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Miech and colleagues demonstrate declines in prevalence of non-medical use of prescription drugs among US high school students and show that these declines can be explained by trends in cigarette smoking.1 These observations are taken as support of the gateway hypothesis in which cigarette smoking increases the likelihood of subsequent other drug use. The authors further argue that these results are inconsistent with a ‘common liability’ model, and that the common liability model predicts that adolescent drug use would have “stayed steady or even increased as adolescents continued to use these drugs regardless of whether they smoked.” In this scenario, adolescents with a predilection toward substance might substitute cigarettes with other drugs as smoking rates decline.
However, this conceptualization of the common liability model is inconsistent with how such models are typically understood. Models that posit a common liability do not assert that the degree of liability is fixed in the population, such that changes in risk for use of one drug increases risk for other drug use. Instead, common liability can be influenced by environmental factors and environmental changes can coherently impact multiple outcomes, resulting in trends similar to those observed by Miech and colleagues.
For over 40 years, Problem Behavior Theory has provided a comprehensive theory and empirical approach to common liability. “Problem behaviors” (later termed...
For over 40 years, Problem Behavior Theory has provided a comprehensive theory and empirical approach to common liability. “Problem behaviors” (later termed “risk behaviors”) can be modeled as a latent factor that predisposes an adolescent to use of multiple substances, delinquency, and other health risk behaviors.2,3 The latent factor is influenced by the environment at multiple levels. We rely on this framework in two recent papers that demonstrate that that US declines in tobacco use, other substance use, substance use disorders, delinquency, and sexual promiscuity among adolescents are consistent with a population-level reduction in a latent factor that predisposes to risk for all of these outcomes.4,5 Similarly, the externalizing spectrum of personality and psychopathology is postulated to arise from a common liability to multiple substance use and other disinhibitory disorders.6 Externalizing liability has been shown to change in response to specific environmental stressors such as minority stress and child maltreatment.7–10
Although common liability models do not invoke causal gateway effects, they are consistent with commonly observed gateway patterns, in which easily available drugs such as alcohol, cigarettes and marijuana are usually used prior to use of other drugs.5 Thus, trends observed by Miech and colleagues do not contradict the common liability model.
1. Miech R, Keyes KM, O’Malley PM, Johnston LD. The great decline in adolescent cigarette smoking since 2000: consequences for drug use among US adolescents. Tob Control. January 2020:tobaccocontrol-2019-055052.
2. Jessor R, Jessor SL. Problem Behavior and Psychosocial Development: A Longitudinal Study of Youth. Academic Press; 1977.
3. Jessor R. Risk behavior in adolescence: A psychosocial framework for understanding and action. Journal of adolescent Health. 1991;12(8):597-605.
4. Grucza RA, Krueger RF, Agrawal A, et al. Declines in prevalence of adolescent substance use disorders and delinquent behaviors in the USA: a unitary trend? Psychological Medicine. 2018;48(9):1494-1503.
5. Borodovsky JT, Krueger RF, Agrawal A, Grucza RA. A Decline in Propensity Toward Risk Behaviors Among U.S. Adolescents. Journal of Adolescent Health. 2019;65(6):745-751.
6. Krueger RF, Markon KE, Patrick CJ, Benning SD, Kramer MD. Linking antisocial behavior, substance use, and personality: an integrative quantitative model of the adult externalizing spectrum. J Abnorm Psychol. 2007;116(4):645-666.
7. Lehavot K, Simoni JM. The impact of minority stress on mental health and substance use among sexual minority women. Journal of Consulting and Clinical Psychology. 2011;79(2):159-170.
8. Eaton NR. Transdiagnostic psychopathology factors and sexual minority mental health: Evidence of disparities and associations with minority stressors. Psychology of Sexual Orientation and Gender Diversity. 2014;1(3):244-254.
9. Rodriguez-Seijas C, Stohl M, Hasin DS, Eaton NR. Transdiagnostic Factors and Mediation of the Relationship Between Perceived Racial Discrimination and Mental Disorders. JAMA Psychiatry. 2015;72(7):706.
10. Vachon DD, Krueger RF, Rogosch FA, Cicchetti D. Assessment of the Harmful Psychiatric and Behavioral Effects of Different Forms of Child Maltreatment. JAMA Psychiatry. 2015;72(11):1135.