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OBJECTIVES. This study sought to describe patterns of initiation, persistence, and cessation in drug use in individuals from their late 20s to their mid-30s, within a broad perspective that spans 19 years from adolescence to adulthood. METHODS. A fourth wave of personal interviews was conducted at ages 34-35 with a cohort of men and women (n = 1160) representative of adolescents formerly enrolled in New York State public secondary high schools. A school survey was administered at ages 15-16, and personal interviews with participants and school absentees were conducted at ages 24-25 and 28-29. Retrospective continuous histories of 12 drug classes were obtained at each follow-up. RESULTS. There was no initiation into alcohol and cigarettes and hardly any initiation into illicit drugs after age 29, the age at which most use ceased. The largest proportion of new users was observed for prescribed psychoactives. Periods of highest use since adolescence based on relative and absolute criteria were delineated. Among daily users, the proportions of heavy users declined for alcohol and marijuana but not for cigarettes. CONCLUSIONS. Cigarettes are the most persistent of any drug used. Drug-focused interventions must target adolescents and young adults.

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Two longitudinal surveys based on random samples of high school students in New York State indicate four stages in the sequence of involvement with drugs: beer or wine, or both; cigarettes or hard liquor; marihuana; and other illicit drugs. The legal drugs are necessary intermediates between nonuse and marihuana. Whereas 27 percent of high school students who smoke and drink progress to marihuana within a 5- to 6-month follow-up period, only 2 percent of those who have not used any legal substance do so. Marihuana, in turn, is a crucial step on the way to other illicit drugs. While 26 percent of marihuana users progress to LSD, amphetamines, or heroin, only 1 percent of nondrug marihuana users and 4 percent of legal drug users do so. This sequence is found in each of the 4 years in high school and in the year after graduation. The reverse sequence holds for regression in drug use.