The role of drug use sequencing pattern in further problematic use of alcohol, tobacco, cannabis, and other drugs.

BACKGROUND There has been considerable debate regarding what typically occurs after experimentation with drugs throughout the life of young people who used various drugs. AIMS To evaluate the clinical importance of the most common sequence for the first use of a drug by two models (the "gateway model" and the "alternative model", which is the most popular sequence for Brazilian university students according to a previous study) regarding the problematic use of alcohol, tobacco, cannabis and other illegal drugs, assessed by ASSIST. METHOD People who had already experimented with three or more drugs across different stages of the two models were selected from a representative sample of university students from 27 Brazilian capitals (n = 12 711). FINDINGS There were no differences regarding the problematic use of the most consumed drugs in Brazil (alcohol, tobacco and cannabis) between the models. Multiple drug seekers and violators had more problematic use of illegal drugs other than cannabis than individuals in the model sequence. However, in the case of violators, this was only evident in the alternative model. CONCLUSIONS Multiple drug seekers and violators deserve special attention due to their increased risk of problematic use of other illegal drugs.