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Research Summary

Alcohol and Other Drug Use Initiation in American Indian Adolescents

Generally, risk of alcohol and tobacco use begins during adolescence, and users of these substances are more likely to progress (up until young adulthood) to marijuana and then other illicit drugs. To examine these risks among American Indian adolescents, investigators studied semiannual survey data collected over 3 years from 14–20 year olds at 7 predominantly American Indian high schools.

  • Of 568 adolescents who were abstinent at the start of the study, 42% initiated use with alcohol, marijuana, and/or inhalants, while 7% initiated use with other illicit drugs (e.g., cocaine). Initiation of substance use peaked at approximately age 18, and alcohol was the most common first substance used.
  • Of 1244 adolescents who used alcohol, marijuana, and/or inhalants at the start of the study, 24% progressed to other illicit drug use.
  • Adolescents who had initiated substance use with marijuana or inhalants (versus alcohol) were significantly more likely to progress to other illicit drug use.
  • Risk of initiation and progression significantly differed by tribal group and season.


All American Indian adolescents, like other adolescents, will not necessarily follow the specified patterns of substance use initiation and progression. The findings of this study, however, do suggest that almost half of American Indian adolescents initiate substance use with alcohol, marijuana, and/or inhalants, and a quarter of users progress to other illicit drugs. This study did not address the role of tobacco in substance use progression (i.e., because it could not distinguish between ceremonial and non-ceremonial use). But, its results do imply that efforts to prevent initiation and progression may need to be tailored to the specific issues facing individual communities.

Richard Saitz, MD, MPH


Novins DK, Barón AE. American Indian substance use: the hazards for substance use initiation and progression for adolescents aged 14 to 20 years. J Am Acad Child Adolesc Psychiatry. 2004;43(3):316–324.
(view abstract)