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Acceptance of Drug Use Mediates Future Hard Drug Use Among At-Risk Adolescent Marijuana, Tobacco, and Alcohol Users


Alternative high school (AHS) students typically report higher levels of alcohol and other drug use compared to students attending traditional high schools. Greater use of such drugs as heroin, methamphetamines, and cocaine in this at-risk population may be driven, in part, by a greater latitude of acceptance toward substance use in general, which may accelerate the transition from gateway drugs to hard drugs. Seven hundred seventy-seven adolescents (mean age 16.6; 56% female) were recruited from alternative high schools throughout Southern California. To understand the factors that may lead AHS students to use hard drugs, a model was tested in order to determine if AHS students’ latitude of acceptance toward substance use was a mediator between the relationship of past use of gateway drugs and future use of hard drugs. Latitude of acceptance was found to be a statistically significant mediator of future hard drug use (b = 0.03, 95% confidence intervals = 0.01 to 0.05) among gateway drug users. An individual’s latitude of acceptance to various drug use behaviors may be consistent with societal norms. However, after exposure to, or use of, gateway drugs, attitudes that are more permissive toward hard drug use may be encountered, the acceptance of hard drugs may expand, and the use of hard drugs may escalate. Interventions designed to reduce the use of hard drugs among at-risk youth may be more persuasive by crafting messages that are within the latitude of acceptance of the target population and prevent the acceptance of hard drug use.

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Fig. 1


  1. Four hundred forty-seven participants completed the Time 2 assessment and 449 participants completed the Time 3 assessment.

  2. Results are substantively similar when analysis with imputed dataset excludes students who reported hard drug use at baseline (BootCI, 0.009–0.015).


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This research was supported by grants from the National Institute on Drug Abuse (DA023368, DA024659, DA024772) and the National Institute on Alcohol Abuse and Alcoholism (AA017996). NIDA and NIAAA had no role in the design of the study, collection, analysis and interpretation of data, or in the writing of the report.

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Correspondence to Christopher Cappelli.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the Claremont Graduate University Institutional Review Board (IRB00001114) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Cappelli, C., Ames, S.L., Xie, B. et al. Acceptance of Drug Use Mediates Future Hard Drug Use Among At-Risk Adolescent Marijuana, Tobacco, and Alcohol Users. Prev Sci 22, 545–554 (2021).

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  • Adolescence
  • Tobacco use
  • Alcohol use
  • Marijuana use
  • Latitude of acceptance
  • Hard drug use
  • Alternative high school
  • Social judgment theory