarettes, and marijuana, whereas associations that included prescription drugs had medium levels of support.

Conclusions: Market Basket Analysis is useful for the detection of common substance use initiation sequences in large-scale surveys. Before initiation of prescription drugs, physicians should consider the adolescents' risk of addiction. Prevention programs should address multiple addictions, substitute addictions, common sequences in drug use initiation, sex and racial differences in PDM, and normative beliefs of parents and adolescents in relation to PDM.

From the Department of Applied Health Science (WPJ) and Department of Epidemiology and Biostatistics (AHY), School of Public Health Bloomington, Indiana University, Bloomington, IN.

Send correspondence and reprint requests to Wasantha Parakrama Jayawardene, MD, Department of Applied Health Science, Room 116, School of Public Health Bloomington, 1025 E 7th St, Bloomington, IN 47405. E-mail:

The authors declare no conflicts of interest.

Received March 16, 2013

Accepted November 17, 2013

© 2014 American Society of Addiction Medicine