Early Substance Use Initiation Is Associated With Difficulty Quitting Among American Indian and Non-American Indian Youth: A Potential Marker of Later Dependence?

OBJECTIVE Early initiation of substance use during adolescence is linked to immediate and long-term risks, including impaired cognitive development, challenges in social, academic, and psychological functioning, and increased vulnerability to addiction. This study examined whether early initiation of cigarettes, alcohol, and cannabis related to difficulty quitting.

METHOD A national sample of 9,178 7-12th grade adolescents (ages 10 through 18) across 42 schools participated in a cross-sectional, epidemiologic survey of substance use among reservation-based AI and non-AI youth between 2021 and 2023. Discrete-time survival analysis estimated hazard and survival probabilities for cigarette, alcohol, and cannabis use. Multinomial logistic regression models tested age of initiation as a predictor of self-reported difficulty quitting.

RESULTS AI youth were more likely than non-AI youth to report initiating cigarette and cannabis use from ages 10 to 14, while hazard probabilities were similar between groups from age 15 onward. There was no consistent evidence of differences in initiation of alcohol between the two groups of adolescents. For all three substances, earlier initiation was associated with increased odds of being unable to quit (compared to being able to quit). These associations did not differ between AI and non-AI students.

CONCLUSIONS Early prevention is needed to delay onset of substances, particularly among AI adolescents. Early initiation of substance use may signal later dependence for both AI and non-AI youth. Screening of students who report early initiation and difficulty quitting may identify the need for tertiary prevention or early treatment for dependence.