title: Crack Cocaine Use in Adolescents: Clinical Characteristics and Predictors of Early Initiation.
abstract: OBJECTIVE
  To describe the clinical characteristics of adolescents with crack cocaine dependence and possible predictors of transition from drug experimentation to crack cocaine dependence.
  
  
  METHODS
  This cross-sectional study enrolled a consecutive sample of 90 adolescents admitted to a psychiatric inpatient unit in the city of Porto Alegre in southern Brazil for crack cocaine detoxification between May 2011 and November 2012. Comorbid psychological conditions were assessed using the Kiddie-SADS-Present and Lifetime Version, and severity of drug use was assessed using the Teen Addiction Severity Index (T-ASI). Comorbidities were compared with those in a community sample of non-drug using controls (n = 81).
  
  
  RESULTS
  Patients' mean age was 15.6 years (85.6% boys, 14.4% girls). Seventy-nine (93.2%) met criteria for cocaine dependence (DSM-IV-TR), while 78 (91.8%) had symptoms consistent with cocaine abuse. All patients had experimented with at least 1 other addictive substance before crack cocaine: 61.4%, tobacco (mean age at first use = 11.61 years); 44.3%, alcohol (age at first use = 12.43 years); and 54.5%, cannabis (age at first use = 12.15 years). Patients had used crack cocaine 23.2 days in the last month, and the mean age at first use of crack cocaine was 13.38 years. The most common psychiatric comorbidity was conduct disorder (81.8%), followed by oppositional defiant disorder (52.3%) and attention-deficit/hyperactivity disorder (44.3%), all of which were more prevalent in the patient population than in controls (P < .001). The T-ASI questionnaire showed severe consequences of drug use in most areas of life assessed. The mean time between onset of drug experimentation and crack cocaine dependence was 2.53 (SD = 1.96) years. When Cox regression models were applied, we found that predictors of earlier progression to using crack cocaine were age at first use of any drug (hazard ratio [HR] = 0.79 [95% CI, 0.71-0.88]; P < .001) and age at admission (HR = 0.7 [95% CI, 0.57-0.87]; P = .001).
  
  
  CONCLUSIONS
  Patients were found to have a multitude of comorbid conditions, which supports the idea of treatment by a multidisciplinary health care team. For each year of delay in the age at first drug use, the chance of crack cocaine initiation is reduced by 18%. Prevention programs aimed at delaying experimentation with addictive substances, especially "gateway" drugs, could delay the progression to crack cocaine dependence.
authors: Rua Ramiro Barcelos 2350, Serviço de Psiquiatria da Infância e Adolescência, 4° andar, Porto Alegre, Rio Grande do Sul, Brasil. tpianca@gmail.com.|Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors: Thiago G
authors: TG
authors: Pianca
authors: Child Psychiatric Service, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents, São Paulo, Brazil.
authors: Luis Augusto
authors: LA
authors: Rohde
authors: Hospital Psiquiátrico São Pedro, Porto Alegre, Rio Grande do Sul, Brazil.
authors: Ronaldo L
authors: RL
authors: Rosa
authors: School of Medicine, Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil.
authors: Ana Paula A
authors: AP
authors: Begnis
authors: School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors: Pedro B
authors: PB
authors: Ferronatto
authors: School of Medicine, Universidade Luterana do Brasil, Canoas, Rio Grande do Sul, Brazil.
authors: Mariana C
authors: MC
authors: Jensen
authors: Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors: Flavio
authors: F
authors: Pechansky
authors: Postgraduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
authors: Keila Maria Mendes
authors: KM
authors: Ceresér
authors: Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
authors: Victoria P
authors: VP
authors: Fairchild
authors: Graduate Program in Psychiatry, Universidade Federal do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.|Hospital de Clínicas de Porto Alegre, Rio Grande do Sul, Brazil.
authors: Claudia M
authors: CM
authors: Szobot
mesh_terms: D000293:Adolescent; D017668:Age of Onset; D001938:Brazil; D019970:Cocaine-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology* / Q000534:rehabilitation; D015897:Comorbidity; D016578:Crack Cocaine; D003430:Cross-Sectional Studies; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology / Q000523:psychology; D012931:Social Environment; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology
chemical_list: D016578:Crack Cocaine