ALCOHOL AND OTHER DRUGS USE BY CANADIAN YOUTH

A NATIONAL ALCOHOL AND OTHER DRUGS SURVEY (1989) REPORT

Introduction

There is ample evidence to suggest that the abuse of alcohol and other drugs affects a significant number of Canadians directly, and many more, indirectly.

Past research efforts, such as the 1985 Health Promotion Survey, generated information on the use of alcohol and other drugs that has proven useful to researchers and practitioners. These efforts also demonstrated the need for an information database that could be used for an in-depth exploration of alcohol and other drug topics.

The development of this database has been a top priority of Canada's Drug Strategy (CDS). The CDS was launched on May 27, 1987, by the Minister of National Health and Welfare, with the objective of reducing harm to individuals, families and communities from the abuse of drugs (Beatty, 1991).

The National Alcohol and Other Drugs Survey (NADS) is the first major Canadian study with an exclusive focus on alcohol and other drug-related issues (see Appendix). The objectives of the study are to document:

* national and regional patterns of alcohol and other drug consumption;

* reasons for using alcohol and other drugs;

* where and when people use alcohol and other drugs;

* the role played by family members and friends with regard to alcohol and other drug-related behaviour;

* consequences of consumption of alcohol and other drugs;

* actions taken in response to, or in anticipation of, these consequences; and

* attitudes and beliefs held by Canadians on alcohol and other drug use, and their opinions on related policy issues.

Methods

The data for the National Alcohol and Other Drugs Survey were collected through telephone interviews. The total sample consisted of interviews among 11,634 Canadians, 15 years of age and older, from all 10 provinces, excluding residents of institutions such as prisons and hospitals. Due to special sampling requirements, separate surveys will be conducted in the Yukon and the Northwest Territories. The exclusion of these populations should not significantly affect national averages.

Seventy-nine percent of those contacted responded to the interviews. This high response rate increases confidence in the representativeness of the sample.

This report restricts attention to 1,887 young Canadians aged 15 to 24 years. Although the focus of this report is on youth, in some sections comparisons are made with other age groups to show the considerable differences that occur across the lifespan. Indeed, it is important to recognize that alcohol and other drug use can differ dramatically even among those aged 15 to 24. As well, the report briefly describes trends in alcohol and other drug use among youth as noted by surveys conducted by Health and Welfare Canada and the Addiction Research Foundation of Ontario. (See Eliany et al. 1990, for survey results regarding the total sample aged 15 and over.)

Statistics Canada conducted the interviews on behalf of Health and Welfare Canada in March 1989. Households were selected using random digit-dialling methods so that most Canadian households were equally likely to be selected. The data were weighted to take into account households without phones, persons who did not respond, multiple telephones in households, the number of persons in the household, census projection counts for the provinces, and the age and sex of the population.

Respondents were asked to report about specific periods, for example, the number of alcoholic beverages consumed in the week prior to the survey. Random sampling takes into account the possibility that some respondents may have had atypically high or low consumption levels during that period. Thus, the report discusses the average number of drinks consumed per week on the assumption that the number of drinks consumed in the week preceding the survey provides a reliable estimate of this statistic. Conducting the survey in March also ensures that special holidays do not inflate estimates of drinking.

All findings in this report were examined for statistical significance. Measures of the reliability of the data, known as the sampling error of the estimate or the coefficient of variation (CV), were used to determine whether findings were suitable for release. In the tables appended to this report, estimates with a CV between 16.5% and 33.0% are marked with an asterisk (*) to indicate that they should be interpreted with caution. Estimates with a CV exceeding 33.0% are not considered reliable and were thus omitted from this publication. (See Appendix on Methodology for additional detail.)

All percentages in the discussions of alcohol use have been rounded off without decimal places. Totals may therefore not equate exactly to 100%. Because a smaller percentage of Canadians use illicit and licit drugs, all percentages in the discussion of drug use are given to one decimal place.

Throughout, differences in responses are expressed as "percentage points," that is, relative to the total response rather than just to those answering the question. For example, a decrease from 77% to 67% is shown as a decrease of 10 percentage points (77-67 = 10), not as a decrease of 13 percent (10/77 x 100).

The findings reported here are based primarily upon descriptive cross-tabulations: they do not attempt to control for the effects of associated phenomena. As such, they should be interpreted with appropriate caution.

Limitations of the Survey

Despite the size and scope of the survey, several important limitations to the data provided here should be considered at the outset.

First, the emphasis in this survey is primarily on alcohol use and secondarily on other drugs. Previous research clearly supports such an emphasis since alcohol is a much greater problem whether considered in terms of extent of use or of problems associated with use.

Second, only a limited range of drugs could be considered in this survey. There are literally thousands of psychotropic and other substances that affect the health of Canadians, and no one study could cover each of these adequately. Consequently, the survey focused upon those drugs that, by virtue of their frequency, quantity and circumstances of use, were most likely to be linked to health or other problems.

Third, the relatively small numbers of users of certain drugs inhibits detailed descriptions of the characteristics of the users and the consequences associated with use. In-depth studies of known user populations are a more appropriate means for addressing these issues.

Fourth, institutionalized Canadians and those not accessible by telephone were excluded from the survey. Patterns of use within these groups can be expected to be significantly different from those of the general population (for youth in particular, see Radford et al. 1989; Smart et al. 1990). Special studies of these populations will be required to supplement the data provided in this report.

Finally, a major concern in any survey of alcohol and other drug use is the accuracy of self-reported data. Wherever possible, this survey adopted standard questions that have proven to be effective in previous research. Further, conforming to the Statistics Act, all respondents were given assurances of anonymity and confidentiality. Allowing respondents to remain anonymous increases the response rate and improves the likelihood that they will respond truthfully to sensitive questions (Bradburn 1985; Gfroerer 1985; Murray and Perry 1987). Confidence in the data can also be bolstered by the high level of response - greater than 99% for most questions.

Research has shown self-reports of drinking to have considerable reliability (Fitzgerald and Mulford 1978; Khavari and Farmer 1978). The validity of self-reported data on drug use is also supported by a growing body of literature (Akers et al. 1983; Bachman and O'Malley 1981; O'Malley et al. 1983; Single et al. 1975; Smart and Jarvis 1981). Although there may be some under-estimation regarding the frequency and quantity of alcohol and other drug use, this should not impair intergroup comparisons (Smart and Adlaf 1987).

However, some degree of under-reporting of alcohol and other drug use can be expected, and the problem of under-reporting is likely to vary depending upon the substance under consideration. For example, in the case of prescription drugs, many respondents may simply not be aware of the specific classes of drugs they have been consuming. In the case of illicit drugs, many people may be reluctant to admit use. Consequently, these estimates should be considered not solely on their own merits, but also within the larger context of the emerging body of information on alcohol and other drug use in Canada. Each potential source of such information has certain advantages, as well as definite limitations. Together, they allow us to produce an increasingly valid and accurate portrait of the problem.

PART ONE: DRINKING BY CANADIAN YOUTH

This section examines the drinking practices of Canadians, 15 to 24 years of age. Most national and international surveys use age 15 and older to define the general adult population. It is important to note, however, many begin using alcohol and may experience problems with alcohol before this age. Respondents were asked to report on both the frequency and the level of their alcohol consumption. The survey also documented where and when young drinkers consume alcohol, why they drink, who they drink with, the prevalence of alcohol‑related problems and attitudes towards alcohol use in specific situations.

Definitions

Throughout this report the term current drinkers is used to describe those Canadians who have consumed at least one drink in the 12 months preceding the survey (Q12 in Appendix A). This definition was used in the 1985 Health Promotion Survey (Health and Welfare Canada 1988) and is also standard in American research (e.g., Clark and Midanik 1982).

A "drink" is defined as:

* one bottle of beer or glass of draft; or

* one glass of wine or a wine cooler; or

* one straight or mixed drink with 44 ml (1.5 oz.) of hard liquor.

Canadians who have consumed alcohol at some time in their life, but not during the 12 months preceding the survey, are referred to as former drinkers. Those individuals who report they have "never" consumed an alcoholic beverage are referred to as lifetime abstainers.

"Level of alcohol consumption" refers to both "frequency" and "quantity" of use. Frequency refers to how often, on average, Canadians consumed alcoholic beverages in the 12 months preceding the survey (Q19 in Appendix A). Quantity is based upon responses to survey questions about the number of alcoholic beverages consumed by the respondents during each of the seven days preceding the interview (Q24 in Appendix A). Weekly consumption estimates are based upon responses to these questions. Another "quantity measure" discussed in this report refers to the usual number of drinks consumed per drinking occasion (Q20 in Appendix A).

Finally, the survey also examined episodes of heavy drinking activity. Heavy drinking is commonly defined as the consumption of five or more drinks on a single occasion (Johnston et al. 1989; Chamberlayne et al. 1988; Smart and Adlaf, 1989). Consistent with past research, heavy drinking activity is considered in this report to be the number of times in the previous 12 months the respondent consumed five or more drinks on one occasion (Q22 in Appendix A).

PREVALENCE OF ALCOHOL CONSUMPTION

Eight out of every ten young Canadians (81%), 15 to 24 years of age, report consuming at least one alcoholic beverage in the 12 months prior to the 1989 survey. An additional 11% are former drinkers, having consumed alcohol at sometime in their life, but not within the 12 months preceding the survey. Thus, 92% of Canadian youth have at least some experience with alcohol. Only 8% report that they have never consumed an alcoholic beverage (Figure 1; Table 1).

For most young Canadians, alcohol consumption is a relatively infrequent activity (Figure 2). Almost one out of every three drinkers (29%), 15 to 24 years of age, reports drinking, on average, less than once per month. An additional 28% drink between one and three times per month. Thus, over half of all young current drinkers (57%) report consuming alcohol less than once per week. Twenty-one percent of young drinkers consume alcohol, on average, once per week. One out of every five (22%) usually drinks two or more times per week. The average young drinker consumes approximately 3.7 drinks per drinking occasion (Table 2).

Over half (52%) of all current drinkers, 15 to 24 years of age, did not consume a drink in the week prior to the survey (Figure 3). This finding is consistent with the fact that over half of all young drinkers (57%) report drinking less than once per week (Table 2). Approximately 34% of young drinkers consumed between one and seven drinks in the week preceding the survey, while 14% consumed eight drinks or more (Table 1).

The results indicate that current drinkers, 15 to 24 years of age, consume approximately 3.4 drinks per week (Table 1). This average, however, is heavily influenced by the 14% who report drinking eight or more drinks. American research suggests that the 10% of drinkers who drink the most heavily are responsible for over half of all alcohol consumed (U.S. Department of Health and Human Services 1987).

Two out of every three current drinkers (67%), 15 to 24 years of age, report consuming 5 or more drinks on at least one occasion during the 12 months preceding the survey. One-third (35%) drank at this level on only one to five occasions. One out of every ten young drinkers (12%) consumed five or more drinks on a single occasion between 6 and 14 times, and 20% did so 15 times or more (Figure 4; Table 3).

PATTERNS OF ALCOHOL USE

Region

In general, alcohol consumption among young Canadians, aged 15 to 24, increases from east to west (Figure 5; Table 4). The Prairie provinces (87%) and British Columbia (86%) have the highest percentage of young current drinkers, followed by Quebec (83%), Ontario (78%) and the Atlantic provinces (75%). Ontario and the Atlantic provinces are the only regions which drop below the national average (81%).

Young people living in the Atlantic provinces consume alcohol less frequently than their counterparts in other regions of the nation (Table 5). For example, only 13% of the young drinkers living in the Atlantic region report consuming alcohol two or more times per week, compared to over 20% in all other regions.

Estimates of the average number of drinks consumed in the week preceding the survey suggest that the Prairie provinces have the highest overall level of alcohol consumption (4.1 drinks per week), followed by British Columbia and Ontario (3.6 drinks), Quebec (3.0 drinks) and the Atlantic provinces (2.5 drinks) (Table 4).

Table 5 suggests that drinkers from the Atlantic provinces may be at greater risk of experiencing negative consequences of drinking than are other youth. Although young drinkers from the Atlantic provinces tend to drink less frequently than their counterparts from other regions, on the occasions when they do drink, they tend to consume more alcohol (Table 5). Current drinkers, 15 to 24 years of age, from both the Atlantic and Prairie provinces consume an average of 4.3 drinks per occasion, followed by British Columbia (3.8 drinks), Ontario (3.5 drinks), and Quebec (3.2 drinks). Males from the Atlantic provinces consume more drinks per occasion (5.3) than any other group.

Young current drinkers from western Canada are more likely than their counterparts in other regions to engage in heavy drinking (Table 6). For example, 25% of those living in the Prairie provinces consumed five or more drinks on 15 or more occasions in the past year, followed by those living in British Columbia (23%), Ontario and Quebec (18%), and the Atlantic Provinces (15%).

Age

Among young Canadians, there is a positive relationship between age and the prevalence of alcohol consumption. In general, the percentage of young people reporting alcohol consumption in the year prior to the survey increases with age (Table 1). Sixty-three percent of Canadians 15 to 16 years of age consumed alcohol in the year preceding the survey, compared to 80% of 17- to 19-year-olds and 88% percent of 20- to 24-year-olds. For the entire Canadian population, those who are 20 to 24 years of age have the highest rate of current consumption, while 15- to 16-year-olds have the second lowest (Figure 6).

Young adults also drink more frequently and in greater quantity than those who are still in their teens (Figure 7). For example, 60% of 15- to 16-year-olds report drinking less than once per month, compared to only 20% of those who are aged 20 to 24. On the other hand, 27% of 20- to 24-year-olds report drinking at least twice per week, compared to only 7% of those who are 15 or 16 years of age. Those who are 20 to 24 years of age also have the highest level of weekly consumption (4.3 drinks per week), followed by 17- to 19-year-olds (3.0 drinks per week) and 15- to 16-year-olds (1.0 drink per week) (Figure 8).

Heavy drinking is also more common among young adults than youth who are still in their teens (Table 3). For example, 71% of 20- to 24-year-olds report consuming five or more drinks on at least one occasion in the previous year, compared to 53% of the drinkers in the youngest age group. Similarly, one-quarter (23%) of 20-to 24-year-olds report consuming five or more drinks on 15 or more occasions, compared to 9% of 15-to 16-year-olds.

It is clear that the drinking style of young Canadians, aged 15 to 24, differs greatly from that of older individuals. In general, young current drinkers consume alcohol less often than their older counterparts (Figure 9), but are more likely to consume larger quantities of alcohol on the occasions when they do drink (Figure 10). This pattern of drinking, which often leads to intoxication, has been linked to alcohol-related problems.

Gender

The results indicate that male youth are more likely to be current drinkers than their female counterparts (Figure 11). Overall, 85% of males, 15 to 24 years of age, report consuming alcohol in the year preceding the survey, compared to 78% of females. The only exception to this general pattern occurs in the youngest age category. Fifteen- to sixteen-year-old females (66%) are slightly more likely to report being current drinkers than males of the same age (61%).

Regardless of age, male youth consume alcohol more frequently than female youth and in greater quantity (Tables 1 and 2). For example, 54% of male current drinkers, aged 15 to 24 years, report that they consume alcohol at least once per week, compared to 30% of females. Furthermore, 29% of young male drinkers report that they consume alcohol two or more times per week, compared to 13% of female drinkers. In terms of quantity, men consume an average of 4.3 drinks per occasion, compared to 3.0 drinks for women.

Estimates of the number of drinks consumed in the week preceding the survey also serve to highlight male-female differences in drinking behaviour (Table 4). For example, 21% of young male drinkers report consuming eight or more drinks in the week preceding the survey, compared to 7% of young female drinkers. Overall, young males, 15 to 24 years of age, report consuming an average of 4.8 drinks per week, compared to 1.9 drinks for women. Men aged 20 to 24 consume more drinks per week (6.1) than any other group (Figure 12).

The results also indicate that male youth are much more likely than females to engage in heavy drinking activity (Table 3). For example, approximately 43% of male drinkers, 15 to 24 years of age, report they consumed five or more drinks on at least six occasions in the year prior to the survey, compared to 20% of female drinkers. On the other hand, 42% of women report that they never consumed five or more drinks on a single occasion, compared to 25% of men.

Recent Trends

Data on the drinking practices of young Canadians from the 1989 National Alcohol and Other Drugs Survey can be compared with similar information collected by the 1985 Canada Health Survey (Health and Welfare Canada 1988). This comparison suggests a trend towards moderation in alcohol consumption: fewer Canadian youth are drinking and those who are drinking are drinking less.

The prevalence of alcohol consumption among young Canadians declined between 1985 and 1989 (Table A). For example, in 1985, 81% of 15- to 19-year-olds reported consuming alcohol in the year preceding the survey, compared to 74% in 1989 (a decrease of seven percentage points). Similarly, among those 20 to 24 years of age, the percentage of current drinkers dropped from 92% in 1985 to 88% in 1989. On the other hand, the percentage of both lifetime abstainers and former drinkers increased between 1985 and 1989.

Furthermore, the data also suggest that current levels of alcohol consumption among Canadian youth have also declined (Table A). In 1985, the average current drinker, 15 to 19 years of age, consumed 3.3 drinks per week, compared to 2.4 drinks in 1989. Similarly, 20- to 24-year-old drinkers consumed an average of 6.0 drinks per week in 1985, compared to 4.3 drinks in 1989. This reduction took place among both males and females (data not tabled).

Provincial student surveys have also documented recent declines in alcohol use (see Adlaf and Smart, 1991 for a review). Among Ontario students aged 12 to 19 years, the percentage of current drinkers declined from a peak of 77% in 1979 to 66% in 1989. Drinking among Catholic Francophone secondary school students declined from 69% in 1976 to 47% in 1984 (Desranleau, 1984). In Vancouver, drinking among students in grades 8 through 12 declined from 78% in 1978 to 62% in 1982 (Hollander and Davis, 1983). However, drinking among New Brunswick students in grades 7 through 12 has not shown any short-term declines, with annual prevalence, varying between 70% in 1986 and 71% in 1989 (Campbell 1989).

Although current drinking has declined, trends in frequency of drinking among Ontario student drinkers has not shown significant changes between 1981 and 1989 (Smart and Adlaf, 1989). Among drinkers, the percentage drinking weekly has remained stable (20% in 1981, 21% in 1983, 21% in 1985, 18% in 1987 and 19% in 1989). More disconcerting are increases among Ontario student drinkers in drinking five or more drinks on a single occasion during the four weeks prior to the survey - from 29% in 1981 to 36% in 1989. Moreover, those reporting consuming five or more drinks frequently (defined by five or more times during the prior four weeks) show steady increases (3.2% in 1981, 4.2% in 1983, 4.0% in 1985, 4.6% in 1987, and 5.2% in 1989).

ALCOHOL-RELATED PROBLEMS

Problems With One's Own Alcohol Use

All young drinkers, 15 to 24 years of age, were asked whether there was ever a time that they felt their alcohol use had had a harmful effect on their physical health, friendships, social life, outlook on life, happiness, home life, studies or employment, and financial position (Q36A to Q36B - Appendix A).

One out of every four current drinkers (23%) aged 15 to 24 reports experiencing an alcohol-related problem in the year preceding the survey (Table 7). Problems with physical health represent the most common consequence of alcohol use (11%), followed by problems with friends or social life (9%), financial position (9%), happiness or outlook (6%), work or studies (5%), and home life (5%).

Similar percentages of 20- to 24-year-olds and 15- to 19-year-olds (23% and 24% respectively) report that they experienced an alcohol-related problem in the year preceding the survey. Age differences are generally small. Those aged 20 to 24 (12%) are slightly more likely to experience health problems as a result of their drinking than 15- to 19-year-olds (9%). For all other types of problems, the difference between age groups is less than one percentage point (Table 7).

Regardless of age, male youth (28%) are more likely than female youth (18%) to report experiencing an alcohol-related problem in the year preceding the survey (Table 7). This difference exists for six of the seven problem categories. Males and females do not differ regarding the effect on their happiness or outlook on life. The high incidence of alcohol-related problems among young male drinkers is consistent with the fact that they consume significantly more alcohol than their female counterparts (see section above).

One in ten young drinkers report experiencing two or more alcohol problems during the 12 months prior to the survey, while one in twenty report three or more problems (Table 8). Again, sex differences are not exceedingly large. For example, 6% of male drinkers report three or more problems compared with 4% of female drinkers. However, male drinkers aged 15 to 19 are more likely than their female counterpart to report three or more alcohol-related problems (7% versus 1%, respectively). Age differences are also not large. About 5% of 15- to 19-year-olds and 6% of 20- to 24-year-olds report experiencing three or more problems during the 12 months prior to the survey.

The results of the National Alcohol and Other Drugs Survey strongly suggest that young drinkers are much more likely to have recently experienced an alcohol-related problem than their older counterparts (Figure 13). For example, 23% of those between 15 and 24 years of age report experiencing an alcohol-related problem in the year preceding the survey, compared to only 4% of those 65 years of age and older.

The negative relationship between age and alcohol-related problems may be a consequence of the "binge" drinking often associated with Canadian youth (see section above). Indeed, young drinkers who do not engage in heavy drinking episodes are far less vulnerable than their counterparts who do (Figure 14). For example, only 8% of the young drinkers who did not consume five or more drinks on a single occasion report experiencing an alcohol-related problem in the year preceding the survey, compared to almost half (48%) of those who consumed five or more drinks on 15 or more occasions.

The Ontario Student Drug Use Survey (Smart and Adlaf 1989) suggests that, despite a decline in the prevalence of drinking, alcohol problems have remained stable between 1981 and 1989. For example, the percentage of students reporting being warned or arrested by police because of their drinking varied between 5.1% and 6.0%. Similarly, the percentage reporting a desire to drink less varied between 4.8% and 6.1%.

Prior research has examined the nature of alcohol use and problems between adolescents and young adults. Generally, longitudinal studies, which follow up the same person over several years, show that alcohol use and problems between adolescence and later adulthood are transient in nature (Donovan et al. 1983; Fillmore and Midanik 1984; Ghodsian and Power 1987; Plant et al. 1985; Temple and Fillmore 1985). One detailed analysis of adolescent drinking problems suggested two aspects to drinking problems (White 1987). The first aspect centred on intensity of drinking, including such things as frequency and quantity of drinking and intoxication. The second centred on related consequences, including interpersonal, social and symptomatic consequences. This research found that problem drinking remained stable between 15 and 21 years, except among males aged 15 to 18. For this group, although consumption remained stable, adverse consequences increased.

Drinking and Driving

About one in five (21%) drivers aged 15 to 19 and one-third (30%) of drivers aged 20 to 24 reports having driven within an hour of consuming two or more alcoholic beverages (Q34 - Appendix A; Table 9). Regardless of age, male drivers are more likely than female drivers to report drinking and driving (26% vs. 14% among 15- to 19-year-olds and 38% vs. 21% among 20- to 24-year-olds).

In general, younger Canadians are more likely to drink and drive than older Canadians (Figure 15). Drinking and driving is most common among those between the ages of 20 and 34 (30%). By contrast, only 8% of current drivers aged 65 and over report driving within an hour of consuming two or more alcoholic beverages.

Drivers between 20 and 24 years of age (30%) are significantly more likely to drink and drive than youth who are still in their teens (21%). Males between 20 and 24 (38%) are second only to males between 25 and 34 (43%) in terms of the prevalence of drinking and driving. Among females, 20- to 24 year-olds have the highest drinking and driving rate at 21% (Table 9).

It is important to note that 15-year-olds are not of legal driving age. Thus, the drinking and driving rates in the youngest age category may be higher if 15-year-olds were omitted from the sample.

Research from the Addiction Research Foundation shows that drinking and driving among Ontario students who drive has declined dramatically during the past decade. The percentage of driving students who reported driving within one hour of drinking two or more drinks at least once during the 12 months prior to the survey declined by 31 percentage points between 1977 and 1989. Rates of drinking and driving were as follows: 58% in 1977, 53% in 1979, 41% in 1981, 47% in 1983, 38% in 1985, 28% in 1987 and 27% in 1989.

Problems Caused by Other People's Alcohol Use

In addition to discussing problems that resulted from their own alcohol use, all respondents (including non-drinkers) reported on the problems they had experienced as a result of other people's drinking behaviour (Q56A to Q56J -Appendix A).

Sixty-nine percent of young Canadians, 15 to 24 years of age, report experiencing at least once one of the 10 problems caused by other people's use of alcohol. No large age or gender differences are apparent. Among 15- to 24-year-olds, males and females are equally likely (61%) to report having experienced at least one problem. About 67% of 15- to 19-year-olds and 71% of 20- to 24-year-olds report one or more problems. Sex differences within each of these age groups are also not large.

Almost 40% of young Canadians, 15 to 24 years of age, report that in the year preceding the survey they had been insulted or humiliated by someone who had been drinking (Table 10; Figure 16). Approximately 35% of Canadian youth report they were disturbed by loud parties in the previous year and 32% report that they had had an argument or quarrel as the result of someone else's alcohol consumption.

A sizeable percentage of Canadian youth (23%) report that, within the year preceding the survey, they had been a passenger in a motor vehicle with a driver who was intoxicated. In fact, almost 3% (or 117,000 people) report they were in a car accident because of someone else's drinking.

Almost one in five Canadian youth (18%) report that, within the year preceding the survey, they were pushed, hit or physically assaulted by someone who had been drinking. Twelve percent of young people report that they had a family problem due to someone else's drinking and 11% report that they had to break off a friendship for this reason. An additional 8% report that their property had been vandalized by someone who had been drinking. Finally, 2% of Canadian youth report that, within the year preceding the survey, they experienced financial difficulties as the result of someone else's alcohol consumption.

In general, differences between 15- to 19-year-olds and 20- to 24-year-olds are small (Table 10). Those in the older age group are only slightly more likely to report being insulted or humiliated (41% vs. 34%), being disturbed by loud parties (39% vs. 32%), being a passenger with a drunk driver (25% vs. 21%), and having family problems (13% vs. 10%).

There are some gender differences in the experience of alcohol-related problems caused by other people's drinking (Table 10). Female youth are more likely than male youth to report being insulted or humiliated (40% vs. 36%), having arguments or quarrels (35% vs. 30%), having family problems (17% vs. 7%), having property vandalized (9% vs. 6%) and being disturbed by loud parties (38% vs. 33%). On the other hand, males are more likely to report being a passenger in a car with a drunk driver (27% vs. 19%), or being pushed, hit or assaulted (21% vs. 14%).

It is important to note that, in some cases, gender differences are much more apparent among 15- to 19-year-olds than 20- to 24-year-olds (Table 10). For example, 37% of 15- to 19-year-old females report having an argument as the result of someone else's drinking, compared to 26% of same aged males - a difference of 11 percentage points. By contrast, this difference is less than one percentage point among 20- to 24-year-olds (33%). However, in other cases, gender differences become larger with age. For example, the same percentage of males and females in the youngest age category report being a passenger in a car with a drunk driver. By contrast, there is a 16 percentage point difference between males and females in the 20- to 24-year-old category (33% vs. 17%).

Although gender and age differences are not large for experiencing at least one problem due to other's drinking, differences do occur for those experiencing more problems (Table 11). Those aged 20 to 24 are more likely to report three or more problems than are those aged 15 to 19 (33% vs. 28%). Among 20- to 24-year-olds, males are more likely than females (36% vs. 30%) to report three or more problems, whereas among 15- to 19-year-olds, females are more likely to report several problems (32% vs. 24%).

Overall, the data suggest the likelihood of experiencing problems with other people's drinking decreases with age (Table 12). For example, 38% of Canadian youth report that, within the previous year, they were insulted or humiliated by someone who had been drinking, compared to only 5% of those 65 years of age or older. Similarly, 18% of youth report being pushed, hit or assaulted by someone who had been drinking, compared to approximately 7% for those 45 or older. Clearly, in terms of both problems with their own use and problems with other people's drinking, Canadian youth are at high risk and thus deserve special consideration. Indeed, a number of future research issues are worthwhile exploring within this context. Youth's greater likelihood of experiencing problems may be due to friendship patterns; that is, they associate more with youths who drink more than other age groups. Second, future research also needs to more closely explore the characteristics of offenders and their victims. As well, more research is needed to examine the relationship between other people's drinking and the respondent's drinking.

REASONS FOR DRINKING

Current drinkers were asked to indicate their reasons for consuming alcoholic beverages in the 12 months preceding the survey. Respondents were allowed to select from one or more of the following reasons: to be sociable; to add to the enjoyment of meals; to feel good; to relax; to forget worries; and to feel less inhibited or shy (see question 18 in Appendix A).

Drinking to be sociable was the most common reason given by young Canadians, 15 to 24 years of age (Figure 17). Seven of ten current drinkers (69%) in this age category report they consumed alcohol for this reason in the year preceding the survey. Drinking to feel good (42%) was the second most common reason, followed by drinking to relax (39%), drinking to add to the enjoyment of meals (32%), drinking to feel less inhibited or shy (23%), and drinking to forget worries (16%).

Male youth are more likely than female youth to report five of the six reasons for drinking provided by the survey (Table 13). In particular, a higher percentage of males (44%) than females (35%) report drinking alcohol to relax. However, females (71%) are more likely than males (68%) to indicate that they drink to be sociable. This is especially true in the youngest cohort (15 and 16-year-olds), where two-thirds of females (66%) report drinking for social reasons, compared to less than half of males (47%).

Drinking to be sociable and to relax increases with age (Table 13). For example, 56% of 15- to 16-year-olds report drinking to be sociable compared to 74% of 20- to 24-year-olds - an increase of 18 percentage points. Similarly, 33% of 15- to 16-year-olds report drinking to relax compared to 41% of 20- to 24-year-olds - an increase of eight percentage points. Among current drinking males, drinking for social reasons increases by 24 percentage points from the youngest to oldest age categories (47% among those 15 to 16 vs. 71% among those 20 to 24).

Drinking to forget worries and to feel less inhibited or shy decreases with age (Table 13). For example, 24% of 15- to 16-year-olds report drinking to forget worries compared to 13% of 20- to 24-year-olds. Similarly, 29% of 15- to 16-year-olds report drinking to feel less inhibited or shy compared to 19% of 20- to 24-year-olds. Among current female drinkers, drinking to feel less inhibited or shy decreases by 17 percentage points from the youngest to oldest age categories.

Aside from drinking to be sociable, young current drinkers consume alcohol primarily for "personal" reasons, whether it be an attempt to achieve a positive mood (i.e., to feel good, to relax) or to alleviate a negative one (i.e., to feel less inhibited or shy, to forget worries). Consistent with previous research, the results of the 1989 National Alcohol and Other Drugs Survey indicate that drinking for personal reasons is associated with heavy drinking behaviour (Johnston and O'Malley 1986). By contrast, drinking for social reasons is related to low or moderate consumption levels (Christopherson et al. 1984). For example, youth who report drinking to forget worries consume an average of 6.5 drinks per week, compared with 3.8 drinks per week by youth who report drinking for social reasons (Table 14). Similarly, over one-third (35%) of those who drink to forget worries report consuming five or more drinks on 15 or more occasions in the previous year, compared to one-fifth (21%) of those who report drinking for social reasons.

The findings also suggest that "personal" reasons for drinking are positively related to drinking consequences (Figure 18). For example, persons who report that they drink in order to forget (50%) are twice as likely as those who drink to be sociable (25%) to report experiencing an alcohol-related problem in the year preceding the survey. However, it should also be noted that a large proportion of those who report drinking for personal reasons also report that they drink to be sociable. Thus, we can assume that estimates of problem drinking among those who drink to be sociable would be even lower if we excluded those who also drink for personal reasons.

THE DRINKING COMPANIONS OF YOUNG CANADIANS

All Canadians who reported that they had consumed alcohol in the year preceding the survey were asked how often they drank, either by themselves or with their friends, spouses, relatives and co‑workers (see question 27 in Appendix A). The findings clearly indicate that drinking among Canadian youth is a social activity (Table 15).

Young drinkers, 15 to 24 years of age, rarely drink alone. Eighty-four percent of current drinkers report that they never drink alone or when others are not drinking. By contrast, only 7% report drinking alone a few times a month or more often. These findings from the National Alcohol and Other Drugs Survey are consistent with previous research (Kandel, 1980).

The majority of youth are introduced to alcohol in the home in the presence of adults. In particular, the consumption of alcohol at home on special occasions is the primary drinking context for young teenagers (Chamberlayne, Kierans and Fletcher 1987; Nutter 1984). However, with increasing age, there is a clear shift among youth from drinking in the home under the control of parents, to drinking at parties under the influence of peers.

Friends

Friends are by far the most common drinking partners of young Canadians (Figure 19). Two-thirds (65%) of young current drinkers consume alcohol with their friends once per month or more often. Only 5% of young drinkers report never consuming alcohol with friends. Male youth drink with their friends more frequently than female youth (Table 15). For example, over one-third (38%) of male youth consume alcohol with their friends once per week or more, compared to 19% of female youth.

Older youth also drink more often with their friends than younger youth. Thirty-four percent of 20- to 24-year-olds drink with their friends once per week or more often, compared to 28% of 17- to 19-year-olds and 13% of 15- to 16-year-olds.

In general, young drinkers consume alcohol more often with their friends than older drinkers. For example, 29% of current drinkers aged 15 to 24 drink once per week or more with their friends (Table 15), compared to about 16% of those aged 35 to 54 and 10% of those 55 and over (Eliany et al., 1990).

Family Members

Among Canadian youth, family members (inside and outside the household) are the second most common drinking partners. One-quarter of young drinkers (24%) report that they consume alcohol with their relatives at least once per month. An additional 47% drink with family members a few times per year. However, a significant minority (29%) report that they never drink with family members.

Among youth, the frequency of drinking with relatives appears to increase with age (Table 15). Approximately three out of every ten 20- to 24-year-olds (28%) report that they drink with their relatives once per month or more, compared to 20% of 17- to 19-year-olds and 17%^* of 15- to 16-year-olds. However, it is important to note that those in the two older categories are more likely than those in the youngest category to report that they never drink with their relatives.

In general, male youth are more likely than female youth to drink frequently with their relatives (Table 15). Thirty percent of male drinkers, 15 to 24 years of age, report that they drink with their relatives at least once per month, compared to 18% of female drinkers of the same age. However, female youth (28%) are just as likely as male youth (30%) to report that they never drink with their relatives.

Co-workers

Among Canadian youth, drinking with co-workers is much less common than drinking with either friends or relatives (Table 15). Six out of every ten drinkers (60%), 15 to 24 years of age, report that they "never" drink with their co-workers. An additional 21% do so less than once per month. Only 19% of young drinkers report that they drink with co-workers once per month or more often.

The low incidence of drinking with co-workers probably stems from the fact that a large proportion of young people either do not have a job or are employed part-time. Indeed, drinking with co-workers is more common among older youth who are more likely to be in the permanent workforce (Table 15).

Male youth (25%) are twice as likely as female youth (13%) to report drinking with co-workers once per month or more. Conversely, females (68%) are more likely than males (53%) to report that they "never" drink with their co-workers.

Spouse or Partner

The majority of young Canadian drinkers (84%) report that they "never" drink with their spouse or partner. Only 10% report that they do so once per month or more (Table 15). The low incidence of drinking with one's spouse is not surprising considering the fact that most young people, 15 to 24 years of age, are not married or living with a steady partner. Drinking with one's spouse or partner is only significant among older youth, who are more likely to have married or established a permanent relationship. Almost all 15- to 16-year-olds (99%) and 17- to 19-year-olds (96%) report that they never drink with their spouse, compared to 74% of 20- to 24-year-olds.

Drinking Alone

The majority of young drinkers (84%), 15 to 24 years of age, report that they never drink alone or when others are not drinking. An additional 8% report that they do so, on average, less than once per month. Only 7% of young drinkers report that they drink alone once per month or more often (Table 15).

Young drinkers engage in solitary drinking less frequently than their older counterparts. For example, 7% of 15- to 24-year-olds engage in solitary drinking once a month or more, compared to 11% of 35- to 54-year-olds and 13% of those 55 years of age and older (Table 15).

Among youth, male current drinkers are more likely than female current drinkers to drink alone or when others are not drinking. For example, 12% of males, 15 to 24 years of age, report drinking alone once a month or more, compared to a negligible percentage of female current drinkers (Table 15).

PLACES YOUNG CANADIANS DRINK

All current drinkers were asked how often they had participated in 11 different activities. They were also asked how often they drank when engaging in each activity and how many drinks they usually consumed (see questions 25 and 26 in Appendix A).

Regardless of age or gender, Canadian youth are most likely to drink when they: go to a bar or tavern; attend a party, social gathering or wedding; engage in outdoor leisure activities; or go to a restaurant for dinner (Figure 20).

Over three‑quarters (78%) of young drinkers report that when they go to a bar or tavern they drink more than half the time. An additional 18% drink half the time or less. Only 4%^* report that they never consume alcohol on such occasions (Table 16).

Fifty‑eight percent of young drinkers usually drink (i.e., drink on more than half of the occasions) when they attend a party, social gathering or wedding. An additional 33% drink on half of these occasions or less. Only 9% report that they never drink when participating in such activities (Table 16).

Twenty‑one percent of current drinkers usually drink when involved in outdoor leisure activities such as camping or boating (Table 16). An additional 44% drink half the time or less when engaged in such activities. However, a sizeable minority (35%) of current drinkers report that they never drink while engaged in such activities. Finally, 19% of young drinkers consume alcohol more than half the time when having dinner at a restaurant, while about 41% drink on half of these occasions or less. An additional 40% report that they never consume alcohol while having dinner at restaurants.

Young drinkers are least likely to drink when they: eat lunch at a restaurant; engage in sporting activities; spend a quiet evening at home; go to a club or meeting; or go to a concert or festival (Figure 20; Table 16).

Eighty-four percent of young drinkers, 15-24 years of age, report that they never drink when having lunch at a restaurant, while only 3%^* drink on more than half of these occasions. Similarly, the majority of young drinkers report that they never drink when they participate in sports activities (74%), spend a quiet evening at home (70%), go to a club or meeting (68%), or attend a concert, game or festival (62%).

Young drinkers, 15 to 24 years of age, tend to consume the greatest amount of alcohol when they participate in leisure activities such as being at a cottage, camping or boating (an average of 4.3 drinks per occasion), go to bars or taverns (3.9 drinks), attend parties, social gatherings or weddings (3.9 drinks), and attend concerts, games or festivals (3.4 drinks - see Figure 21). Alcohol consumption is lowest when having lunch or dinner at restaurants (1.5 and 1.7 drinks respectively) and spending quiet evenings at home (2.1 drinks). In each of the 11 settings, young male drinkers consume a higher number of drinks per occasion than their female counterparts (Table 16).

The findings from the National Alcohol and Other Drugs Survey are consistent with those found in other literature. Other research has also found that alcohol consumption among youth is most likely to occur in a social context (Brown, Stetson and Beatty 1989; Harford and Speigler 1982; Harford and Grant 1987; Single 1988). In particular, heavy drinking is associated with peer contexts that endorse informal group participation; that is, gathering for enjoyment rather than in organized groups endeavouring to accomplish specific objectives (Crano and Selnow 1986). This research supports the findings in this survey that the majority current drinkers (67%) abstain from drinking at clubs or meetings or when participating in sports activities.

Canadian youth, 15 to 24 years of age, are slightly more restrictive about drinking when a couple is having dinner by themselves at home. About 14% feel no drinking should take place under these circumstances, 62% approve of one or two drinks, and 17% feel that it is all right to drink enough to feel the effects (Table 17).

Approximately two-thirds (62%) of young Canadians feel that it is acceptable for people to drink with friends after work. However, almost half (49%) feel that alcohol consumption in this situation should be restricted to one or two drinks. Only 7% feel that it is appropriate to drink enough to feel the effects in this context (Table 17).

One out of every two young people (48%) feels that no drinking should take place when people get together for sports events or recreational activities. An additional two-fifths (39%) maintain that alcohol consumption in this setting should be restricted to one or two drinks. Only 8% report that drinking enough to feel the effects is acceptable in this context.

Most young Canadians (56%) feel people should not consume alcohol when they are at lunch with co-workers. Although 38% feel that one or two drinks in this context is acceptable, only 1%^* say people should feel free to drink enough to feel the effects.

In general, male youth tend to hold less restrictive attitudes about drinking than female youth (Table 17). For example, 37% of males report that it is acceptable to drink enough to feel the effects at a party, compared to 25% of females. There is even evidence to suggest that male youth are more tolerant of female drinking than females themselves. While one-third (33%) of male youth feel it is acceptable for a female to drink enough to feel the effects when she is at a bar with friends, only one-quarter (24%) of female youth feel the same way.

The findings also suggest that, among youth, normative support for drinking and getting drunk increase with age (Table 17). For example, 24% of 15- to 16-year-olds report that drinking enough to feel intoxicated is acceptable at parties, compared to 35% of 20- to 24-year-olds - an increase of 11 percentage points. Similarly, 29% of 15- to 16-year-olds report that drinking enough to feel the effects is acceptable for men in a bar with friends, compared to 39% of 20- to 24-year-olds - an increase of 10 percentage points.

Clearly, different youth have different drinking practices, different settings, and different reasons for drinking. Thus, the population of drinkers may be represented by different clusters or groups of youth and young adults. Pandina (1986), for example, views the at-risk population as three concentric rings or overlapping layers. The largest ring consists of regular drinkers whose intensity of alcohol consumption varies considerably. This may reflect the experimental drinking practices of youth. The middle level is composed of about 30% to 40% of the entire population of regular drinkers. Youth in this subgroup drink with greater frequency, are more likely to experience frequent intoxication and have friends with similar drinking practices. The innermost level is represented by the heaviest drinkers (an estimated 5% to 10% of drinkers). This group of youth are intoxicated frequently and are more than likely weekend drinkers. This model suggests that the likelihood of experiencing negative consequences increases as one moves toward the inner ring.

PART TWO: CIGARETTE SMOKING BY CANADIAN YOUTH

The National Alcohol and Other Drugs Survey (1989) questioned Canadian youth, 15 to 24 years of age, about their use of tobacco. In this report, the term current smoker is used to describe those respondents who answered "yes" to the question "At the present time do you smoke cigarettes"? (Q10 - Appendix A). The term former smoker is used to identify individuals who have smoked cigarettes at some time in their life, but were not using tobacco at the time of the survey (Q7 - Appendix A). Level of smoking refers to the usual number of cigarettes smoked per day by current users (Q11 - Appendix A).

The Prevalence of Smoking

One out of every three young Canadians (30%) - or approximately 1.2 million individuals aged 15 to 24 - are current smokers (Table 18). An additional 14% are former smokers - having used tobacco at some time in the past but not at the time of the survey. Thus, 44% of young Canadians have had at least some experience with tobacco. On the other hand, over half (56%) of young Canadians report that they have never smoked cigarettes on a regular basis (Figure 23).

Almost all young smokers (99%) are regular ( i.e., daily) smokers. The majority (58%) consume between 11 and 25 cigarettes per day (Table 19; Figure 24). Only 4%^* can be classified as "heavy smokers" - consuming an average of 26 cigarettes per day or more. One in three young smokers (35%) is a "light smoker" - consuming an average of 10 cigarettes a day or less.

Region

The data suggest regional differences exist in the prevalence of smoking among Canadian youth (Figure 25; Table 20). The Prairie provinces have the highest percentage of current smokers, 15 to 24 years of age (35%), followed by the Atlantic provinces (34%), Quebec (31%), Ontario (29%), and British Columbia (20%). On the other hand, British Columbia has the highest percentage of youth who report never having smoked cigarettes (62%), followed by Ontario (60%), Quebec (53%), the Atlantic provinces (52%) and the Prairie region (51%).

Regional differences are also apparent for the prevalence of heavy smoking - that is, smoking 26 or more cigarettes daily (Table 21). However, regional differences in heavy smoking bear little resemblance to regional differences in the prevalence of current smoking. Among 15- to 24-year-olds, heavy smoking is highest in Quebec (6.3%) and British Columbia (6.0%), followed by the Atlantic provinces (5.4%), Ontario (3.0%) and the Prairie provinces (1.9%). Thus, although British Columbia had the lowest percentage of current smokers (20%), it had one of the highest rates of heavy smoking (6.0%). Similarly, the Prairie provinces, which had the highest rate of current smoking (35%), had the lowest rate of heavy smoking (1.9%).

Age

Among young Canadians, smoking tends to increase with age (Table 18). Only 13% of 15- to 16-year-olds are current smokers, compared to 28% of 17- to 19-year-olds and 37% of 20- to 24-year-olds. By contrast, three-quarters (76%) of 15-16 year-olds report that they have never smoked cigarettes, compared to 59% of 17-19 year-olds and 48% of 20- to 24-year-olds. Interestingly, the percentage of former smokers remains relatively constant across age groups. For example, 11%^* of 15- to 16-year-olds are former smokers, compared to 13% of 17- to 19-year-olds and 15% of 20- to 24-year-olds.

Among young smokers, amount smoked increases steadily with age (Table 19). Thirty-seven percent of 15- to 16-year-old smokers report consuming an average of 11 or more cigarettes per day, compared to 55% of 17- to 19-year-olds and 72% of those between 20 and 24 years of age.

Gender

A similar proportion of male (30%) and female youth (31%) are current smokers (Table 18). Males (58%) are slightly more likely than females (54%) to report never smoking cigarettes.

Regardless of age, male youth tend to smoke more heavily than female youth (Table 19). Overall, 71% of young male smokers report consuming 11 or more cigarettes per day, compared to 58% of female smokers.

Trends in Smoking Behaviour

Previous research suggests the prevalence of cigarette smoking by Canadian youth declined markedly between 1970 and 1985. During this period, the proportion of current smokers declined from 31% to 18% among 15- to 19-year-olds and from 48% to 32% among 20- to 24-year-olds (Rootman et al. 1988). Findings from the 1989 National Alcohol and Other Drugs Survey suggest, however, that this downward trend may have slowed or perhaps even reversed in recent years. Between 1985 and 1989 the percentage of current smokers increased slightly from 18% to 23% among 15- to 19-year-olds and from 32% to 37% among 20- to 24-year-olds.

Although the prevalence of smoking among youth remained stable or even increased slightly during the 1980s, the data suggest that those who are currently using tobacco are smoking less. For example, in 1985, 68% of 15- to 19-year-old smokers reported that they consumed 11 or more cigarettes per day, compared to 56% in 1989 - a decrease of 12 percentage points. Similarly, in 1985, 80% of 20- to 24-year-old smokers reported that they consumed 11 or more cigarettes per day, compared to 70% in 1989 - a decrease of 10 percentage points.

Surveys of Ontario students aged 12 to 19 show large declines in current smoking beginning after 1979. The trend in smoking is as follows: 30% in 1977, 35% in 1979, 30% in 1981, 29% in 1983, 25% in 1985, 24% in 1987, and 23% in 1989 (Smart and Adlaf 1989).

PART THREE: OTHER DRUGS

The National Alcohol and Other Drugs Survey (1989) questioned Canadian youth about their use of various illicit and licit drugs. In this analysis, the illicit drugs discussed include cannabis (marijuana and hashish), cocaine, LSD, speed and heroin. The licit drugs include sleeping pills, tranquillizers, diet pills, anti‑depressants and prescription opiates such as codeine, demerol and morphine (see questions 58 and 59 of Appendix A).

While many other categories of drugs exist, this survey included those most likely to have been used by the survey's target population: people 15 years of age and older. The current report however, focuses on young Canadians between the ages of 15 and 24 years.

As the use of these drugs is generally less common than the use of alcohol, percentages are given to one decimal place. Typically, the percentage of Canadian youth using any one drug is small, less than 10%. This implies that differences in percentages should be interpreted with care. Similarly, the small sample of self-reported users and high sampling variability among some categories warrant further caution in interpreting the data.

ILLICIT DRUG USE

Respondents were asked whether or not they had ever used marijuana or hashish, cocaine or crack, LSD, speed or heroin (Q59 - Appendix A). Those admitting use at sometime in their life were then asked whether or not they had used the substance during the 12 months preceding the survey.

Research suggests that while illicit drug use peaks between late adolescence and young adulthood (Johnston, Bachman and O'Malley 1989; Kandel and Logan 1984; Newcomb and Bentler 1986; Yamaguchi and Kandel 1984a, 1984b), the greatest period of risk for introduction to drugs begins in early adolescence (Kandel and Logan 1984). For example, introduction to marijuana generally begins about age 13, peaks about age 18 and declines between the ages of 19 and 20 years. The greatest risk for introduction to illicit drugs, other than cocaine, is reduced considerably by age 21 (Kandel and Logan 1984). The risk for introduction to cocaine use, on the other hand, continues to rise beyond age 24.

Approximately one-third of Canadian youth (34.0%) report that they have used an illicit substance at some point in their life (Table 22). Lifetime use is more prevalent among males (37.1%) than females (30.8%). The data suggest that, among young people, use of illicit drugs increases with age. For example, 43.8% of those aged 20 to 24 report using an illicit substance at some time in their life, compared to 28.3% of 17- to 19-year-olds and 14.5% of 15 to 16 year-olds (Table 22).

Cannabis (Marijuana and Hashish)

Cannabis is the most commonly used illicit substance among Canadian youth (Figure 26). One-third (33.6%) of young Canadians, 15 to 24 years of age, report that they have used cannabis (marijuana or hashish) at some time in their life. One in six (15.5%) report using cannabis during the year preceding the survey. Almost half (46.2%) of current marijuana users, 15 to 24 years of age, report using the drug less than once per month. An additional 27.4% use cannabis between one and three times a month, and 22.7%^* use the drug once a week or more often (Table 24).

Lifetime use of cannabis by young Canadians differs by region (Table 23; Figure 27). Use is most prevalent in British Columbia where one half (50.3%) of 15 to 24 year-olds have used the drug at some time in their lives. The Prairie provinces have the second highest lifetime prevalence rate (37.3%), followed by Quebec (32.1%), the Atlantic provinces (30.1%) and Ontario (28.7%). Only British Columbia and the Prairie provinces have lifetime prevalence rates above the national average (33.6%).

The current use of marijuana shows similar regional differences. Use is highest in British Columbia (27.6%), followed by Quebec (16.9%), the Prairie provinces (13.0), Ontario (12.8%) and the Atlantic provinces (12.8%).

Young people living in British Columbia and the Prairie provinces use cannabis more frequently than their counterparts in other regions of Canada (Table 25). For example, approximately 28.9%^* of 15- to 24-year-olds living in British Columbia and 24.3%^* of their counterparts in the Prairie provinces report using cannabis once a week or more often. This compares to 21.9%^* of 15- to 24-year-olds in Ontario, 20.3%^* in Quebec, and 16.2%^* in the Atlantic provinces.

In general, the current use of cannabis is more common among younger than older Canadians (Figure 28). For example, 15.5% of those 15 to 24 years of age report using marijuana in the year preceding the survey (Table 23), compared to only 1.2% of those between 45 and 54 (Figure 28). The survey findings show that both lifetime and annual marijuana use increases with age for both males and females (Table 22). Lifetime use increases from 14.5% among 15- to 16-year-olds to 28.0% among 17- to 19-year-olds to 43.1% among 20- to 24-year-olds. Similarly, current use increases from 10.8%^* among 15- to 16-year olds to 13.2% among 17- to 19-year-olds and to 18.4% of 20- to 24-year-olds.

Typically, more male youth (36.8%) than female youth (30.3%) have used marijuana (Table 22). However, females (16.1%^*) in the youngest age group (15 to 16 years) are more likely to have used marijuana than males of the same age (13.1%^*). The highest rate of use was reported by 20- to 24-year-old males (49.4%), followed by their female counterparts (36.7%). The second highest rate of use was reported by 17- to 19-year-old males (29.1%) closely followed by females in the same age group (26.9%).

Male youth (19.1%) are also more likely than female youth (11.7%) to report using marijuana in the year preceding the survey (Table 22). However, females (11.5%^*) in the youngest age group (15 to 16 years) are slightly more likely to be current marijuana users than males of the same age (10.4%). The highest rate of current use was reported by 20 to 24 year-old males (23.7%), followed by males 17 to 19 years of age (16.6%). The third highest rate of current use is found among females 20 to 24 years of age (13.0%). It is interesting to note that both males and females in the youngest age category have higher rates of current usage than females aged 17 to 19 years (9.8%^*). Males (24.9%^*) are more likely than females (19.0%^*) to report using marijuana once per week or more often. Frequent use (i.e., once a week or more) is most common among 20 to 24 year old males (Table 24).

Cocaine or Crack

Only 3.5% of all Canadians, 15 years of age or over, report that they have used cocaine or crack at some time in their lives; and only 1.4% indicate that they used cocaine or crack in the year preceding the survey (Table 26).

There are regional differences in the lifetime and annual prevalence rates of cocaine or crack use by young Canadians (Table 23; Figure 27). Use of the drug is most prevalent in British Columbia, where 9.0^*% of 15- to 24-year-olds report using it at some time in their lives. Quebec has the second highest lifetime prevalence rate of cocaine or crack use among 15- to 24-year-olds (7.5%^*), followed by the Prairie provinces (4.3%^*), Ontario (3.1%^*) and a negligible percentage for the Atlantic provinces. Current use of cocaine or crack among Canadian youth is most prevalent in British Columbia (6.3%^*), Quebec (4.3%^*) and the Prairie provinces (1.9%^*). The rates of current use in both Ontario and the Atlantic provinces are too low to be reported here.

The use of cocaine is higher among Canadian youth than it is among the general population. Almost one out of every twenty young Canadians (4.9%), 15 to 24 years of age, report using cocaine or crack at some time in their life. An additional 2.5%^* of Canadian youth report using this substance in the year preceding the survey (Table 22).

As with marijuana, lifetime prevalence rates for cocaine or crack use increase with age. Among 20 to 24 year-olds, 7.0% report using cocaine or crack at some time in their lives. This compares to 3.5%^* of 17- to 19-year-olds and an insignificant proportion of 15- to 16-year-olds (Table 22).

In general, male youth (5.7%) are slightly more likely than female youth (4.1%^*) to have used cocaine or crack at some point in their lives (Table 22). Similarly, a slightly higher percentage of males (3.2%^*) than females (1.9%^*) report using the drug in the year preceding the survey. Rates of current use are highest among 20- to 24-year-old males (4.0%).

LSD, Speed or Heroin

One out of every twenty-five Canadians (4.1%), 15 years of age or over, report having used LSD, speed or heroin at some time in their life. However, only one out of every two hundred Canadians (0.4%) used at least one of these illicit substances in the year preceding the survey (Table 26). Although one in twenty young Canadians (4.6%), 15 to 24 years of age, indicate that they have used LSD, speed or heroin at some time in their lives, less than one in fifty (1.6%^*) are current users (Table 22).

As with marijuana and cocaine, lifetime use of LSD, speed, or heroin is most prevalent in British Columbia (Table 23; Figure 27). Approximately 7.9%^* of youth, 15 to 24 years of age, in this province report using at least one of these drugs at some time in their lives, followed by Quebec (5.2%^*), the Prairie provinces (4.9%), the Atlantic provinces (3.9%^*), and Ontario (3.3%^*).

Canadian youth are not as likely to have used LSD, speed, or heroin as are adults in their late twenties to early forties (Table 26). For example, 7.5% of individuals between 25 to 34 years of age report using these drugs at some point in their life, followed by 35- to 44-year-olds (5.9%), 20- to 24-year-olds (4.7%^*) and 15- to 19-year-olds (4.5%^*). However, young Canadians 15 to 19 years of age (particularly 17- to 19-year-olds) have the highest rate of current use among all Canadians. For example, 2.1%^* of 15- to 19-year-old youth report having used LSD, speed or heroin during the year preceding the survey compared to an insignificant proportion among all other age groups (Table 26).

In general, more male youth (5.5%) than female youth (3.7%^*) have used these drugs (Table 22). Among young Canadians aged 15 to 24 years, the highest rate of use of LSD, speed or heroin is reported by 17- to 19-year-old males (6.5%^*). The second highest rate is reported by 20- to 24-year-old males (6.0%^*). Among female youth, the highest rate was among 17- to 19-year-olds (5.2%^*).

The results of the National Alcohol and Other Drug Survey are consistent with previous research, which shows that the use of marijuana and cocaine is much more prevalent among younger than older individuals (Eliany 1989; Adlaf and Smart 1989; Johnston et al. 1989; Smart 1986). Rates of current use are generally low in early adolescence (ages 12 and 13), rise steeply into the late teenage years, peak during the early twenties, and drop off in the late twenties and early thirties (Menard and Huizinga 1989). Over the age of 50, illicit drug use is extremely rare (Kandel and Logan 1984; Kandel 1980).

Many experts believe that one of the main reasons for this pattern is that a direct relationship exists between age and the acquisition of adult roles and responsibilities (Kandel 1980; O'Malley, Bachman and Johnston 1988). In support of this hypothesis, Brown et al. (1974) found that the cessation of marijuana use among college students is not due to changes in attitudes towards illicit drugs but to the constraints imposed by job situations, family responsibilities, and changes in friendship patterns after graduation. Indeed, the results of this and other Canadian and American research indicate that the employed have significantly lower rates of drug use than do students and unemployed persons of the same age. Married individuals are also less likely to use illicit drugs than are single, separated or divorced persons.

Trend surveys of adolescent students have found significant declines in the use of cannabis and other illicit drugs during the past decade (Adlaf and Smart 1991). Declines in cannabis use have been noted in Ontario (Smart and Adlaf 1989), Montreal (Desranleau 1984), Vancouver (Hollander and Davis 1983), and Halifax (Mitic and Neuman 1983).

To date, the most systematic of these surveys is conducted by the Addiction Research Foundation (Smart and Adlaf 1989). In Ontario, the long-term trend in cannabis use shows an increase between 1977 and 1979 (from 25.1% to 31.7%), and has since been declining to a rate of 14.1% in 1989 (a figure comparable to the 12.3% of Canadian youth aged 15 to 19 in the National Alcohol and Other Drugs Survey). In Ontario, cocaine use among students has remained relatively stable during the past decade and appears to be on a downward trend. Cocaine use peaked in 1979 at 5.1% and has been slowly declining since, to a rate of 2.7% in 1989 (a rate similar to the 1.9% found among Canadian youth in the National Alcohol and Other Drugs Survey). LSD, speed and heroin are substances with differing rates of use. In 1989, 5.9%, 2.5% and 1.2% of Ontario students reported the use of LSD, speed and heroin during the 12 months prior to the survey. During the decade, the use of heroin and speed has been relatively stable, fluctuating between 1.2% and 2.0%, and between 2.5% and 3.9%, respectively from 1981 to 1989. Use of LSD, on the other hand, has declined from a high of 10.2% in 1981 to 5.9% in 1989.

LICIT DRUG USE

The 1989 National Alcohol and Other Drugs Survey also asked Canadians about their use of a broad array of prescription and over‑the‑counter drugs. Respondents were asked to report on any medicines and/or pills they had taken in the 30 days preceding the survey. Of the five classes of licit drugs studied, prescription opiates (including codeine, demerol and morphine) are the most widely used, followed by diet pills or other stimulants, sleeping pills, tranquillizers and anti‑depressants (Table 27).

One out of every 20 adult Canadians (5.0%), 15 years of age or over, reports having used a prescription opiate in the 30 days prior to the survey, while 3.6% have used sleeping pills and 3.1% have used tranquillizers. Two percent of the population report using anti-depressants, while 0.9% report that they have used diet pills or stimulants (Table 27).

Unlike illicit drugs, the use of most licit substances (sleeping pills, tranquillizers and anti-depressants) is much more common among older than younger Canadians (Figure 29; Table 27). For example, 11.1% of Canadians 65 years of age and older report using sleeping pills in the month preceding the survey, compared to 1.0%^* of those between 15 and 24 years of age. Similarly, 5.4% of those 65 years of age or older report using tranquillizers in the month preceding the survey, compared to less than one percent (0.9%^*) of Canadian youth, 15 to 24 years of age.

Prescription opiates (codeine, demerol and morphine) are the only licit substances used by any degree of young Canadians (Table 27). Almost six of every one hundred (5.6%) young Canadians, 15 to 24 years of age, report having used a prescription opiate in the thirty days prior to the survey. Females (5.9%^*) are slightly more likely than males (5.3%^*) to report use of these substances.

The low rates of licit drug use among young people, 15 to 24 years of age, prevent a more detailed discussion of patterns of use (i.e., the data are suppressed).

Trend data from the Ontario Student Drug Use Survey (Smart and Adlaf 1989) show declines in the use of medical substances during the past decade. Among students aged 12 to 19, the use of stimulant and diet pills declined from 6.6% in 1977 to 3.3% in 1989; the use of tranquillizers declined from 8.6% in 1977 to 3.1% in 1989; and the use of barbiturates declined from 14.2% in 1977 to 7.8% in 1989.

PART FOUR: MULTIPLE DRUG USE

This section examines the combined use of selected licit and illicit drugs in Canada. Multiple drug use is defined as the current use of two or more of the following substances: alcohol, tobacco, marijuana, cocaine, LSD, heroin used during the prior year and sleeping pills, tranquillizers and prescription opiates used during the prior 30 days.

The findings indicate that more than one third (37.0%) of young Canadians, 15 to 24 years of age, are multiple drug users. One-quarter (25.0%) report the current use of two substances, while 12.0% report the use of three drugs or more. One out of every two young Canadians (48.0%) reports the current use of only one drug. A minority (15.0%) did not currently use any of the above substances (Figure 30; Table 28).

Over 30% of youth in each region report using two or more drugs in the year preceding the survey (Figure 31). The highest rates are found in British Columbia (39.0%), Quebec (38.0%) and the Prairie provinces (37.0%), while the lowest rates are found in Ontario and the Atlantic region (31.0% each). The use of three or more drugs is highest in British Columbia (19.0%), followed by the Prairies region (14.0%), Quebec (11.0%), Ontario (11.0%), and the Maritimes (11.0%).

The data suggest that, among youth, multiple drug use increases with age (Table 28). For example, almost half of Canadians between 20 and 24 years of age (46.0%) report using two or more substances in the year preceding the survey, compared to 33.0% of 17- to 19-year-olds and 20.0% of 15- to 16-year-olds. On the other hand, the percentage of young people reporting no drug use decreases with age. Thirty-two percent of 15- to 16-year-olds report that they did not use alcohol, tobacco or other drugs, compared to 15.0% of 17- to 19-year-olds and 9.0%^* of 20- to 24-year-olds.

In terms of the entire Canadian population, the data suggest that multiple drug use is more common among younger than older Canadians (Table 29). For example, 37.0% of 15- to 24-year-olds report using two or more substances in the year preceding the survey, compared to 19.7% of those 65 years of age or older. Similarly, 15.9% of those 20 to 24 report using three or more drugs, compared to approximately 5.0% of those 65 years of age or older. The data also suggest that there are at least two distinct types of multiple drug use: alcohol and illicit drug use among the young, and sleeping pill and tranquillizer use among the elderly.

Not only does the number of drugs used vary by age, but so does the pattern or combination of drugs used (Table 29). There are several general findings worthy of mention. Regardless of age, use of alcohol only is the most common pattern, varying from 36.9% to 46.6%. It is also apparent that the percentage restricting their drug use to medical substances increases with age. Finally, it is important to note that less than 1% use marijuana without using other drugs.

Some important differences occur between those aged 15 to 19 and those aged 20 to 24 (Table 29). The most striking difference shows that those aged 20 to 24 are less likely than those 15- to 19-year-olds to use no drugs (8.5% vs. 20.9%). As well, 20- to 24-year-olds are more likely than those aged 15 to 19 to report the use of both alcohol and tobacco (20.7% vs. 11.8%), the use of alcohol and tobacco and medical substances (3.3% vs. 0.9%), and the use of alcohol and tobacco and cannabis (7.9% vs. 3.8%).

An equal proportion of male (38.0%) and female (37.0%) youth report the current use of two or more substances (Table 28). However males (14.0%) are slightly more likely than females (11.0%) to report the use of three or more drugs. On the other hand, females (17.0%) are slightly more likely than males (12.0%) to report that they did not use any drugs in the year preceding the survey. Gender differences are more apparent in the older age categories (Table 28).

Trend data from the Ontario Student Drug Use Survey show large changes in the pattern and number of drugs used. The most striking finding shows that more Ontario students in 1989 used no drug (including alcohol and tobacco) than did students in 1977 (29% vs. 18%). In addition, the survey found more students in 1989 restricted their drug use to alcohol only (35%) than did students in 1979 (28%).

The results of the 1989 National Alcohol and Other Drugs Survey suggest that, among young Canadians, the use of one substance is highly related to the use of other substances (Table B). For example, although young smokers are only slightly more likely to report using alcohol than youth in general (89.0% vs. 81.4%), they are twice as likely to use marijuana (27.4% vs. 15.5%) and cocaine (5.7% vs. 2.5%). Similarly, almost all young marijuana and cocaine users (98.6% and 89.4% respectively) report consuming alcohol in the year preceding the survey.

The rate of tobacco use among young marijuana and cocaine users (53.7% and 68.5% respectively) is also far above the national average (30.3%). Furthermore, marijuana users, 15 to 24 years of age, are approximately seven times more likely to report the current use of cocaine than youth in general (13.7%^* vs. 2.5%^*). Finally, eight out of every ten cocaine users (83.6%) report using marijuana in the year preceding the survey, compared to 15.5% of the general population.

Much of the public concern over illicit drug use is based on the assumption that the use of various illicit drugs is highly intercorrelated, and the more specific belief that the use of marijuana leads to the use of "harder" drugs such as cocaine and heroin (Lidz and Walker 1980). Indeed, while early arguments against the legalization of marijuana stressed that it led to aggressive and criminal behaviour, more recent arguments have stressed that it leads to drug addiction. In support of this argument, research has consistently found that marijuana use is highly related to lifetime multiple drug use in both treatment and non-treatment samples (Kandel 1984; Kleinman et al. 1984; Santo and Friedman 1980; Grupp 1972). Retrospective and longitudinal studies have also confirmed that the use of marijuana usually precedes the use of other illicit substances (Rainone et al. 1987; Newcomb and Bentler 1986; Welte and Barnes 1985; O'Donnell and Clayton 1982; Robins and Wish 1977; Single, Kandel and Faust 1974). In fact, most cocaine and heroin addicts reported using marijuana several years before trying harder drugs (Miller et al. 1989). Commenting on the statistical connection between marijuana use and other illegal drugs, one expert has commented that the "evidence supporting these relationships is overwhelming, persuasive, and incontrovertible" (Goode 1989:156).

However, more recent research has suggested that the progression into drug use tends to be cumulative, beginning not with marijuana but with the use of legal substances such as alcohol and tobacco. A number of studies have shown that, unless alcohol or tobacco is used first, there is very little use of other drugs (Donovan et al. 1983; Newcomb and Bentler 1986; Yamaguchi and Kandel 1984b; Wilkinson et al. 1987; Welte and Barnes 1985). This finding is consistent with the fact that a high proportion of those in treatment for illicit drug dependence also require treatment for alcohol abuse (Miller 1987; Gold et al. 1985; Barr and Cohen 1980).

These findings suggest a "stepping-stone" theory of drug use; that is, a pattern of progression from alcohol or tobacco use to marijuana use to the use of cocaine and other hard drugs. However, such progressions are not necessarily causal. The use of one drug does not automatically lead to the use of another. Indeed, results from the 1989 National Alcohol and Other Drugs Survey indicate that the vast majority of young drinkers (81.3%) do not use marijuana and that the vast majority of marijuana users (86.3%) do not use cocaine. Moreover, the precise nature of the progression is still unclear. Cigarette smoking and non-prescription medication have been particularly difficult to integrate into progression models (Newcomb and Bentler 1986) and these models vary by gender (Yamaguchi and Kandel 1984). As well, different progression sequences occur between early and late adolescence and young adulthood. Such findings suggest the existence of several sequences that may vary by developmental stage and historical period.

DISCUSSION

Just as society is constantly changing, so are patterns of drug use. Indeed, past (e.g., hallucinogens in the late 1960s) and recent (e.g., cocaine and crack in the 1980s) drug-use history shows that changes in drug use can occur quickly and with little warning. Consequently, it is important to use epidemiological surveys such as the National Alcohol and Other Drugs Survey to monitor rates of use and characteristics of users in order to better understand the distribution and diffusion of alcohol and other drug-use behaviours. As well, such surveys serve as a vehicle to monitor the progress of implemented policies and programs, such as the Canadian Drug Strategy.

This report focused specifically on youth and young adults for an important reason: the transition from adolescence to young adulthood is a critical period for drug use, and indeed, results of the survey clearly confirm this. There are several general findings worthy of brief comment.

First, it is clear that legal drugs, namely alcohol and tobacco, pose the greatest health threat to youth and young adults. The survey found that 20% of young Canadians consumed five or more drinks of alcohol on a single occasion 15 or more times during the prior year; 23% experienced an alcohol-related problem; 10% experienced three or more alcohol problems; and 69% reported one or more problems caused by other people's drinking. As well, about one-third were current smokers, with 4% of smokers consuming 26 or more cigarettes daily.

Second, illicit drug use among young Canadians is generally low, less than 10%, and has declined during the past decade. However, the low rates of use do not imply that drug use is not problematic among some youth and young adults. Drug use can be exceedingly high among high-risk groups, such as school drop-outs and street youth (Radford et al. 1989; Smart et al. 1990). Also the survey replicated a finding that illegal drug use tends to peak among older adolescents (20 to 24 years) and decline with age (Menard and Huizinga 1989). The specific reasons for declining drug use among adolescents is difficult to evaluate, and is probably due to the cumulative effect of numerous factors rather than due to a few unique factors. Still, research has linked changing drug-specific attitudes and beliefs regarding drugs to the decline in drug use rather than to changing lifestyle factors (Bachman et al. 1988, 1991; Smart and Adlaf 1989).

Only large national surveys are able to examine regional differences in drug use, and the results of the National Alcohol and Other Drugs Survey point to the need for more detailed research on regional differences in drug use. Most striking is the general finding that young Canadians from British Columbia are more likely than youth from other regions to drink alcohol, to frequently drink heavily, to smoke heavily, and to use illicit drugs.

The hazardous use of alcohol and other drugs is a social problem endemic to society. Indeed, as results of this survey have shown, drug use poses a health hazard to a large number of youth and young adults.

REFERENCES

Adlaf, E.M. and R.G. Smart. 1991. "Drug Use Among Adolescent Students in Canada and Ontario: The Past, Present and Future." Journal of Drug Issues. 21: 59-72.

Adlaf, E.M and R.G. Smart. 1989. The Ontario Adult Alcohol and Other Drug Use Survey: 1977-1989. Toronto: Addiction Research Foundation.

Akers, R.L., Massey, J., Clarke, W. and Lauer, R.M. 1983. "Are Self-reports of Adolescent Deviance Valid? Biochemical Measures Randomized Response, and the Bogus Pipeline in Smoking Behavior." Social Forces 62:234-251.

Bachman, J.G., Johnston, L.D. and O'Malley, P.M. 1991. "Explaining the Recent Decline in Cocaine Use among Young Adults: Further Evidence that Perceived Risks and Disapproval Lead to Reduced Drug Use." Journal of Health & Social Behavior. 31:173-184.

Bachman, J.G., Johnston, L.D., O'Malley, P.M. and Humphrey, R.H. 1988. "Explaining the Recent Decline in Marijuana Use: Differentiating the Effects of Perceived Risks, Disapproval, and General Lifestyle Factors." Journal of Health & Social Behavior. 29:92-112.

Bachman, J.G., Johnston, J.D., and O'Malley, P.M. 1981. "Smoking, Drinking and Drug Use among American High School Students: Correlates and Trends, 1975-1979." American Journal of Health. 71: 59-69.

Barr, H. and A. Cohen. 1980. "The Problem Drinking Drug Addict." National Alcohol Collaborative Project: Issues in Multiple Substance Abuse. Washington, D.C.: U.S. Government Printing Office.

Beatty, P. 1991. Forward. Journal of Drug Issues. 21: 59-72.

Bradburn, N.M. 1985. "Response Effects." In: Rossi, P.H., Wright, J.D. & Anderson, A.B. (Eds.) Handbook of Survey Research New York: Academic Press. pp. 22-30.

Brown, J., D. Glaser, E. Waxer and G. Geis. 1974. "Turning Off: Cessation of Marijuana Use After College." Social Problems. 21: 527-38.

Brown, S.A., Stetson, B.A. and Beatty, P.A. 1989. "Cognitive and behavioural features of adolescent coping in high-risk drinking situations." Addictive Behaviours. 14: 43-52.

Campbell, E. 1986. Preliminary Report: 1986 Provincial School Drug Survey. St. John, New Brunswick: The Alcoholism and Drug Dependency Commission of New Brunwick.

Chamberlayne, R., Kierans, W. and Fletcher, L. 1988. British Columbia Alcohol and Drug Programs Adolescent Survey: 1987 Technical Report. British Columbia Ministry of Health, Victoria.

Christiansen, B.A., Goldman, M.S. and Inn, A. 1982. "The development of alcohol-related expectancies in adolescents: Separating pharmacological and social learning influences." Journal of Consulting and Clinical Psychology. 50: 336-344.

Christopherson, Victor, Monika Escher and Barry Bainton. 1984. "Reasons for drinking among the elderly in rural Arizona." Journal of Studies on Alcohol. Vol. 45 (5): 417-423.

Clark, A. and Midanik, C. 1982. Alcohol Use and Alcohol Problems Among U.S. Adults: Results of the 1979 National Survey. Alcohol and Health Monograph No. 1: Alcohol Consumption and Related Problems. U.S. National Institute on Alcohol Abuse and Alcoholism.

Crano, W.D. and Selnow, G.W. 1986. "Formal vs. informal group affiliations: Implications for alcohol and drug use among adolescents." Journal of Studies on Alcohol. 47: 48-52.

Desranleau, C. 1984. La Consommation de Drogues Chez les Jeunes du Secondaire en 1984. Montréal: La Commission des Écoles Catholiques de Montréal.

Donovan, J. R. Jessor and L. Jessor. 1983. "Problem Drinking in Adolescence and Young Adulthood: A Follow-up Study." Journal of Studies on Alcohol. 44: 109-137.

Eliany, Marc. 1989. Licit and Illicit Drugs in Canada. Ottawa. Health and Welfare Canada. Cat. No. H39-159/1989E.

Eliany, Marc, N. Giesbrecht, M. Nelson, B. Wellman and S. Wortley. 1990. National Alcohol and Other Drugs Survey: Highlights Report. Health and Welfare Canada.

Fillmore, K.M. and Midanik, L. 1984. "Chronicity of drinking problems among men: A longitudinal study." Journal of Studies on Alcohol, 45:228-236.

Fitzgerald, J.L. and Mulford, H.A. 1978. "Distribution of Alcohol Consumption and Problem Drinking: Comparisons of Sales Records and Survey Data." Journal of Studies on Alcohol. 39: 879-893.

Gfroerer, J. 1985. "Influence of Privacy on Self-Reported Drug Use Among Youths." In: Rouse, B.A., Kozel, N.J. & Richards, L.G. (Eds.) Self-Report Methods of Estimating Drug Use. Washington D.C.: National Institute on Drug Abuse. pp. 22-30.

Ghodsian, M. and Power, C. 1987. "Alcohol consumption between the ages of 16 and 23 in Britain: A longitudinal study." British Journal of Addictions, 82:175-180.

Gold, M., A. Pottash and T. Estroff. 1985. "Substance Induced Organic Mental Disorders." In R. Hales and A. Frances (Eds.). Psychiatry Update: 227-240.

Goode, E. 1989. Drugs in American Society. Third Edition. New York: Alfred A. Knopf.

Grupp, S. 1972. "Multiple Drug Use in a Sample of Experienced Marijuana Smokers." International Journal of the Addictions. 7 (3): 481-491.

Harford, T.C. and Grant, B.F. 1987. "Psychological factors in adolescent drinking contexts." Journal of Studies on Alcohol. 48: 551-557.

Harford, T.C. and Speigler, D.L. 1982. Environmental influences in adolescent drinking. Alcohol and Health Monograph 4. Special Population issues. DHHS Pub. No. (ADM) 82-1193, 167-193.

Health and Welfare Canada. 1988. Canada's Health Promotion Survey: Technical Report. Cat. H39-119/1988E. Ottawa.

Health and Welfare Canada. 1981. The Health of Canadians: Report of the Canada Health Survey. Cat. 82-538. Ottawa.

Hollander, M.J. and Davis, B.L. 1983. Trends in Adolescent Alcohol and Drug Use in Vancouver. Vancouver: Ministry of Health.

Huba, G.J. and Bentler, P.M. 1983. "Test of a drug use causal model using asymptotically distribution free methods." Journal of Drug Education, 13:3-14.

Johnston, L.D. and O'Malley, P.M. 1986. "Why do the nation's students use drugs and alcohol? Self-reported reasons from nine national surveys." The Journal of Drug Issues. 16, 28-66.

Johnston, L., P. O'Malley and J. Bachman. 1989. Drug Use, Drinking and Smoking: National Survey Results from High School, College and Adult Populations - 1975-1988. Washington, D.C. U.S. Government Printing Office. DHHS Pub. No. ADM 88-1638.

Kandel, Denise. 1980. "Drug and Drinking Behaviour Among Youth." Annual Review of Sociology. 6: 235-285.

Kandel, Denise. 1984. "Marijuana Users in Young Adulthood." Archives of General Psychiatry. 41 (2) 200-209.

Kandel, D.B. and Logan, J.A. (1984). "Patterns of drug use from adolescence to young adulthood: Periods of risk for initiation, continued use, and discontinuation." American Journal of Public Health. 74: 660-667.

Khavair, K.A. and Farmer, P.D. 1978. "A Profile Instrument for the Quantification and Assessment of Alcohol Consumption: The Khavari Alcohol Test." Journal of Studies on Alcohol. 39: 1525-1539.

Kleinman, P., E. Wish, S. Deren and G. Rainone. 1984. The "Pure" Marijuana Using Client: Where? Paper presented at the Annual Meeting of the American Psychological Association. Toronto, Canada.

Lidz, C.W. and Walker, A.L. 1980. Heroin, Deviance and Morality. Sage: Beverly Hills.

Menard, S. and Huizinga, D. 1989. "Age, Period, and Cohort Size Effects on Self-Reported Alcohol, Marijuana, and Polydrug Use: Results from the National Youth Survey." Social Science Research 18:174-194.

Miller, N. 1987. "A Primer for the Treatment Process for Alcohol and Drug Addiction." Psychiatry Letter. 5 (7): 30-37.

Miller, N., R. Millman and S. Keskinen. 1989. "The Diagnosis of Alcohol, Cocaine, and Other Drug Dependence in an Inpatient Treatment Population." Journal of Substance Abuse Treatment. 6: 37-40.

Mitic, W. and Neuman, B. 1983. Drug Use Among Halifax Adolescents, 1983. Halifax, Nova Scotia: Commission on Drug Dependency.

Murray, D.M. and Perry, C.L. 1987. "The Measurement of Substance Use Among Adolescents: When is the Bogus-Pipeline Method Needed?" Addictive Behaviors, 12:225-233.

Newcomb, M.D. and Bentler, P.M. 1986. "Frequency and Sequence of Drug Use: A Lontitudinal Study from Early Adolescence to Young Adulthood." Journal of Drug Education 16:101-120.

Nutter, C. 1984. Drinking and related behaviours among Alberta teens. Alberta Alcohol and Drug Abuse Commission. Longwoods Research Group Limited. Toronto.

O'Donnell, J.A. and Clayton, R.R. 1982. "The Stepping-Stone Hypothesis: A Reappraisal." Chemical Dependencies 4:253-268.

O'Malley, P.M., Bachman, J.G. and Johnston, L.D. 1988. "Period, Age, and Cohort Effects on Substance Use among Young Americans: A Decade of Change, 1976-86." American Journal of Public Health 78:1315-1321.

O'Malley, P.M. Bachman, J.G. and Johnston, L.D. 1983. "Reliability and Consistency of Self-Reports of Drug Use." International Journal of Addictions 18:805-824.

Pandina, R.J. 1986. "Methods, Problems, and Trends in Studies of Adolescent Drinking Practices." Annals of Behavioral Medicine, 8:20-25.

Plant, M.A., Peck, D.F. and Samuel, E. 1985. Alcohol, Drugs, and School-leavers. London: Tavistock.

Radford, J.L., King, A.J.C. and Warren, W.K. 1989. Street Youth & Aids, Health & Welfare Canada: Ottawa.

Rainone, G., S. Deren, P. Kleinman and E. Wish. 1987. "Heavy Marijuana Users Not in Treatment: The Continuing Search for the "Pure" Marijuana User." Journal of Psychoactive Drugs. 19 (4): 353-359.

Robins, L. and E. Wish. 1977. "Childhood Deviance as a Developmental Process." Social Forces. 56 (2): 448-473.

Rootman, I., Warren, R., Stephans, T. and Peters, L. 1988. Canada's Health Promotion Survey: Technical Report. Health and Welfare Canada. Ministry of Supply and Services Canada.

Santo, Y. and A. Friedman. 1980. "Overview of Selected Findings from the National Youth Polydrug Study." Contemporary Drug Problems. 9 (3): 285-300.

Single, E. 1988. "The epidemiology of public drinking in Ontario." Paper presented at the 35th Congress on Alcoholism and Drug Dependence. Oslo, August, 1988.

Single, E., Kandel, D. and Johnson, B.D. 1975. "The Reliability and Validity of Drug Use Responses in a Large Scale Longitudinal Survey." Journal of Health & Social Behavior, 15:344-357.

Single, E., Kandel, D. and Faust, R. 1974. "Patterns of Multiple Drug Use in High School." Journal of Drug Issues, 5:425-443.

Smart, R.G. and Adlaf, E.M. 1989. The Ontario Student Drug Use Survey: Trends Between 1977-1989. Toronto: Addiction Research Foundation.

Smart, R.G., Adlaf, E.M., Porterfield, K.M. and Canale, M.D. 1990. Drugs, Youth and the Street, Addiction Research Foundation, Toronto.

Smart, Reginald G. and Adlaf, Edward M. 1987. Alcohol and Other Drug Use Among Ontario Adults. Addiction Research Foundation, Toronto.

Smart, Reginald G. and Jarvis, G. 1981. "Do Self-report Studies of Drug Use Really Give Dependable Results?" Canadian Journal of Criminology. 23: 83-92.

Smart, Reginald G. 1986. "Cocaine Use and Problems in North America." Canadian Journal of Criminology. 28: 109-128.

Temple, M.T. and Fillmore, K.M. 1985-86. "The Variability of Drinking Patterns and Problems among Young Men, Age 16-31: A Longitudinal Study." The International Journal of the Addictions, 20:1595-1620.

U.S. Department of Health and Human Sciences. 1989. National Household Survey on Drug Abuse: Population Estimates 1988. Public Health Service, Alcohol, Drug Abuse and Mental Health Administration, Washington, D.C.

Welte, J. and G. Barnes. 1985. "Alcohol: The Gateway to Other Drug Use Among Secondary School Students." Journal of Youth and Adolescence. 14 (6): 487-498.

White, H.R. 1987. "Longitudinal Stability and Dimensional Structure of Problem Drinking in Adolescence." Journal of Studies on Alcohol, 48:715-740.

Wilkinson, D., G. Leigh, J. Cordingly, G. Martin and H. Lei. 1987. "Dimensions of Multiple Drug Use and a Typology of Users." British Journal of Addiction. 82 (3): 259-273.

Yamaguchi, K. and Kandel, D.B. 1984a. "Patterns of drug use from adolescence to young adulthood: III. Predictors of progression." American Journal of Public Health. 74: 673-681.

Yamaguchi, K. and Kandel, D.B. 1984b. "Patterns of drug use from adolescence to young adulthood: II. Sequences of progression." American Journal of Public Health. 74: 668-672.

SELECTED BIBLIOGRAPHY

Addiction Research Foundation. 1985. Statistics on Alcohol and Drug Use in Canada and Other Countries. Vol. II. Statistics on Drug Use.

Barnes, G.M. and Welte, J.W. 1988. "Predictors of driving while intoxicated among teenagers." The Journal of Drug Issues. 18: 367-384.

DiTecco, D. and Schlegel, R. 1982. "Alcohol use among young adult males: An application of problem-behaviour theory." In J. Richard Eiser (Ed.). Social Psychology and Behavioural medicine. Wiley and Sons Ltd: 199-233).

Farber, P.D., Khavari, K.A. and Douglass, F.M. 1980. "A factor analytic study of reasons for drinking: Empirical validation of positive and negative reinforcement dimensions." Journal of Consulting and Clinical Psychology. 48: 780-781.

Jessor, R. (1984). "Adolescent development and behavioural health." In Matarazzo, J.D., Weiss, S.M., Herd, J.A., Miller, N.E. and Weiss, S.M. (Eds.). Behavioural Health: A Handbook of Health Enhancement and Disease Prevention. New York: Wiley.

McCarty, Dennis and Michael Kaye. 1984. "Reasons for drinking: Motivational patterns and alcohol use among college students." Addictive Behaviours. 9: 185-188.

Millar, W.J. 1988. The Smoking Behaviour of Canadians - 1986. Health and Welfare Canada. Ministry of Supply and Services Canada.

Norem-Hebeisen, A. and Hedin, D.P. 1983. "Influences in adolescent problem behaviour: Causes, connections and contexts." In Isralowitz, R. and Singer, M. (Eds.). Adolescent Substance Abuse: A Guide to Prevention and Treatment. New York: Hawthorn Press.

Ratliff, K.G. and Burkhart, B.R. 1984. "Sex differences in motivations for and effects of drinking among college students." Journal of Studies on Alcohol. 45: 26-32.

Statistics Canada. 1987. The Control and Sale of Alcoholic Beverages in Canada. Catalogue 63-202.

Stephens, T. 1991. Smoking in Canada - 1989. Tobacco Programs Unit. Health Promotion Directorate. Health and Welfare Canada.

Vingilis, E., DeGenova, K. and Adlaf, E.M. 19??. "Drinking-driving Behaviour of Ontario High School Students." Canadian Journal of Public Health, 77:196-200.

Warren, R.A., Simpson, H.M., Lucas, D.M., Cimbura, G. and Bennett, R. 1980. "Drug involvement in traffic fatalities in the Province of Ontario." Proceedings of the 24th Conference of the American Association for Automotive Medicine. Martin Grove, Illinois. American Association for Automotive Medicine: 16-23.

Williams, A.G., Pear, M.A., Crouch, D.J., Walls, J.K. and Finkle, B.S. 1984. Drugs in fatally injured young male drivers. Washington, D.C.: Insurance Institute for Highway Safety.

APPENDIX A --

NATIONAL ALCOHOL AND OTHER DRUGS SURVEY QUESTIONNAIRE

{Insert Questionnaire Here}

APPENDIX B -- METHODOLOGY

The two random digit-dialling methods used were the "Elimination of Non-Working Banks Design" for Newfoundland, Nova Scotia, Ontario and Alberta (Statistics Canada 1986), and the "Waksberg" method for the other six provinces (Waksberg 1978). Data collection was conducted from centralized telephone interviewing locations in Statistics Canada's eight regional offices.

Approximately 2% of the households in Canada do not have telephones and were therefore excluded from the survey. Previous studies indicate that these households tend to consist of young, single men who are less educated than the general population.

Because the level of response is so high (79%), the numbers and percentages of non-responses are not shown in the tables.

The estimates derived from this survey were based on a sample of households. Somewhat different figures might have been obtained if a census of the total population had been taken. The difference between the estimates taken from the sample and the results of a complete count is called the "sampling error of the estimate."

Although the exact sampling error cannot be measured from sample results alone, it is possible to produce a statistical measure of sampling error from the sample data: this is the standard error. Using the standard error, confidence intervals for estimates (ignoring the effects of non-sampling error) may be obtained under the assumption that the estimates are normally distributed about the true population value. The chances of the difference between a sample estimate and the true population value being less than one standard error is about 68%, about 95% that the difference would be less than two standard errors, and it is virtually certain that the differences would be less than three standard errors.

Because of the large variety of estimates that can be produced from a survey, the standard error is usually expressed relative to the estimate to which it pertains. The resulting measure, known as the "coefficient of variation" (CV), is obtained by dividing the standard error of the estimate by the estimate itself. It is expressed as a percentage of the estimate.

Data published in this report have been reviewed for release according to the following criteria:

(a) unqualified - CV not larger than 16.5%;

(b) qualified - CV between 16.6% and 33.3% (marked with an asterisk to indicate that the estimate should be regarded with caution);

APPENDIX C -- TABLES

{insert tables here}