Starting and stopping: Adolescents' decision-making about drug use

Use of alcohol, tobacco and other addictive drugs (ATD) is a well-recognized public health concern and one of society's greatest problems. Evidence indicates that some youth begin and end drug use during adolescence. A grounded theory methodology was used to explore adolescents' views of their experience of beginning and ending ATD use. A Basic Social Psychological Process, Starting and Stopping, was identified from 12 interviews. Informants were age 14 to 18, had tried drugs at least 6 times and abstained for at least 6 months. Decision making about drug use was described. Three stages of use that led to decision points were found. If adolescents did not stop use during the beginning stage, Exploratory Use, the adolescents had the potential to progress through two additional stages of use, Purposeful Use and Intentional Use. The intensity of use increased with each stage. Each stage had identifiable triggers and barriers that had the potential to influence continued ATD use. Curiosity was a strong stimulus for beginning drug use and then exploring never-used-before drugs. An intervening dramatic event moved adolescents more quickly toward stopping. Future orientation was present as informants stopped drug use. Decisional points were characterized by the integration of what adolescents felt were benefits of use (friend relationships, liking the experience, learning about drugs, getting relief from perceived problems) and barriers to continued use (no continued interest, not liking the experience, goals obtained, effect on relationships, effect on future, dramatic event). A Basic Social Structural Process was beginning to emerge. The structural process included drug availability, peer drug use and societal environment. The theory of adolescent decision-making about ATD use provides an opportunity for health professionals to better understand adolescent drug use