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The Relationship between Consumption of Alcohol and Other Drugs and Problematic Internet Use among Adolescents/Relacion entre el consumo de alcohol y otras drogas y el uso problematico de Internet en adolescentes.

The consumption of alcohol and other substances among young people constitutes one of the main public healthcare problems in Spain. Although the levels of consumption of different substances appear to have declined in recent years, prevalence figures remain high, as the data from the latest National Survey on Drug Use among Secondary School Students in Spain [ESTUDES 2014-2015] (Plan Nacional sobre Drogas, 2016) reveal, with 76.8% of students between 14 and 18 years of age having consumed alcohol in the previous year (68.2% in the previous month), 31.4% having smoked tobacco (25.9% in the previous month) and 25.4% having used cannabis (18.6% in the previous month). Other substances such as cocaine, ecstasy, amphetamines or hallucinogens have much lower prevalence figures at below 3%. Regarding risky alcohol consumption, while ESTUDES does not use any screening tool as such, it does offer data on street drinking ('botellon') (which stands at 57.6% in the previous year), binge drinking (32.2% in the previous month), drunkenness (22.2% in the previous month) and risky drinking at the weekend (31.9%). No less worrying is the prevalence of problematic cannabis use obtained through the Cannabis Abuse Screening Test (CAST) (Legleye, Piontek & Kraus, 2011), which amounts to 2.5% of Spanish adolescents between 14 and 18 years of age.

However, the consumption of alcohol and drugs is not the only issue that society faces. The rapid technological advances witnessed over the past two decades has furthered the expansion and massive use of the Internet and social networks. According to data from the National Institute of Statistics (INE) (2016), 95.2% of children in Spain between the ages of 10 and 15 have used the Internet in the last 3 months. This technological boom has contributed to the emergence of a new social concern about how adolescents use the Internet. Despite the innumerable benefits brought about by technological advances, there are many risks that can arise from their misuse (Livingstone, Haddon, Gorzig & Olafsson, 2011; Munoz-Miralles et al., 2016; Rial, Golpe, Gomez & Barreiro, 2015; Valkenburg & Peter, 2011). Apart from studies warning of the abusive use of the Internet by young people (Blinka et al., 2015; Gencer & Koc, 2012), with uncontrolled access to pornographic, violent, racist and sexist content, there are also those alerting to the many high-risk practices (Garaigordobil & Aliri, 2013; Strassberg, McKinnon, Sustaita & Rullo, 2013; Wolak, Finkelhor & Mitchell, 2004) related to Internet use, such as cyberbullying, sexting and grooming. Some authors have even gone so far as to discuss the possibility of developing an addiction (Jorgenson, Hsiao & Yen, 2016; Young, 1996) or, at least, problematic Internet use (Anderson, Steen & Stavropoulos, 2016; Shapira et al., 2003). While Internet addiction or problematic use was initially identified primarily as a result of the overuse of the Internet, this approach has given way among both professionals and researchers to a focus which sees the problematic use of the Internet as a different problem that goes beyond the mere time online (Beard & Wolf, 2001; Hansen, 2002). In any case, it is precisely the lack of agreement regarding the conceptualization and operationalization of this problem which is behind the considerable variation in prevalence figures estimated by the different studies. For example, at the national level, the work of Oliva et al. (2012) claims that 0.76% of adolescents and young people have a serious level of internet addiction and 21.9% are moderately addicted, while Gomez, Rial, Brana, Varela and Barreiro (2014) put the prevalence of problem users among compulsory secondary education students at 19.9%.

Both problems (consumption of alchol and other drugs, and use of the Internet), are tha cause of grave social concern today, so much so that they are the focus of the latest edition of the European School Survey Project on Alcohol and Other Drugs (ESPAD) (European Monitoring Center for Drugs and Drug Addiction, 2016). Furthermore, the increasing importance that they have been acquiring has led in recent years to different authors concerning themselves with analyzing the relationship between these two problems, both in terms of consumption habits (Evren, Dalbudak, Evren & Demirci, 2014; Lee, Han, Kim & Renshaw, 2013; Rucker, Akre, Berchtold & Suris, 2015). High comorbidity between both, as well as hazardous consumption, especially in the case of alcohol has been found. For example, Ko et al. (2008) or Wartberg et al. (2016) coincide precisely in pointing out that problematic Internet users are more likely to have risky alcohol consumption.

In Spain there is still a dearth of studies analyzing the relationship between the problematic use of the Internet and substance use, and those that have been carried out tend to explore this relationship in a partial way. Thus, for example, the work of Secades-Villa et al. (2014) establishes a link between the time spent online and the frequency of consumption of alcohol, tobacco, cannabis and other illegal drugs among European adolescents, but does not examine the problematic use of the Internet itself, nor the 'hazardous consumption' of drugs with the appropriate instruments. The work of Fernandez-Villa et al. (2015), meanwhile, analyzes the relationship between problematic Internet use and the consumption of different substances among university students without finding any association between the two. Nevertheless, the authors themselves acknowledge that this result could be explained by the fact that a classification criterion was used that does not distinguish between cases of occasional or problematic use. In fact, when the relationship with the consumption of alcohol risk is examined in the study, results reveal that problem users are more likely to obtain a positive result in screening. In another study, Gamez-Guadix, Calvete, Orue and Las Hayas (2015) find a positive relationship between problematic Internet use and the consumption of alcohol risk in adolescents, but do not address the consumption of other drugs.

In short, we are dealing with an issue that has been attracting increasing interest among institutions and researchers worldwide, without, however, producing much evidence to date. This is particularly the case in our country, where most of the work has focused on analyzing the relationship between both problems, but usually with some limitations: either (1) paying attention exclusively to alcohol without taking the consumption of other drugs into acount, or (2) or not assessing hazardous consumption as such by using suitable instruments such as the Alcohol Use Disorders Identification Test [AUDIT] (Vent, Source, Saunders & Grant, 1989), the CRAFFT Abuse Screening Test (Knight et al., 1999) or the Cannabis Abuse Screening Test [CAST] (Legleye et al., 2011), or (3) using samples from university students rather than adolescents, the latter being a key population with regard to prevention.

Consequently, the present work has a twofold objective: (1) to perform a descriptive analysis of the habits of Internet use, high-risk practices and problematic Internet use, as well as consumption habits for the different substances and the hazardous consumption of alcohol and other drugs, and (2) to analyze the relationship between the problematic Internet use and the hazardous consumption among adolescents through the use of appropriate screening tools with proven psychometric properties.

Method

Participants

A selective methodology was employed, consisting of a survey of compulsory secondary education (ESO) and baccalaureate students in the provinces of A Coruna and Pontevedra. For sample selection, purposive sampling was used in an attempt to access as wide and heterogeneous a sample as possible. A total of 15 educational centers in different municipalities took part, both public and private/state-maintained private ('concertado'), both urban and rural.

The initial number of questionnaires collected was 4063, although 62 were eliminated after an exhaustive review process, either because they had an excessive number of missing values (32) or incoherent response patterns (30). In addition, a further 119 cases were eliminated because they were outside the age range under study (12-18 years). Thus the final sample consisted of 3882 adolescents (49.9% males and 50.1% females) aged between 12 and 18 (M = 14.52 and SD = 1.72). Of these, 2669 attended public schools and 1213 were in private or state-maintained private schools, with 74.8% in compulsory secondary education (38% in the first cycle and 36.8% in the second) and 25.2% baccalaureate students.

Instrument

The data were collected through a questionnaire which was specially drawn up for the present study and included questions grouped in four blocks: (1) the first comprises questions of our own creation to assess the habits of Internet use (frequency of use and time spent online) and possible high-risk practices (sexting, online betting, contact with strangers, etc.) (2) a second block was extracted from the ESTUDES (2010) National Survey on Drug Use among Secondary School Students (Plan Nacional sobre Drogas, 2011) to collect information on the consumption habits for both alcohol and other substances; (3) a third block that includes four screening tools: the Alcohol Use Disorders Identification Test (AUDIT) in its self-administered version (Rial, Gomez, Araujo, et al., 2015) to estimate risky alcohol consumption, the internal consistency of which in the present work was acceptable ([alpha] =, 82); the Cannabis Abuse Screening Test (CAST) (Legleye et al., 2011) to estimate the risk of cannabis use, with high internal consistency ([alpha] =, 85); the version of the CRAFFT Abuse Screening Test translated into Spanish and validated by Araujo et al. (2015), which presented an a of .62, and the Problematic Internet Use Scale (EUPI-a) (Rial, Gomez, Isorna, Araujo & Varela, 2015). Although the EUPI-a is a tool with less of a tradition than other existing ones, it is an instrument adapted to the Spanish cultural context which has been specifically developed and validated for the adolescent population of our country and which has displayed satisfactory psychometric properties, both in terms of internal consistency ([alpha] = .87), sensitivity (81%), specificity (82.6%) and construct validity, with a duly tested cut-off point for screening; and (4) a final section collecting information on sociodemographic variables such as gender and age.

Process

The data were collected in the classrooms of each center, in small groups (between 15 and 20 individuals), through a questionnaire that each student completed individually. A team of psychologists with proven experience in the accomplishment of this type of tasks carried out the information collection. All participants were informed of the purpose of the study, as well as the confidentiality and anonymity of their responses. The consent and collaboration of the each center's management as well as the respective parents' associations was obtained. Participation was totally voluntary and questionnaire completion time was approximately 20 minutes. The work was also approved by the bioethics committee of the University of Santiago de Compostela.

Data analysis

A bivariate tabulation was made with the use of Student's t tests for the comparison of means and [chi square] contrasts for the comparison of percentages. Correlation analysis was also performed (with Pearson for metric variables and Spearman for ordinal variables). Finally, a univariate and multivariate logistic regression analysis, adjusted for gender and age, was performed to predict the high-risk use of alcohol as well as other substances. The analyses were performed using the IBM SPSS Statistics 20 statistical package.

Results

Problematic Internet use and high-risk practices

As shown in Table 1, the use of the Internet among adolescents is widespread: 83% are online every day or almost every day, with 56.4% connecting for a moderate period of time (three hours or less), while 10.8% spend more than 5 hours a day online and 15.9% say they are online "throughout the day". Girls have a higher connection frequency and spend longer online, with 15 being the age when the greatest increase in the use of the Internet is observed, both in terms of frequency and connection time. Furthermore, 63.8% of adolescents are be registered in three or more social networks, with a significantly higher percentage among women (67.3% vs 60.3%), and particularly above the age of 15 (80.6% %). The most common high-risk practices are: contact with strangers (31.9%) and access to websites with erotic content (30.1%). While women more frequently feel threatened, harassed or humiliated online and have been blackmailed by threats of disseminating photos or videos of them with erotic content, boys admit to a greater extent threatening, harassing or humiliating others, contacting strangers, accessing websites with erotic content and placing bets online. Involvement in most of the high-risk practices analyzed is generally greater with increasing age, and rising especially sharply from the age of 15 onwards. Regarding problematic Internet use as such, 18.4% of adolescents exceeded the cut-off point established on the EUPI-a scale ([greater than or equal to] 16), and can thus be considered problematic users. This percentage was significantly higher among girls and in the older age group (17-18). In addition, in order to analyze the relationship between the problematic Internet use and time online, a Spearman correlation analysis was carried out, obtaining a value [r.sub.xy] = .45 (p < .001). This shows that time online only accounts for 20% of the variance in problematic Internet use ([r.sub.xy.sup.2] = .20).

Consumption of alcohol and other drugs

As shown in Table 2, the most commonly consumed substance among adolescents is alcohol (52.1% previous year, 32.3% previous month), followed by tobacco and cannabis. The results obtained regarding consumption habits in the previous year by gender show that there are only significant differences in relation to smoking, with a slightly higher percentage among girls. Regarding the previous month, statistically significant differences have also been found in the consumption of alcohol, intensive consumption (3 or more alcoholic drinks per sitting and drunkenness) and tobacco, with higher percentages, once again, in the case of girls. There is also a considerable increase in the levels of consumption of many substances with increasing age. The results of screening for hazardous use also show that 19.8% of adolescents drank alcohol (AUDIT), 3.8% consumed cannabis (CAST) and 18% consumed alcohol and other drugs in general (CRAFFT). There were no differences based on gender, although age differences were found, with a significant increase in the consumption of alcohol and other drugs with increasing age.

Relationship between problematic Internet use and consumption of alcohol and other drugs

The relationship between the problematic Internet use and the consumption of alcohol and other drugs was initially verified through an analysis of correlations between the EUPI-a, CRAFFT, AUDIT and CAST scales, all of which statistically significant ([r.sub.xy] EUPI-CRAFFT = 0.39, p < .001) ([r.sub.xy] EUPI-AUDIT = 0.36; p < .001) (rxy EUPI-CAST = .11; p < .001). However, correlation and effect sizes indicate that this relationship is relevant only in the case of drugs and alcohol, where it is moderate (> .30) (Weinberg & Abramowitz, 2002).

To analyze this relationship in greater depth, the sample was divided into two groups (problematic Internet users vs. non-problematic users), and their consumption habits in the previous year and the previous month were compared. The results reported in Table 3 reveal statistically significant differences for almost all substances, with rates almost twice as high among problem users.

The same can be said of hazardous consumption, with significantly higher rates among problem users, three times higher in the case of CRAFFT (39.4% vs. 13.3%) ([c.sup.2] = 248.66; p < .001). The analysis of the effect size once again reveals that this is a moderate relationship in both alcohol ([CC.sub.EUPI-AUDIT] = .21) and drugs in general ([CC.sub.EUPI-CRAFFT]= .25) and practically non-existent in the case of cannabis (([CC.sub.EUPI-CAST] = .08). Similarly, the mean scores obtained on the different screening scales are significantly higher for problematic users, with an almost identical pattern for effect (sizes) ([[eta] .sub.EUPI-CRAFFT] = .26; [[eta] .sub.EUPI-AUDIT = .22; [[eta] .sub.EUPI-CAST]= .08).

Finally, logistic regression analysis (Table 5) revealed that both age and problematic Internet use are risk factors for the development of alcohol and other drug abuse. Specifically, increasing age, the probability of obtaining a positive result in AUDIT (POR = 1.95 [95% CI: 1.83 - 2.08]) and in the CRAFFT (POR = 1.87 [95% CI: 1.75 - 1.99]). With regard to problematic Internet users, these present almost three and four times greater likelihood of developing hazardous use of alcohol and of drugs in general, respectively.

Discussion

The results obtained serve to reinforce some of the findings in ESTUDES 2014-15 (Plan Nacional sobre Drogas, 2016), according to which alcohol remains the psychoactive substance most consumed by adolescents, followed by tobacco and cannabis. Furthermore, the data confirm the trend already noted by other authors (Vargas & Trujillo, 2012; White et al., 2015) regarding the reduction of the gender gap in the consumption of different substances, which is even inverted in the case of alcohol and tobacco. Although the rates found in the lowest age range are apparently small, when carried over to population figures, would mean that between 2000 and 5000 Galician adolescents between 12 and 14 got drunk, smoked tobacco and consumed cannabis in the previous month. These figures are of particular concern in view of the important implications that the consumption of these substances can have on the developing brain, as can be seen in the works of Cadaveira (2009), Jacobus and Tapert (2015), and Yuan, Cross, Loughlin and Leslie (2015). In terms of hazardous consumption, it is important to note that the overall prevalence figures obtained 'mask' very unequal percentages depending on age range, with rates of up to eight times higher registered in the group of 17 to 18-year olds in comparison with the youngest age group (12-14).

With regard to the Internet, the data obtained show that its use is nowadays widespread among Spanish adolescents. Although both Internet and social network use are more intensive with increasing age, it is noteworthy that between the ages of 12 and 14, seven out of ten adolescents are online daily, and one in four for more than five hours. It should be pointed out, however, that in spite of a positive and significant correlation between the hours that adolescents spend online and problematic Internet use being found, the magnitude of this relationship turned out to be moderate, which shows that problematic Internet use is a different issue, which goes beyond time spent online and whose defining element is the degree of interference it causes in the life of the adolescent (Beard & Wolf, 2001). Moreover, it is observed that the vast majority are members of a social network and almost half of three or more. It is clear, therefore, that adolescents make relatively intensive use of the Internet, with the consequences, both physical and psychosocial, that this can lead to (Randy et al., 2015).

The most frequent high-risk practices are contact with strangers and access to websites with erotic content, which can be of concern when dealing with individuals whose brain maturity does not yet allow them to develop an adequate cognitive, emotional and behavioral response to certain situations (Owens, Behun, Manning & Reid, 2012). With regard to the prevalence of problematic Internet use, this stood at 18.4%. This result is similar to that obtained in other studies carried out on the same population and with the same screening tool as the one by Gomez et al. (2014) and Gomez, Rial, Brana, Golpe and Varela (2017), or that obtained by Lopez-Fernandez, Freixa-Blanxart and Honrubia-Serrano (2012) using the Problematic Entertainment Use Scale for Adolescents. However, it is important to point out that for both theoretical and methodological reasons there is still a significant problem of comparability between the results of the different studies, which is one of the main challenges to date in this field of research.

Beyond the analysis of the consumption levels of the different substances and the possible problematic use that adolescents make of the Internet, the results obtained also show the existence of a link between both behaviors. This not only confirms the findings of other studies regarding the relationship between problematic Internet use and consumption of alcohol risk (Fernandez-Villa et al., 2015; Gamez-Guadix et al., 2015), but also evidence that problematic Internet use is associated with the hazardous use of other drugs. A logistic regression analysis has also shown a significantly higher rate of hazardous consumption among adolescents who make problematic use of the Internet, up to four times in the case of CRAFFT.

Numerous studies until today have highlighted the link between problematic Internet use and substance use (Cia, 2013; Holden, 2001; Sun et al., 2012). This suggests, as proposed in the problematic behavior theory (Jessor, 1991), that different types of deviant behavior might respond to the same determinants. According to this approach, there would be a common "psychosocial propensity" to develop the different problem behaviors defined by personality traits as well as the social context, the perceived environment and the individual's own behavior. Thus, for example, the work of Ko et al. (2008) found that certain psychosocial characteristics such as being a man, a dysfunctional family, having low self-esteem and low life satisfaction were associated with both problematic alcohol consumption and Internet addiction. The main implication of the results obtained at the applied level may be the importance of proposing transversal prevention, beyond approaches or programs focused on specific behaviors, and capable of acting on the variables common to both problem behaviors. Thus, interventions aimed at improving education in values and the learning of life skills could provide a platform on which to develop preventive work, insofar as they start from an individual-environment interaction model that has been shown to be effective in drug prevention (European Monitoring Center for Drugs and Drug Addiction, 2011; Faggiano, Minozzi, Versino & Buscemi, 2014; Moshki, Hassanzade & Taymoori, 2014).

Finally, the present work has some limitations, the first of which would be the sample used. Despite being based on data from 4000 adolescents, the fact that non-probabilistic sampling was used for their selection and that they originate exclusively from the provinces of A Coruna and Pontevedra limits the external validity of the results. Secondly, it is important to refer to the transversal nature of the work, which prevents causal relationships being established among the variables under study. Finally, mention should be made of the fact that all variables have been self-reported, making it impossible to know for certain to what extent adolescents may have underestimated or overestimated both their levels of consumption and the amount of time they spend online. However, as various experts in the field of addictive behavior have previously pointed out, self-report measures have proven to be reliable and even better than other methods in assessing levels of alcohol and other drug use (Babor, Kranzler & Lauerman, 1989; Winters, Stinchfield, Henly & Schwartz, 1990).

Acknowledgments

The authors of this paper would like to acknowledge the funding received through the Delegacion del Gobierno para el Plan Nacional sobre Drogas (Ref. 2013/046) to carry out this study.

Conflict of interests

The authors of this article declare that they have no conflict of interest.

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SANDRA GOLPE (*), PATRICIA GOMEZ (*), TERESA BRANA (*), JESUS VARELA (*), ANTONIO RIAL (*).

(*) Universidad de Santiago de Compostela, Espana.

Received: October 2016; Accepted: January 2017.

Send correspondence to:

Antonio Rial Boubeta. Facultad de Psicologia, C/ Xose Maria Suarez Nunez, s/n. Campus Vida- Universidad de Santiago de Compostela. 15782- Santiago de Compostela (Espana). E-mail: antonio.rial.boubeta@usc.es
Table 1. Habits of Internet and social network use, high-risk practices
and problematic use.

                                     Global (%)          Sex
Connection frequency                             Male (%)  Female (%)

Never/almost never                    1.1         1.2       1
Occasionally during the month         3.2         3.9       2.4
Occasionally during the week         12.7        13        12.4
Every/almost every day               83          81.9      84.2
Time online per day
Less than 1 hour                     14          14.5      13.5
1-2 hours                            24.2        26.5      21.8
2-3 hours                            18.2        19.9      16.6
3-5 hours                            16.9        17.3      16.7
Over 5 hours                         10.8        10.6      11
All day                              15.9        11.3      20.5

Social networks

None                                  7.8         8.7       6.8
1 or 2                               28.4        31        26
3 or more                            63.8        60.3      67.3

High-risk practices

Victim of threats, harassment or
humiliation                           5.9         4.5       7.4
Initiator of threats, harassment or
humiliation                           4.6         6         3.1
Sexting                               5.2         4.5       5.8
Victim of blackmail (publishing/
disseminating photos or videos of
yours with erotic content)            3           1.9       4.1
Accessing erotic websites            30.1        49.9      10.3
Online betting                        6.7        11.8       1.5
Contact with strangers               31.9        34.4      29.5
Meeting strangers                    14          14.7      13.2
Problematic use (EUPI-a)             18.4        16.6      20.4

                                                       Age (years)
Connection frequency                 [chi square]  12-14 (%)  15-16 (%)

Never/almost never                      8.60 (*)    2.1        0.1
Occasionally during the month                       5.4        1
Occasionally during the week                       20.7        4.7
Every/almost every day                             71.8       94.2
Time online per day
Less than 1 hour                       65.37 (**)  22.9        5.3
1-2 hours                                          31.9       17.1
2-3 hours                                          18.5       19.6
3-5 hours                                          13.2       20.9
Over 5 hours                                        7.1       13.2
All day                                             6.5       23.9

Social networks

None                                   20.15 (**)  12.6        3.1
1 or 2                                             40.5       16.3
3 or more                                          46.8       80.6

High-risk practices

Victim of threats, harassment or
humiliation                            14.80 (**)   5.9        6.1
Initiator of threats, harassment or
humiliation                            18.92 (**)   3.5        5.7
Sexting                                 3.23        1.9        7.9
Victim of blackmail (publishing/
disseminating photos or videos of
yours with erotic content)             14.85 (**)   2.8        3.2
Accessing erotic websites             717.23 (**)  17.2       40.5
Online betting                        162.51 (**)   4.3        7.9
Contact with strangers                 10.57 (**)  23.8       39.8
Meeting strangers                       1.79        8.9       18
Problematic use (EUPI-a)                8.92 (*)   14         22

                                     Age (years)
Connection frequency                 17-18 (%)    [chi square]

Never/almost never                    0.5          343.72 (**)
Occasionally during the month         0.8
Occasionally during the week          4.7
Every/almost every day               94
Time online per day
Less than 1 hour                      5.6          589.33 (**)
1-2 hours                            16
2-3 hours                            14.3
3-5 hours                            19.9
Over 5 hours                         17.4
All day                              26.8

Social networks

None                                  3            477.20 (**)
1 or 2                               16.4
3 or more                            80.6

High-risk practices

Victim of threats, harassment or
humiliation                           5.8             .08
Initiator of threats, harassment or
humiliation                           5              9.93 (*)
Sexting                               9.8           88.57 (**)
Victim of blackmail (publishing/
disseminating photos or videos of
yours with erotic content)            3.3                  .70
Accessing erotic websites            47            302.19 (**)
Online betting                       11.1           40.30 (**)
Contact with strangers               39.9          114.32 (**)
Meeting strangers                    20.8           82.01 (**)
Problematic use (EUPI-a)             24.7           50.65 (**)

Note. (*) p < .05; (**) p <.oo1.

Table 2. Substance use habits and hazardous consumption.

                                       Global (%)         Sex
Substance use habits (previous year)               Male (%)  Female (%)

Drinking alcohol                       52.1        50.7      53.4
3 or more alcoholic drinks per day     33.1        31.8      34.2
6 or more alcoholic drinks per day     18.1        18.7      17.2
Getting drunk                          26.3        25.4      27
Tobacco                                23.4        21.2      25.4
Marijuana or hashish                   14.8        15.3      14.3
Cocaine                                 0.9         1.1       0.6
Ecstasy, amphetamines                   1.1         1.2       0.9
or hallucinogens

Substance use habits (previous month)

Drinking alcohol                       32.3        30        34.5
3 or more alcoholic drinks per day     20          18.2      21.8
6 or more alcoholic drinks per day      8.6         8.9       8.3
Getting drunk                          12.9        11.7      14
Tobacco                                16.1        14.3      17.8
Marijuana or hashish                    8.5         8.6       8.4
Cocaine                                 0.4         0.4       0.4
Ecstasy, amphetamines                   0.4         0.3       0.5
or hallucinogens

Hazardous consumption

AUDIT                                  19.8        19        20.6
CAST                                    3.8         4.2       3.4
CRAFFT                                 18          17.2      18.9

                                                          Age (years)
Substance use habits (previous year)   [chi square]  12-14  15-16  17-18

Drinking alcohol                           2.74      32.9   68.2   76.9
3 or more alcoholic drinks per day         2.31      14.4   47.1   60.9
6 or more alcoholic drinks per day         1.34       6.4   25.9   36.8
Getting drunk                              1.18      10.1   38     50.8
Tobacco                                    9.2 (*)   11.9   31.2   41.8
Marijuana or hashish                       0.65       5.9   20.3   30.3
Cocaine                                    1.97       0.6    1.2    1
Ecstasy, amphetamines                      0.89       0.6    1.4    1.8
or hallucinogens

Substance use habits (previous month)

Drinking alcohol                           8.69 (*)  16.1   43.7   57.8
3 or more alcoholic drinks per day         7.36 (*)   7.1   28.4   41.7
6 or more alcoholic drinks per day         0.33       3.1   11.3   19.5
Getting drunk                              4.70 (*)   4.5   17.1   29.6
Tobacco                                    8.54 (*)   8     21.3   30.2
Marijuana or hashish                       0.04       3.6   11.5   17.6
Cocaine                                    0.00       0.4    0.4    0.2
Ecstasy, amphetamines                      0.26       0.3    0.6    0.2
or hallucinogens

Hazardous consumption

AUDIT                                      1.37       5.3   30.1   43.8
CAST                                       1.27       1.8    5.5    6.1
CRAFFT                                     1.64       5.1   26.8   39.3


Substance use habits (previous year)   [chi square]

Drinking alcohol                       569.59 (**)
3 or more alcoholic drinks per day     631.02 (**)
6 or more alcoholic drinks per day     373.70 (**)
Getting drunk                          542.83 (**)
Tobacco                                300.55 (**)
Marijuana or hashish                   266.76 (**)
Cocaine                                  3.84
Ecstasy, amphetamines                    9.44 (*)
or hallucinogens

Substance use habits (previous month)

Drinking alcohol                       489.18 (**)
3 or more alcoholic drinks per day     436.12 (**)
6 or more alcoholic drinks per day     179.36 (**)
Getting drunk                          292.58 (**)
Tobacco                                209.42 (**)
Marijuana or hashish                   137.98 (**)
Cocaine                                  0.81
Ecstasy, amphetamines                    2.61
or hallucinogens

Hazardous consumption

AUDIT                                  538.35 (**)
CAST                                    40.38 (**)
CRAFFT                                 454.79 (**)

Note. (*) p < .05; (**) p <.001.

Table 3. Differences in substance use habits among problematic Internet
users.

Substance use habits                   EUPI
(previous year)             Positive (%)  Negative (%)  [chi square]

Drinking alcohol                65.7         48.9        62.62 (**)
3 or more alcoholic drinks      47.5         29.8        78.87 (**)
per day
6 or more alcoholic drinks      27.9         15.7        56.17 (**)
per day
Getting drunk                   39.5         23.3        76.03 (**)
Tobacco                         35.8         20.4        74.09 (**)
Marijuana/hashish               23.8         12.7        54.26 (**)
Cocaine                          1.4          0.7         3.10
Ecstasy/amphetamines/            2            0.8         6.82 (*)
hallucinogens

Substance use habits
(previous month)

Drinking alcohol                42.6         29.8        42.13 (**)
3 or more alcoholic drinks      29.2         17.8        44.87 (**)
per day
6 or more alcoholic drinks      13.5          7.4        25.82 (**)
per day
Getting drunk                   20.6         11          46.16 (**)
Tobacco                         24.2         14.1        42.22 (**)
Marijuana/hashish               13.3          7.2        26.30 (**)
Cocaine                          0.1          0.4         0.56
Ecstasy/amphetamines/            0.9          0.3         2.72
hallucinogens

Note. (*) p < .05; (**) p <.001.

Table 4. Differences in hazardous consumption among problematic
Internet users.

Hazardous
consumption            EUPI                       Contrast
              Positive     Negative

AUDIT              38.1%        15.8%  [chi square] = 165.92 (**)
             Mean = 4.54  Mean = 1.83             t = -16.67 (**)

CAST                7%           2.9%   [chi square] = 24.69 (**)
             Mean = 0.70  Mean = 0.28              t = -4.95 (**)

CRAFFT             39.4%        13.3%  [chi square] = 248.66 (**)
             Mean = 1.51  Mean = 0.62             t = -18.01 (**)

Note. (*) p < .05; (**) p <.001.

Table 5. Logistic regression models for predicting hazardous
consumption.


                       AUDIT                     CRAFFT
Variable     Univariate     Multivariate (1)    Univariate
            POR (95% CI)      POR (95% CI)     POR (95% CI)

SEX
Male      1                 1                 1
Female    1.11 (0.94-1.30)  1.11 (0.92-1.34)  1.12 (0.95-1.32)
AGE       1.97 (1.86-2.10)  1.95 (1.83-2.08)  1.88 (1.77-1.99)
EUPI-a
Negative  1                 1                 1
Positive  3.28 (2.73-3.96)  2.92 (2.38-3.69)  4.25 (3.52-5.13)

              CRAFFT
Variable  Multivariate (1)
           POR (95% CI)

SEX
Male      1
Female    1.07 (0.89-1.30)
AGE       1.87 (1.75-1.99)
EUPI-a
Negative  1
Positive  3.90 (3.17-4.80)

Note. POR = Prevalence of odds ratio; CI= confidence interval;
1Adjusted for the other independent variables included in the column.
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Author:Golpe, Sandra; Gomez, Patricia; Brana, Teresa; Varela, Jesus; Rial, Antonio
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Date:Dec 1, 2017
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