Étude des trajectoires d’usage de substances psychoactives chez l’adolescent et l’adulte jeune : Exploration de la théorie de l’escalade

Abstract : According to Gateway theory, tobacco or alcohol uses may lead to cannabis use, which may itself lead to initiation with other illicit drugs (OID). The aim of this study was to study the transitions between use of licit drugs, cannabis and OID. Data from two large population-based surveys (ESCAPAD for adolescents and Baromètre santé for young adults (year 2005)) were used. Self-reported ages at initiation of several substance uses permitted to define different stages of use. The analyses of transition between uses were performed using structural equation models and Markov multi-states models, taking into account some cofactors. Results of this study permitted to describe a drug use stage process, mediated by cannabis and susceptible to lead to OID use. These results were in accordance with the Gateway theory described by Kandel in 1975 and satisfied to some criteria: strength and stability of associations, dose-response trend, coherence with previous research and temporal relation. The theory which emerge from our research could be a “string of opportunities”, OID experiment being a consequence of initial opportunity to use the more accessible illicit drug, cannabis. However, it is important to mention that the Gateway theory, despite compatible with the majority of sequences of uses observed, is presently questioned by some authors which prefer the theory of a common vulnerability factor to addictions.
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Aurélie Mayet. Étude des trajectoires d’usage de substances psychoactives chez l’adolescent et l’adulte jeune : Exploration de la théorie de l’escalade. Médecine humaine et pathologie. Université René Descartes - Paris V, 2012. Français. ⟨NNT : 2012PA05S008⟩. ⟨tel-00725997⟩

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