patterns of alcohol, cigarette and illicit drug use in english adolescents

Addiction (1998) 93(8), 1199 ± 1208

RESEARCH REPORT

Patterns of alcohol, cigarette and illicit druguse in English adolescents

IAN SUTHERLAND & PAUL WILLNER

Centre for Substance Abuse Research, Department of Psychology, University of Wales,

Swansea, UK

Abstract

Aim s. The aim of this study was to describe associations between alcohol, tobacco and illicit drug use in

adolescen ts and demographic factors associated with substance use. Design, setting, subjects. The study

was a classroom survey of the total population of pupils (n 5 5383, ages 11± 16) in six schools selected from

different locations around England. M easures. Respondents were asked con® dentially about their use and

extent of use of alcohol, cigarettes and illegal drugs. Findings. The prevalence of regular substance use within

the sample rose from 30.4% at age 11 to 83.9% at age 16. The prevalence of alcohol use did not differ

between girls and boys, but smoking was more prevalent in girls and illegal drug use was more prevalent in

boys. Alcohol was used more frequently than any other substance, or combination of substances, and alcohol

use almost invariably accompanied the use of other substances: exclusive use of cigarettes or illegal drugs was

negligible. In addition, high levels of alcohol intoxication were associated with increased use of both illegal

drugs and cigarettes. Overall, around half the drinkers (46.8%) preferred alcopops to other types of alcoholic

drink; this ® gure was greater in girls (56.4%) than in boys (37.1%), but fell sharply with age (62.9% at

age 11; 37.7% at age 16), particularly in boys. Preference for spirits increased with age, and was particularly

marked in girls (28.4% in girls vs. 18.5% in boys at age 16). Spirits drinkers were more likely to use

cigarettes and drugs, and had been more frequently drunk, than either beer/wine or alcopops drinkers; these

measures also tended to be higher in alcopop drinkers than in beer/wine drinkers, particularly among

11± 13-year-old girls. Conclusion. The use of both tobacco and illicit drugs appears to be strongly associated

with alcohol use, which is more prevalent, and the risk of smoking and illicit drug use is particularly high

in adolescen ts who report high levels of drunkenness . Our results are consistent with a simple threshold model

of substance abuse in which alcohol occupies a low threshold position relative to the higher threshold of

cigarettes and illegal drugs. Smoking, drug use and drunkennes s were lowest in beer/wine drinkers,

intermediate in alcopop drinkers, and highest in spirits drinkers.

Introduction

Use by adolescents of alcohol, tobacco and illicit

drugs is a matter of increasing concern world-

wide. This paper reports on a study that aimed

to increase understanding of the nature of this

problem by examining the associations between

alcohol, cigarette and illicit drug use in a large

young-teenage sample.

Correspondence to: Paul Willner, Centre for Substance Abuse Research, Department of Psychology, Universityof Wales, Swansea SA2 8PP, UK. Tel: 1 44 (0) 1792 295844 ; Fax: 1 44 (0) 1792 295679; e-mail:[email protected]

Submitted 8th July 1997; initial review completed 27th September 1997 ; ® nal version accepted 30th January 1988.

0965 ± 2140 /98/081199 ± 10 $9.50 Ó Society for the Study of Addiction to Alcohol and Other Drugs

Carfax Publishing Limited

1200 Ian Sutherland & Paul W illner

In 1943 only 75% of 7± 14-year-olds in Eng-

land had used alcohol, a ® gure which rose to

96% by 1988 (Bagnall, 1988). It was noted

recently that alcohol consumption patterns are

changing, with young children using large quan-

tities of alcohol at each drinking session, the

suggestion being that these young people (14/15-

year-olds) are now drinking speci® cally in order

to get drunk (Measham, 1996). These ® ndings

are particularly worrying in the light of recent

studies suggesting that the younger the age of

alcohol initiation the greater the level of alcohol

misuse at age 17± 18 (Gruber et al., 1996;

Hawkins et al., 1997).

The scale of cigarette smoking in adolescents

is also a matter of great concern and there is

evidence that, after a period of decline, smoking

is again increasing in young people. Bagnall

(1988) found that 34% of her sample of UK

13-year-olds admitted to having smoked

cigarettes, and 6% said that they did so at the

time of the study. This change in smoking pat-

terns is found elsewhere. For example, in Aus-

tralia, Hill et al. (1995) reported that the

percentage of 12± 15-year-olds who were current

smokers rose from 15.7 to 17.5% between 1990

and 1993. This ® gure is similar to the one found

by the National Household Survey (SAMHSA,

1996) which suggested that 18% of 12± 17-year-

olds in America were current tobacco smokers.

While unacceptably high, these ® gures are lower

than in some other countries. In Italy, for exam-

ple, a recent study reported that up to 47% of

young adolescents were regular smokers (Donato

et al., 1995). The prevalence in adolescents, and

age of initiation, of illegal drug use has also been

examined. Balding (1994), in his continuing sur-

vey of health behaviour in English adolescents,

found that 24.3% of 14± 15-year-olds and 3.8%

of 11± 12-year-olds had used illegal drugs. Bald-

ing also noted gender differences in the onset of

adolescent illegal drug use: 3.8% of 11-year-old

boys, but only 1.8% of 11-year-old girls had

used illegal drugs, ® gures which rose to 34.7% of

15-year-old boys and 28.0% of 15-year-old girls

(Balding, 1994).

In addition to studies reporting on the usage of

individual substances, there have also been a

number of studies of associations between

alcohol, cigarettes and illegal drug use. It is clear

that the use of one or more of these substances,

particularly alcohol, is associated with sub-

sequent use patterns of the others, but the issue

of causality is open to debate (for a review see

De-Piano & Van-Hasselt, 1994). In a study of

over 4000 young teenagers, Bailey (1992) found

that levels of use of both alcohol and cigarettes

were associated with whether or not subjects

initiated later drug use, with heavier drinking

and smoking indicating greater risk. This ® nding

was supported by Yu & Williford (1992), who

reported that alcohol use was associated with an

increased chance of using cigarettes and mari-

juana among a sample of 3000 young people,

and that alcohol and cigarette use in combi-

nation was associated with an increased likeli-

hood of using marijuana. Kandel, Yamaguchi &

Chen (1992) found that whereas progression to

illicit drugs among men was associated with prior

use of alcohol, among women either cigarettes or

alcohol was a risk factor for progression to mari-

juana.

The consensus among researchers appears to

be that there is a relationship between cigarette,

alcohol and drug use in adolescents. However,

there are insuf® cient data on pre-teenage sam-

ples and, to our knowledge, no studies of the

inter-relationships between the usages of differ-

ent substances by adolescents have been carried

out in the United Kingdom.

A secondary objective of the present study

concerned the use of ª alcopopsº by under-age

drinkers. These sweet-tasting alcoholic drinks,

which ® rst arrived in the United Kingdom in

1995, have generated a moral uproar, fuelled by

suggestions in the popular media that young

adolescents are being ª seducedº into drinking

these potent but pleasant-tasting drinks and that

the extent of their consumption has reached

epidemic proportions (see McKeganey, 1996;

Hughes et al., 1997). We therefore report also on

the prevalence of alcopop use within our sample,

and the relationship of alcopop preference to

other substance use.

Method

Subjects

Participants were 5492 adolescents from six

English secondary schools. The total population

of the six schools was 6974. Although it was

planned to use the entire student population this

was not possible because of examination com-

mitments, absenteeism and school outings. Of

the 5492 participants, 5402 returned useable

questionnaires; 867 of these subjects, aged 11±

Adolescent substance abuse 1201

15, and attending one of the schools were sur-

veyed in a pilot study carried out in the spring of

1996. The remaining 4535 subjects, aged 11± 17

and attending the other ® ve schools, were sur-

veyed in the spring of 1997. Data from 17-year-

olds were excluded from the analysis as there

were only 19 respondents in total in this sub-

group. The data reported were supplied by the

remaining 5383 respondents.

The total numbers of respondents in each age

group were: 11, 482; 12, 1026; 13, 1001; 14,

1306; 15, 1028; 16, 540. Except for the fact that

school 1, used in the pilot study, does not have a

sixth form (hence, no 16-year-olds), the age and

gender distribution was similar across schools.

The six schools surveyed in this study were

chosen to re¯ ect different geographical areas and

demographic characteristics. However, the sam-

ple is not assumed to be representative of

English schoolchildren as a whole, so prevalence

estimates must be viewed with caution. Two of

the schools were in one of the most economically

deprived inner London boroughs, two were in a

city in the south of England, parts of which are

very deprived and two were semi-rural: one of

these (pilot study) was in the south west of

England, and the other was in a relatively

af¯ uent part of the north midlands.

M aterials

The data presented in this study were abstracted

from responses to a longer questionnaire, which

are not reported in full. The data reported were

derived from answers to the following questions:

Do you smoke cigarettes?

Do you drink alcohol?

If you do drink alcohol, what is your favourite

drink?

If you do drink alcohol, how many times a week

would you usually drink?

Have you ever been drunk?

If you have been drunk, how many times has this

happened?

If you have used drugs not given to you by a

doctor, please say what they were.

About how many times have you used these

drugs?

If you use them regularly, how many times a

week do you use them?

To ensure that brief experimentation of sub-

stances was not included in the analysis, the data

presented refer to ª regular useº , which was

de® ned as use of alcohol, tobacco or illegal drugs

that takes place at least once a week for a period

of more than 3 months. Teachers administering

the questionnaire were asked to speci® cally

emphasize this point. The exceptions to this

were the questions about alcohol intoxication

which asked for life-time incidence.

The data were coded and entered by a single

person over a period of some 6 weeks. In order to

con® rm the reliability of the coding, the same

person randomly selected and re-coded 50 ques-

tionnaires 6 months later; the scores were ident-

ical.

Procedure

Participants were told at general school assem-

blies that over a period of a week, as timetabling

allowed, a questionnaire survey was being car-

ried out into various aspects of their lives. They

were told that this would be done in tutor groups

and that details would be explained to them by

their individual tutors. Tutors were briefed at the

same time by the head teacher and were asked to

administer the questionnaire at their weekly

tutor class during the designated week.

Tutors were asked to ensure that pupils under-

stood that completion of the questionnaire was

not an examination and that there were no right

or wrong answers, that pupils did not have to

participate if they did not want to, and that they

could withdraw from the survey at any time. In

addition, teachers were asked to stress that the

survey was completely con® dential and that nei-

ther the teachers nor the experimenters had any

desire to know individuals’ names and there was

no space on the questionnaire for names to be

written. Tutors were asked to emphasize that

each questionnaire would be handed out with a

plain envelope and should be returned, sealed, in

that envelope, again ensuring con® dentiality.

This was done in order to reassure students that

the teachers would not be able to glance at the

completed questionnaires and recognize individ-

uals by their handwriting.

Finally, it was made clear by the teachers that

answers should refer to regular use, as de® ned

above, and should not include experimentation

or occasional use on special occasions.

Statistical analysis

Data were analysed by logistic regression. The

011

(a)

Per

cent

age

usin

g

Age

20

40

60

80

100

12 13 14 15 16011

(b)

20

40

60

80

100

12 13 14 15 16


Figure 1. Proportion of (a) boys and (b) girls of different ages using alcohol, cigarettes and illicit drugs. d , Any use;

r , alcohol; j , cigarettes; m , drugs.

results of these analyses are presented as

Mantel± Haenszel c 2 values.

Results

Data from the pilot study and the main study

were very similar. The two sets of data have

therefore been amalgamated for the purposes of

presentation. The exception to this is the section

on alcohol preferences where the data from the

pilot study (n 5 867) have been excluded, as

alcopops were only just beginning to appear on

the market when this work was undertaken.

Age and gender differences in substance use

Only 1982 (36.9%) of the subjects who returned

useable questionnaires said that they did not use

any kind of psychotropic substance. Overall, the

prevalence of substance use rose from 30.4% of

the sample at age 11 to 83.9% at age 16. Alcohol

was the most heavily used substance with 30.4%

of the sample drinking regularly at age 11, rising

to 82.8% at age 16. Cigarettes were the second

most heavily used substance with 5.4% of 11-

year-olds smoking regularly, rising to 29.5% at

age 15 and decreasing slightly to 26.6% at age

16. Regular use of illegal drugs rose from 1.3%

of the sample at age 11 to 31.8% of the sample

at age 16.

There were no gender differences in overall

substance use or in alcohol use ( C 2 5 1.2 and

2.7, respectively, NS); however, cigarette smok-

ing was signi® cantly more prevalent in girls than

in boys ( C 2 5 14.5, p , 0.001), and illicit drug

use was signi® cantly more prevalent in boys than

in girls ( C 2 5 14.3, p , 0.001). In line with these

observations, girls were more likely to smoke

than to take drugs and boys were more likely to

take drugs than to smoke ( c 2 5 57.8, p , 0.001)

(Fig. 1).

Patterns of substance use

Exclusive consumption of alcohol dominated

adolescent substance use, with 39.2% of the

overall sample using only alcohol. However,

there was virtually no exclusive use of either

cigarettes or illicit drugs at any age. Conjoint use

of cigarettes and drugs (but not alcohol) was also

negligible. Rather, cigarettes and drugs were

almost invariably used in combination with

alcohol: 5.3% of the sample used a combination

of alcohol and drugs, 8% used alcohol and

cigarettes and 9.4% used all three types of sub-

stance. In all 22.7% reported regular use of

cigarettes and/or drugs in combination with

alcohol, and this ® gure rose to 37.5% by age 16.

By contrast, only 1.3% of the sample used

cigarettes and/or drugs without alcohol, and this

® gure remained negligible across all age groups

(Fig. 2).

The differences between alcohol drinkers and

alcohol abstainers are dramatically illustrated in

Fig. 3, which shows all use of cigarettes

( c 2 5 439.5; p , 0.001) and all use of drugs

( c 2 5 452.8 p , 0.001) in each of these groups.

Among regular users of illicit drugs 74.6%

reported using primarily marijuana, 11.1% said

011

Per

cent

age

usin

g

Age

10

12 13 14 15 16X X

X X X X

15

5

20

25

30

35

40

45

50

011

Per

cent

age

usin

g ci

gare

ttes

and/

or d

rugs

Age

10

12 13 14 15 16

20

30

40

0Never

Per

cent

age

usin

g

Occasions of alcohol intoxication

20

1-5 6-10 11-15 16-20 20+

10

30

40

50

60

70


Figure 2. Proportion of respondents of different ages using

alcohol (A) alone or in combination with cigarettes (C) or

illicit drugs (D). The line labelled C, D, C & D shows

the total of all alcohol-exclusive combinations. d , Alcohol

only; r , A & C; j , A & D; m , A & C & D; 3 , C, D,

C & D.

Among the drinkers in our sample beer was

preferred by 36.8%, alcopops by 46.8% and

spirits by 16.5%. Preferences for beer remained

fairly constant across the age range (35.6% at

age 11, 38.0% at age 16). Alcopops, on the other

hand decreased in popularity with age: they were

the preferred drink of 62.9% of 11-year-olds, but

only 37.7% of 16-year-olds. Conversely, prefer-

ence for spirits increased with age, from 1.5% at

age 11 to 24.3% at age 16. These overall ® gures

Figure 3. Cigarettes and/or illicit drugs at different ages:

proportions of alcohol drinkers and alcohol abstainers using.

d , Males drinkers; m , male abstainers; j , female drinkers;

r , female abstainers.

Figure 4. Cigarette and illicit drug use in relation to

frequency of alcohol intoxication. The ª Neverº category does

not include non-drinkers. j , Cigarettes; m , drugs.

they used primarily amphetamines, 8.6%

MDMA, and 5.7% opiates or cocaine. 13.2% of

the drug users reported polydrug use comprising

marijuana and ecstasy and/or amphetamines.

Intoxication

The relationship between alcohol intoxication

and cigarette and illicit drug use is shown in

Fig. 4.

Of those with 1± 5 reported episodes of drunk-

enness, 21.2% said they smoked cigarettes and

13.2% said that they took drugs, as opposed to

61.5% and 57.6%, respectively, of subjects who

reported more than 20 episodes of drunkenness

(cigarettes, c 2 5 193.3, p , 0.001; drugs,

c 2 5 410.0, p , 0.001). This association between

levels of drunkenness and cigarette and drug use

does not arise accidentally from the fact that

cigarette smoking, drug use and problem drink-

ing increase with age. Binary logistic regression

indicated that these effects were age-independent

( c 2 5 204.6, df 5 8, p , 0.001).

Alcohol preferences

We examined preferences for three broad cate-

gories of alcoholic drink: beer/lager/cider/wine

(referred to below as simply beer); alcopops; and

spirits.

011

(a)

Per

cent

age

usin

g

Age

20

40

60

80

100

12 13 14 15 16011

(b)

20

40

60

80

100

12 13 14 15 16

0

Per

cent

age

Boys

Drug use

11-13 yearsGirls Boys Girls

14-16 years

20

40

60

80

100

0Boys

Cigarette use


14-16 years

20

40

60

80

100

0Boys

Ever drunk


14-16 years

20

40

60

80

120

0Boys

Drunk more than five times


14-16 years

20

40

60

80

100

100


Figure 5. Drink preferences of (a) boys and (b) girls. The percentages are of drinkers only. d , Beer/wine; r , alcopops; j ,

spirits.

Figure 6. Boys’ and girls’ cigarette and illicit drug use and incidences of drunkenness, as a function of their preferences for

beer ( h ), alcopops ( 7 ) or spirits ( j ).

conceal large sex differences (Fig. 5). Girls

showed a marked preference for alcopops

(56.4%; beer: 23.5%; spirits: 16.5%), while boys

tended to prefer beer (0.1%; alcopops: 37.1%;

spirits: 12.8%). Except at age 16, when alcopop

preference fell sharply in boys (to 16.9%), the

sex difference in alcopop preference remained

roughly constant (around 20%) across 11± 15 age

range. As boys started at a lower baseline, this

represents a much greater proportional change

with age in boys than in girls. The age-related

increase in the number of adolescents reporting a

preference for spirits was particularly marked in

girls (28.4% vs. 18.5% at age 16).

The relationship between drink preference and

other types of substance use was examined sepa-

rately for a younger (11± 13) and an older (14±

16) age group (Fig. 6).

Four measures were examined, cigarette use,

drug use, ever drunk and drunk . 5 times. On all


four measures, in both age groups and both

sexes, spirits drinkers were signi® cantly more

delinquent than either beer or alco-pop drinkers

(minimum c 2 5 7.2, p , 0.01). Additionally,

alcopop drinkers were more delinquent than

beer drinkers, particularly in the younger group,

where alcopop drinkers were signi® cantly higher

than beer drinkers in cigarette use ( c 2 5 7.8,

p , 0.01), ever drunk ( c 2 5 9.8, p , 0.01) and

drunk . 5 times ( c 2 5 6.0, p , 0.02); the differ-

ence in drug use was also nearly signi® cant

( c 2 5 2.9, p , 0.1). Separate examination of boys

and girls showed that all these measures, includ-

ing drug use ( c 2 5 7.9, p , 0.01), were

signi® cantly higher among alcopop drinkers in

younger girls, but none of the alcopop-beer dif-

ferences were signi® cant in younger boys. In the

older group, alcopop users smoked more than

beer drinkers ( c 2 5 6.2, p , 0.02), but these two

sub-groups did not differ signi® cantly on the

other three measures. Again, the higher value for

alcopop drinkers was true for girls ( c 2 5 12.1,

p , 0.001), but not for boys. Among the girls,

drunk . 5 times was also higher in alcopop

drinkers than in beer drinkers ( c 2 5 4.3,

p , 0.02).

Discussion

All types of substance use increased with age

with alcohol being the most heavily used sub-

stance followed by cigarettes and then by illicit

drugs. Exclusive use of either cigarettes or drugs

was very rare; use of either substance was almost

invariably accompanied by alcohol. It was also

found that the quantity of alcohol drunk effected

other substance use with those who reported

having been intoxicated in excess of 20 times

being considerably more at risk than those who

had been drunk less often. These data are

derived from a whole-school census of six non-

randomly chosen secondary schools, and cannot

be considered to represent a random sample of

the adolescent population. Nevertheless, the size

of the sample ( . 5000) and the fact that the six

schools were drawn from geographically and

demographically diverse locations, suggests that

the data may have some degree of generality.

Despite there being no marked gender differ-

ences in overall alcohol use, cigarette smoking

was signi® cantly greater in girls than in boys and

drug use was greater in boys than in girls. This

gender bias in smoking has received a great deal

of attention, and has been noted in previous

studies of teenage smoking in the United King-

dom (e.g. Miller, Plant & Duffy, 1995). The

reasons for the prevalence of smoking among

teenage girls are not well understood, but may

re¯ ect an increase in the targeting of cigarette

advertising towards this group (Pierce & Gilpin,

1994). Alternatively, Lowe, Foxcroft & Sibley

(1993) have suggested that drunkenness is not as

acceptable for girls as it is for boys, so girls

compensate by increased cigarette smoking.

However, this suggestion is not supported by the

present ® ndings, as girls and boys did not differ

signi® cantly in levels of drunkenness.

The most important ® nding of this study is

that it may be possible to use alcohol consump-

tion as an indicator of both illegal drug use and

cigarette smoking by English adolescents. At all

ages, within our sample of 11± 16-year-olds, both

illicit drug use and smoking were strongly associ-

ated with alcohol drinking, such that consump-

tion of other substances was minimal in

non-drinkers. These ® ndings are consistent with

the concept that alcohol may be the gatekeeper

to smoking and illegal drug use, within this

population. This concept was ® rst advanced by

Kandel (1975) and colleagues on the basis of a

cohort of subjects in New York State ® rst stud-

ied in the early 1970s at the age of 15, and

followed-up in their mid-20s and mid-30s

(Yamaguchi & Kandel, 1984; Kandel et al.,

1992). These studies reported a sequential pro-

gression from alcohol to cigarettes to illicit drug

use. The progression from alcohol to illicit drugs

among New York adolescents has been

con® rmed by others (Welte & Barnes, 1985).

However, the progression from alcohol to

cigarettes, while con® rmed in a sample of Israeli

teenagers, was not found in a French sample

(Adler & Kandel, 1981) and, as noted, some

evidence suggests that the importance of alcohol

as a gateway to marijuana use among New York-

ers may have declined with the increased avail-

ability of marijuana (Golub & Johnson, 1994).

While the data are consistent with the gateway

hypothesis they are also consistent with an

alternative approach, which views substance use

as a manifestation of a more general delinquent

behaviour pattern (Donovan & Jessor, 1978; Jes-

sor, 1987). Thus, in addition to the relationships

between the use of alcohol and the use of other

substances, we have also identi® ed an important

relationship with the level of alcohol consump-


tion. For instance, drinkers who had been drunk

more than ® ve times were more than twice as

likely to smoke cigarettes as drinkers who had

been drunk less than ® ve times. In the same way,

the prevalence of illegal drug use was over 3.5

times as high among those who had been drunk

more than 20 times compared with those who

had been drunk less than ® ve times and, if girls

only are considered, this ® gure rises to over ® ve

times. Similar data have been reported in earlier

studies by Jessor and colleagues, who found

signi® cant correlations between extent of prob-

lem drinking on one hand and smoking and illicit

drug use on the other hand. In one of their

studies, the prevalence of marijuana use among

American 17± 18-year-olds rose from 1% among

non-drinkers to 36% among non-problem

drinkers to 80% among problem drinkers

(Donovan & Jessor, 1978; Jessor, 1987). The

present study con® rms these observations and

extends them to a UK cohort and to a much

younger age group.

These ® ndings, that adolescents who smoke or

use illicit drugs almost invariably also drink

alcohol, and that their likelihood of other sub-

stance use increases as their drinking becomes

more problematic, have important implications

for the prevention of smoking and drug abuse.

The present data suggest that smoking and illicit

drug prevention initiatives should be targeted at

children who drink: children who have not ini-

tiated drinking appear to be at very low risk for

other substance use. Also, as alcohol use may be

predictive of later smoking and illicit drug use it

would seem appropriate to ensure that parents

are aware of this connection, as alcohol initiation

usually takes place within the home environment

at an early age (Plant, Peck & Samuel, 1985).

Our results also suggest that particular atten-

tion should be focused on the type of alcohol

consumed. While most current concern is

focused on alcopops, the fact that spirits are the

preferred drink of over 25% of 16-year-old girls

is extremely disturbing, not only for the adverse

health implications that this implies, but also

because spirits drinkers were more likely to use

cigarettes and drugs, and had been more fre-

quently drunk, than either beer/wine or alcopops

drinkers. These data support the suggestion that

involvement with certain types of beverages may

may be particularly likely to lead adolescents to

experience problems (Smart & Walsh, 1995).

The popularity of alcopops in our sample, at

around 50%, is remarkable considering how

recently these drinks were introduced to the

United Kingdom, but is consistent with other

surveys (Health Promotion Wales, 1997; Bald-

ing, 1997; Hughes et al., 1997). These drinks are

of concern for a number of reasons. First, alco-

pop drinkers were more likely than drinkers who

preferred beer or wine (although less so than

spirits drinkers), to display other forms of delin-

quency, such as drunkenness, smoking and, to a

lesser extent, drug use; this was particularly the

case in girls. The greater incidence of drunken-

ness may arise because the aversive ¯ avour of

ethanol is so well disguised that it is relatively

easy to consume a large quantity of alcopop in a

short period of time. Adolescent drinkers, partic-

ularly the younger ones, are likely to be relatively

inexperienced with the physiological, psychologi-

cal and behavioural effects of ingestion of alcohol

and as a result, alcopop drinkers may be

especially susceptible to a potentially pathologi-

cal pattern of ª binge-drinkingº .

The popularity of alcopops among adolescents

may result, in part, from their sweetness. A

potentially revealing observation in this connec-

tion is the well documented ® nding that most

strains of alcohol-naive animals have a strong

aversion to alcohol. However, taste preferences

among these non-drinking animals can be

modi® ed by initiating them into drinking alcohol

by adding sucrose to their beverage (Samson et

al., 1989). These studies have shown that the

exposure to high levels of initial sweetness results

in the prolonged maintenance of drinking, sub-

sequent to a ª fading-outº procedure during

which sweetener is gradually removed from the

alcohol (Samson et al., 1989). This experimental

procedure closely mirrors the age-dependent

decline in alcopop usage among teenage

drinkers. Alongside the evidence that the early

initiation of alcohol use leads later to increased

use of alcohol and other drugs (Gruber et al.,

1996), there is cause for concern that early

experience with alcopops may result in higher

levels of later alcohol consumption. This possi-

bility will require careful monitoring as the cur-

rent generation of alcopop users matures to

adulthood and switches to less sweet drinks.

One ® nal point concerns the rates of alcohol

and other substance use reported by the present

sample of English adolescents. These ® gures are

somewhat higher than have been reported in

earlier surveys: for example, our ® gure of 61%


for the mean across ages (11± 16) of the pro-

portion of adolescents who regularly drink

alcohol stands in marked contrast to previously

published statistics indicating thatÐ prior to the

introduction of alcopopsÐ only about 20% of

English schoolchildren drank regularly (Gilvarry,

McCarthy & McArdle, 1995). It is possible that

our prevalence estimates could be in¯ ated by

respondents reporting ª ever-useº rather than

ª regular useº , though the teachers administering

the questionnaire stressed that respondents

should think in terms of regular use (ª at least

once a week for at least three monthsº ) and it

seems unlikely that the majority would ignore

this clear instruction. It should also be noted that

our data are not derived from a random sample

of the adolescent population, so the prevalence

estimates presented in this study should be

treated with caution. Nevertheless, our data are

consistent across the six schools surveyed (range

of overall means, 52± 69% for regular alcohol

consumption). They are also consistent with the

results of a very recent survey which reported

that 50% of 12± 13-year-old British adolescents

are ª regular drinkersº (Balding, 1997). While

the recent ® ndings may be at odds with previous

statistics because of differing de® nitions of

ª regular drinkingº , it may also be that under-

aged drinking has in fact very recently risen, and

that the availability of alcopops may be encour-

aging experimentation with other types of

alcohol, themselves acting as gateway or

threshold drinks. Such an upward shift in regular

drinking, if continued, would signify a radical

departure from historical trends.

We cannot, from the present data, adjudicate

the con¯ icting hypothesis of the nature of the

relationship between alcohol use and abuse on

one hand and use of cigarettes and illegal drugs

on the other hand. Indeed, the data are consist-

ent with a simple threshold model of substance

abuse among teenagers in which alcohol use has

a low threshold while cigarette and illicit drug

use have higher thresholds.

However, results indicate that alcohol con-

sumption by secondary school pupils represents

a major risk factor or marker for underage smok-

ing and the use of other illicit drugs. Further-

more, relative to under-age beer or wine

drinkers, under-age alcopop drinkers, particu-

larly girls, were more likely to use cigarettes and

drugs and had higher levels of drunkenness;

although all these problems were even greater in

spirits drinkers. The high prevalence of alcohol

and other drug use, and the possibility that these

problems may have been exacerbated by the

introduction of alcopops, raises concern that the

conditions may exist for a steep rise in alcohol-

related problems, accompanied by a correspond-

ing rise in the use of cigarettes and illegal drugs,

as well as the various antisocial behaviours gen-

erally associated with these substance using

activities.

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