Can initial experiences with drugs predict future drug abuse risks?

Initial experiences with drugs may influence an individual's motivations for continued use. This study evaluated the relationship between subjective effects elicited by an individual's first use of alcohol or cannabis, Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) alcohol use disorder (AUD) or cannabis use disorder (CUD) severity, and behavioral economic demand for alcohol or cannabis. Self-reports of initial subjective effects associated with drugs were analyzed for N = 463 participants whose first substance use was either alcohol or cannabis. The likelihood that a particular subjective effect at the time of first use was associated with current AUD/CUD was assessed using ordinal logistic regression with subjective effects as predictors of DSM-5 severity. Behavioral economic demand was assessed using a hypothetical purchase task in which participants indicated their hypothetical consumption of alcohol or cannabis as a function of price. Significant associations were observed for initial subjective effects elicited by alcohol or cannabis and increased DSM-5 severity: (alcohol) relief (OR = 2.52 [95% CI 1.51-4.25], p = .0005) and (cannabis) energetic (OR = 2.31 [95% CI 3.27-55.5], p = .0004). The mean (± SEM) P_max value for the alcohol subgroup endorsing relief ($96.22 ± $26.48) was significantly greater than the P_max value for the alcohol subgroup not endorsing relief ($33.81 ± $12.93), t(237) = 2.276, p = .0237. These results suggest that the initial subjective effects associated with a given substance may predict the development and/or severity of substance misuse and substance use disorders (SUDs). These findings are consistent with anecdotal reports that persons with SUD feel energized by the use of substances whereas persons without SUD do not report experiencing such subjective effects upon first use. (PsycInfo Database Record (c) 2023 APA, all rights reserved).