Progression to regular heroin use: Examination of patterns, predictors, and consequences

Abstract Background The present study retrospectively evaluated the chronology and predictors of substance use progression in current heroin-using individuals. Methods Out-of-treatment heroin users (urinalysis-verified; N = 562) were screened for laboratory-based research studies using questionnaires and urinalysis. Comprehensive substance use histories were collected. Between- and within-substance use progression was analyzed using stepwise linear regression models. Results The strongest predictor of onset of regular heroin use was age at initial heroin use, accounting for 71.8% of variance. The strongest between-substance predictors of regular heroin use were ages at regular alcohol and tobacco use, accounting for 8.1% of variance. Earlier onset of regular heroin use (≤ 20 years) vs. older onset (≥ 30 years) was associated with a more rapid progression from initial to regular use, longer duration of heroin use, more lifetime use-related negative consequences, and greater likelihood of injecting heroin. The majority of participants (79.7%) reported substance use progression consistent with the gateway hypothesis. Gateway-inconsistent individuals were more likely to be African-American and to report younger age at initial use, longer duration of heroin use, and more frequent past-month heroin use. Conclusions Our findings demonstrate the predictive validity and clinical relevance of evaluating substance use chronology and the gateway hypothesis pattern of progression.