CORK Bibliography: Substance Use and Conduct Disorders

26 citations. January 2009 to present

Prepared: September 2012

Bandiera FC; Richardson AK; Lee DJ; He JP; Merikangas KR. Secondhand smoke exposure and mental health among children and adolescents. Archives of Pediatrics & Adolescent Medicine 165(4): 332-338, 2011. (51 refs.)

Objective: To examine a potential association between biologically confirmed secondhand smoke exposure and symptoms of Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) (DSM-IV) major depressive disorder, generalized anxiety disorder, panic disorder, attention-deficit/hyperactivity disorder, and conduct disorder using a nationally representative sample of US children and adolescents. Design: Nationally representative cross-sectional survey of the United States. Setting: Continental United States. Participants: Children and adolescents aged 8 to 15 years who participated in the National Health and Nutrition Examination Survey from 2001 to 2004. Intervention: Measurement of serum cotinine level to assess secondhand smoke exposure among nonsmokers. Main Outcome Measures: The DSM-IV symptoms were derived from selected modules of the National Institute of Mental Health's Diagnostic Interview Schedule for Children Version IV, a structured diagnostic interview administered by trained lay interviewers. Results: Among nonsmokers, serum cotinine level was positively associated with symptoms of DSM-IV major depressive disorder, generalized anxiety disorder, attention-deficit/hyperactivity disorder, and conduct disorder after adjusting for survey design, age, sex, race/ethnicity, poverty, migraine, asthma, hay fever, maternal smoking during pregnancy, and allostatic load. Associations with serum cotinine level were more apparent for boys and for participants of non-Hispanic white race/ethnicity. Conclusions: Our results are consistent with a growing body of research documenting an association between secondhand smoke exposure and mental health outcomes. Future research is warranted to establish the biological or psychological mechanisms of association.

Barnes GM; Welte JW; Hoffman JH; Tidwell MCO. The co-occurrence of gambling with substance use and conduct disorder among youth in the United States. American Journal on Addictions 20(2): 166-173, 2011. (37 refs.)

The co-occurrence of gambling with substance use and conduct disorder was examined in a representative U.S. household sample of 2,274 youth 14-21 years old. The findings show that problem gambling occurs within a problem-behavior syndrome with other substance-use behaviors and conduct disorder. Male gender, being black, and being Hispanic were found to be significant in predicting problem gambling over and above the effects of all four substance use and conduct disorder variables. Clinical interventions for one specific problem behavior in youth should consider assessing the other problem behaviors as well.

Bauer L; Dick D; Bierut L; Bucholz K; Edenberg H; Kuperman S et al. Obesity, smoking, and frontal brain dysfunction. American Journal on Addictions 19(5): 391-400, 2010. (55 refs.)

Obesity, smoking, and conduct problems have all been associated with decrements in brain function. However, their additive and interactive effects have rarely been examined. To address the deficiency, we studied P300a and P300b electroencephalographic potentials in 218 women grouped by the presence versus absence of: (1) a BMI >= 30 kg/m2; (2) recent smoking; and (3) >= 2 childhood conduct problems. Analyses revealed smaller P300a and P300b amplitudes over the posterior scalp among recent smokers versus nonsmokers. No corresponding group differences were found in P300 latencies or frontal scalp amplitudes. The most interesting analysis result was an interaction between conduct problems and obesity limited to the frontally generated P300a component: its latency was significantly greater in women with both attributes than in those with either or neither attribute. An exploratory ANOVA, substituting the genotype of a GABRA2 SNP for conduct problems, also demonstrated an interaction with obesity affecting P300a latency. It is hypothesized that conduct problems, and a conduct-problem-associated GABRA2 genotype, decrease the age-of-onset and/or increase the lifetime duration of obesity. As a result, they may potentiate the adverse effects of obesity on frontal white matter and thereby increase P300a latency. Smoking may affect brain function by a different mechanism to reduce posterior scalp P300a and P300b amplitudes while preserving frontal scalp P300a latency and amplitude.

Becker SJ; Curry JF; Yang CM. Factors that influence trajectories of change in frequency of substance use and quality of life among adolescents receiving a brief intervention. Journal of Substance Abuse Treatment 41(3): 294-304, 2011. (65 refs.)

This study aimed to identify factors influencing trajectories of change in two outcome domains, frequency of substance use and quality of life (QOL), among adolescents receiving a brief evidence-based intervention. Participants were 106 adolescents, aged 13 to 21 years, who met criteria for a substance use disorder. The adolescents received a five-session intervention and completed four assessments over 12 months. Based upon a theoretical and empirical review, five putative predictors were tested: gender, age, severity of conduct disorder, severity of depression, and peer substance involvement. Results of a parallel-process latent growth curve model indicated that higher peer substance involvement and conduct severity predicted higher frequency of use at baseline, whereas higher peer substance involvement and depression severity predicted poorer QOL at baseline. Counter to predictions, higher depression severity predicted greater improvements in QOL following substance use treatment. The implications of baseline risk factors on adolescents' response to intervention are discussed.

Biederman J; Monuteaux MC; Faraone SV; Mick E. Parsing the associations between prenatal exposure to nicotine and offspring psychopathology in a nonreferred sample. Journal of Adolescent Health 45(2): 142-148, 2009. (35 refs.)

Purpose: Several studies have suggested an association between maternal smoking during pregnancy and both attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) in the offspring of women who smoke during pregnancy. However, it is unclear whether one or both of the documented links are spurious, given the considerable comorbidity between these disorders. The main aim of this study was to disentangle the association between maternal smoking during pregnancy with psychopathological outcomes, adjusting for possible confounders. Methods: Two large, identically designed, longitudinal, case-control family studies of male and female probands with and without ADHD were combined. We used data from the nonreferred siblings of the probands from both studies (n = 536). All subjects were blindly assessed with structured diagnostic interviews. Logistic regression analysis was used to determine the adjusted effect of exposure to maternal smoking during pregnancy. Results: Among all siblings, maternal smoking during pregnancy was significantly associated with ADHD, independent of CD and other covariates. In contrast, maternal smoking during pregnancy was a risk factor for CD only in siblings of control probands, after adjusting for covariates. Conclusions: These results support the hypothesis that maternal smoking during pregnancy is a risk factor for both ADHD and CD, independently of each other. However, the risk for CD appears to be conditional on family risk status.

Carpentier PJ; Knapen LJM; van Gogh MT; Buitelaar JK; De Jong CAJ. Addiction in developmental perspective: Influence of conduct disorder severity, subtype, and attention-deficit hyperactivity disorder on problem severity and comorbidity in adults with opioid dependence. Journal of Addictive Diseases 31(1): 45-59, 2012. (62 refs.)

This retrospective cross-sectional study examines whether conduct disorder and attention deficit hyperactivity disorder are associated with problem severity and psychiatric comorbidity in 193 middle-aged, opioid-dependent patients. Conduct disorder history, attention deficit hyperactivity disorder, psychiatric comorbidity, and problem severity were assessed by structured interviews and validated instruments. A conduct disorder history was confirmed in 116 (60.1%) participants. Conduct disorder patients had significantly higher problem severity scores, more frequent comorbid substance use disorders, and more severe psychiatric comorbidity. Attention deficit hyperactivity disorder was found to increase the risk for psychiatric comorbidity. Conduct disorder persistence is a useful model for elucidating complex psychiatric comorbidity of opioid-dependent patients.

Carpentier PJ; van Gogh MT; Knapen LJM; Buitelaar JK; De Jong CAJ. Influence of Attention Deficit Hyperactivity Disorder and Conduct Disorder on opioid dependence severity and psychiatric comorbidity in chronic methadone-maintained patients. European Addiction Research 17(1): 10-20, 2011. (60 refs.)

Background: Persistent attention deficit hyperactivity disorder (ADHD) and a history of conduct disorder (CD) are highly prevalent among patients with substance use disorders (SUD). We examined the influence of both diagnoses on problem severity, psychiatric comorbidity, and quality of life in methadone-maintained patients. Methods: 193 patients in long-term methadone maintenance treatment (MMT) were assessed for ADHD through a semi-structured interview. Psychiatric disorders and SUD were assessed with the MINI, the CIDI-SAM, and the SIDP-IV. Results: Childhood ADHD was diagnosed in 68 (35.2%) patients; 48 (24.9%) had persisting ADHD; a CD history was present in 116 (60.1%). Patients with adult ADHD had significantly higher problem severity scores, lower quality of life scores, more comorbid SUD and more psychiatric comorbidity. Although both ADHD and CD contributed to problem severity, addictive pathology and psychopathology, ADHD was found to substantially increase the risk of psychiatric comorbidity, independent of CD. Conclusion: ADHD in MMT patients is characterised by greater addiction severity and more comorbid psychopathology, only partly explained by the influence of a coexisting CD. The presence of ADHD in a substantial minority of patients accentuates the need for early detection and treatment of this complicating disorder.

Castellanos-Ryan N; Rubia K; Conrod PJ. Response inhibition and reward response bias mediate the predictive relationships between impulsivity and sensation seeking and common and unique variance in conduct disorder and substance misuse. (review). Alcoholism: Clinical and Experimental Research 35(1): 140-155, 2011. (145 refs.)

Background: Disinhibited traits, assessed both at the self-report and at the cognitive/behavioral levels, have been frequently implicated in externalizing behaviors, such as conduct disorder (CD), binge drinking, and drug use. However, self-report measures of disinhibition, such as impulsivity (IMP) and sensation seeking (SS), and cognitive measures of disinhibition are not often studied together in the same participants. Thus, it is still unclear how cognitive measures such as response inhibition and reward response bias relate to self-report measures of IMP and SS, and whether they can explain some of the association found between these self-report measures and specific facets of externalizing problems. Methods: The aim of this study was to assess whether cognitive measures of disinhibition relate to self-report measures of disinhibition and can mediate the specific relationships between self-report measures of disinhibition and CD symptoms, binge drinking and drug use in adolescence. Seventy-six adolescents were assessed on personality, substance use, and conduct problems every 6 months from 14 to 16 years of age and completed a test battery that included a Stop task, rewarded go/no-go task, digit span, and intelligence quotient tests at 16 years of age. Results: Multiple regression analyses showed that self-report IMP at 14 and deficits in response inhibition were associated with a 2-year average CD symptoms score and that deficits in response inhibition partially mediated the association between self-report IMP and CD symptoms (ab = 0.018 CI: 0.00002 to 0.04827). In contrast, SS and reward response bias were significantly associated with the unique variance in binge drinking, and that part of the overlap between SS and binge drinking was mediated by reward response bias (ab = 0.019, CI: 0.00131 to 0.04662). Conclusions: Findings show a dissociation between inhibitory measures associated with CD symptoms and those associated with binge drinking, with "cool" inhibitory and executive functions being associated with CD but "hot," reward-related disinhibition measures being specific mediators between SS and binge drinking. The findings support the theoretical conceptualization for dual cognitive/motivational pathways of disinhibition, in this case IMP and SS, and their unique association with externalizing behavior in adolescence.

Cavazos-Rehg PA; Spitznagel EL; Bucholz KK; Nurnberger J; Edenberg HJ; Kramer JR et al. Predictors of sexual debut at age 16 or younger. Archives of Sexual Behavior 39(3): 664-673, 2010. (52 refs.)

The present study examined the extent to which variables within the self system (i.e., symptoms of alcohol dependence and conduct disorder, gender, race, and metropolitan status) and the familial system (i.e., having an alcohol dependent biological parent or second-degree relative, religious background, educational background of parents, and being born to a teenage mother) were associated with sexual debut at 16 years old or earlier. Participants were 1,054 biological relatives, aged 18-25 years, of alcohol dependent probands who participated in the Collaborative Study on the Genetics of Alcoholism project. Comparison participants (N = 234) without alcohol dependent biological parents were also evaluated. Clinical and sociodemographic variables were assessed by structured, personal interviews. Parental history of alcohol dependence was evaluated by direct interview of parents in most cases and family history in uninterviewed parents. In a multivariate survival analysis, increased risk of becoming sexually active at 16 years of age or earlier was significantly associated with 6 of the 10 predictor variables, including race, one or more alcohol dependence symptoms, and/or one or more conduct disorder symptoms. Having an alcohol dependent biological parent or second-degree relative (e.g., aunt, uncle, or grandparent), educational background of mother, and being born to a teenage mother were also significantly associated with increased risk. These results provide evidence that specific variables in the self and familial systems of influence are important in predicting sexual debut at 16 years old or earlier.

Crowley TJ; Dalwani MS; Mikulich-Gilbertson SK; Du YPP; Lejuez CW; Raymond KM et al. Risky decisions and their consequences: Neural processing by boys with antisocial substance disorder. PLoS ONE 5(9): e12835, 2010. (90 refs.)

Background: Adolescents with conduct and substance problems ("Antisocial Substance Disorder" (ASD)) repeatedly engage in risky antisocial and drug-using behaviors. We hypothesized that, during processing of risky decisions and resulting rewards and punishments, brain activation would differ between abstinent ASD boys and comparison boys. Methodology/Principal Findings: We compared 20 abstinent adolescent male patients in treatment for ASD with 20 community controls, examining rapid event-related blood-oxygen-level-dependent (BOLD) responses during functional magnetic resonance imaging. In 90 decision trials participants chose to make either a cautious response that earned one cent, or a risky response that would either gain 5 cents or lose 10 cents; odds of losing increased as the game progressed. We also examined those times when subjects experienced wins, or separately losses, from their risky choices. We contrasted decision trials against very similar comparison trials requiring no decisions, using whole-brain BOLD-response analyses of group differences, corrected for multiple comparisons. During decision-making ASD boys showed hypoactivation in numerous brain regions robustly activated by controls, including orbitofrontal and dorsolateral prefrontal cortices, anterior cingulate, basal ganglia, insula, amygdala, hippocampus, and cerebellum. While experiencing wins, ASD boys had significantly less activity than controls in anterior cingulate, temporal regions, and cerebellum, with more activity nowhere. During losses ASD boys had significantly more activity than controls in orbitofrontal cortex, dorsolateral prefrontal cortex, brain stem, and cerebellum, with less activity nowhere. Conclusions/Significance: Adolescent boys with ASD had extensive neural hypoactivity during risky decision-making, coupled with decreased activity during reward and increased activity during loss. These neural patterns may underlie the dangerous, excessive, sustained risk-taking of such boys. The findings suggest that the dysphoria, reward insensitivity, and suppressed neural activity observed among older addicted persons also characterize youths early in the development of substance use disorders.

Day C; Kowalenko S; Ellis M; Dawe S; Harnett P; Scott S. The Helping Families Programme: A new parenting intervention for children with severe and persistent conduct problems. Child and Adolescent Mental Health 16(3): 167-171, 2011. (18 refs.)

Background: Severe and persistent conduct problems in children during the primary school years are associated with school exclusion, increased risk of delinquency and early substance abuse. Method: Literature reviews and consultation with experts in the field were used to better understand the factors that contribute to severe and persistent conduct problems and to identify the principles and potential methods to be included in a new intervention. Results: Grounded in an ecological perspective, an innovative, multimodal intervention, the Helping Families Programme, has been developed. It uses a modular approach to systematically address parent behaviour, cognition and emotion across five key risk factor domains: parental mood and dysregulation; parent-child, family and school relationships; substance misuse; social support and networks; and managing life events and crises. Conclusion: Initial piloting of the Programme has offered early support for the potential value of the underlying principles and methods of the Programme.

Falls BJ; Wish ED; Garnier LM; Caldeira KM; O'Grady KE; Vincent KB et al. The association between early conduct problems and early marijuana use in college students. Journal of Child & Adolescent Substance Abuse 20(3): 221-236, 2011. (58 refs.)

Early conduct problems have been linked to early marijuana use in adolescence. The present study examines this association in a sample of 1, 076 college students that was divided into three groups: (1) early marijuana users (began marijuana use prior to age 15; N=126), (2) late marijuana users (began marijuana use at or after age 15; N=607), and (3) nonusers (never used marijuana; N=343). A conduct problem inventory used in previous studies was adapted for use in the present study. Early conduct problems were associated with early marijuana use but not with late marijuana use, holding constant other risk factors. Results suggest that early conduct problems are a risk factor for early marijuana use even among academically achieving college-bound students.

Glaser B; Shelton KH; van den Bree MBM. The moderating role of close friends in the relationship between conduct problems and adolescent substance use. Journal of Adolescent Health 47(1): 35-42, 2010. (40 refs.)

Purpose: Conduct problems and peer effects are among the strongest risk factors for adolescent substance use and problem use. However, it is unclear to what extent the effects of conduct problems and peer behavior interact, and whether adolescents' capacity to refuse the offer of substances may moderate such links. This study was conducted to examine relationships between conduct problems, close friends' substance use, and refusal assertiveness with adolescents' alcohol use problems, tobacco, and marijuana use. Methods: We studied a population-based sample of 1,237 individuals from the Cardiff Study of All Wales and North West of England Twins aged 11-18 years. Adolescent and mother-reported information was obtained. Statistical analyses included cross-sectional and prospective logistic regression models and family-based permutations. Results: Conduct problems and close friends' substance use were associated with increased adolescents' substance use, whereas refusal assertiveness was associated with lower use of cigarettes, alcohol, and marijuana. Peer substance use moderated the relationship between conduct problems and alcohol use problems, such that conduct problems were only related to increased risk for alcohol use problems in the presence of substance-using friends. This effect was found in both cross-sectional and prospective analyses and confirmed using the permutation approach. Conclusions: Reduced opportunities for interaction with alcohol-using peers may lower the risk of alcohol use problems in adolescents with conduct problems.

Glass K; Flory K. Are symptoms of ADHD related to substance use among college students? Psychology of Addictive Behaviors 26(1): 124-132, 2012. (67 refs.)

Attention-deficit/hyperactivity disorder (ADHD) is a common childhood disorder that often persists into adolescence and adulthood and has been associated with an increased risk for substance use. Due to improved treatment and educational policies, more students with high levels of ADHD symptoms are attending college despite continued ADHD symptoms. Little research has examined whether college students with higher levels of ADHD symptoms are at increased risk for heavy substance use compared to college students with few ADHD symptoms. The current study examined the relation of ADHD symptoms to substance use (e.g., cigarette smoking, alcohol use, marijuana use, and cocaine use). We hypothesized that greater ADHD symptomatology (inattentive, hyperactive/impulsive, and total ADHD) would be related to higher rates of cigarette smolcing, alcohol use, alcohol-problems, and illicit drug use. Participants were 889 college undergraduates who completed an online survey. Results suggest that ADHD symptoms, particularly inattentive symptoms, were positively associated with cigarette smoking and problems associated with alcohol after controlling for conduct disorder (CD) symptoms. ADHD symptoms were not significantly associated with alcohol use or illicit drug use after the effects of CD symptoms were accounted for. Results have important implications for prevention and treatment of college student substance use. Limitations and future directions are discussed.

Howard R; Finn P; Jose P; Gallagher J. Adolescent-onset alcohol abuse exacerbates the influence of childhood conduct disorder on late adolescent and early adult antisocial behaviour. Journal of Forensic Psychiatry & Psychology 23(1): 7-22, 2012. (52 refs.)

This study tested the hypothesis that adolescent-onset alcohol abuse (AOAA) would both mediate and moderate the effect of childhood conduct disorder on antisocial behaviour in late adolescence and early adulthood. A sample comprising 504 young men and women strategically recruited from the community were grouped using the criteria of the Diagnostic and Statistical Manual (DSM-IV, American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: APA), as follows: neither childhood conduct disorder (CCD) nor alcohol abuse/dependence; CCD but no alcohol abuse or dependence; alcohol abuse/dependence but no CCD; both CCD and alcohol abuse/dependence. The outcome measure was the sum of positive responses to 55 interview items capturing a variety of antisocial behaviours engaged in since age 15. Severity of lifetime alcohol-related and CCD problems served as predictor variables in regression analysis. Antisocial behaviour problems were greatest in individuals with a history of co-occurring conduct disorder (CD) and alcohol abuse/dependence. While CCD was strongly predictive of adult antisocial behaviour, this effect was both mediated and moderated (exacerbated) by AOAA.

Kabir Z; Connolly GN; Alpert HR. Secondhand smoke exposure and neurobehavioral disorders among children in the United States. Pediatrics 128(2): 263-270, 2011. (33 refs.)

OBJECTIVES: The association between parent-reported postnatal secondhand tobacco smoke exposure in the home and neurobehavioral disorders (attention-deficit/hyperactivity disorder, learning disabilities, and conduct disorders) among children younger than 12 years in the United States was examined using the 2007 National Survey on Children's Health. Excess neurobehavioral disorders attributable to secondhand smoke (SHS) exposure in the home in 2007 were further investigated. METHODS: The methods used in this study were multivariable logistic regression models that accounted for potential confounders and complex survey designs to evaluate associations. RESULTS: A total of 6% of 55 358 children (aged < 12 years), corresponding to a weighted total of 4.8 million children across the United States, were exposed to SHS in the home. The weighted prevalence and 95% confidence intervals of each of the children's neurobehavioral outcomes were 8.2% (7.5-8.8) with learning disabilities, 5.9% (5.5-6.4) with attention-deficit/hyperactivity disorder, and 3.6% (3.1-4.0) with behavioral and conduct disorders. Children exposed to SHS at home had a 50% increased odds of having >= 2 childhood neurobehavioral disorders compared with children who were not exposed to SHS. Boys had a significantly higher risk. Older children, especially those aged 9 to 11 years, and those living in households with the highest poverty levels were at greater risk. In absolute terms, 274 100 excess cases in total of these 3 disorders could have been prevented if children had not been exposed to SHS in their homes. CONCLUSIONS: The findings of the study, which are associational and not necessarily causal, underscore the health burden of childhood neurobehavioral disorders that may be attributable to SHS exposure in homes in the United States.

Loeber R; Stepp SD; Chung T; Hipwell AE; White HR. Time-varying associations between conduct problems and alcohol use in adolescent girls: The moderating role of race. Journal of Studies on Alcohol and Drugs 71(4): 544-553, 2010. (39 refs.)

Objective: The aims of this study were to examine the time-varying developmental associations between conduct problems and early alcohol use in girls between ages 11 and 15 and to test the moderating role of race. Method: The study is based on annual, longitudinal data from oldest cohort in the Pittsburgh Girls Study (n = 566; 56% African American, 44% White). Two models of the association between conduct problems and alcohol use were tested using latent growth curve analyses: conduct-problem-effect (conduct problems predict time-specific variation in alcohol use trajectory) and alcohol-effect (alcohol use predicts time-specific variation in conduct problem trajectory) models. Results: Girls' conduct problems and alcohol use increased over ages 11-15. Results provided support for a conduct-problem-effect model, although the timing of the associations between conduct problems and alcohol use differed by ethnicity. Among White girls, conduct problems prospectively predicted alcohol use at ages 11-13 but not later, whereas among African American girls, prospective prediction was observed at ages 13-14 but not earlier. Conclusions: Study findings indicate developmental differences in the time-varying association of conduct problems and alcohol use during early adolescence for African American and White girls. Ethnic differences in the development of alcohol use warrant further study, and have potential implications for culture-specific early screening and preventive interventions.

Malcolm CP; Picchioni MM; DiForti M; Sugranyes G; Cooke E; Joseph C et al. Pre-morbid Conduct Disorder symptoms are associated with cannabis use among individuals with a first episode of psychosis. Schizophrenia Research 126(1-3): 81-86, 2011. (39 refs.)

Background: Early cannabis use has consistently been associated with an increased risk for the later development of psychosis. Studies suggest that Conduct Disorder (CD) is more common amongst young people who later go on to develop psychosis. CD has been associated with greater and earlier cannabis use in general population samples. Based on this evidence, we hypothesised that among patients experiencing their first episode of psychosis, the presence of CD symptoms prior to age 15 would be associated with cannabis use. Method: 102 patients experiencing a first episode of psychosis were interviewed to assess CD symptoms prior to age 15 and use of cannabis and other substances. Results: The number of CD symptoms was significantly associated with lifetime cannabis use (odds ratio = 5.41 (1.76-16.57), p = 0.03) and with first use of cannabis before age 14 (odds ratio = 1.46 (1.12-1.92), p = 0.006), after controlling for stimulant/hallucinogen use and level of education. Conclusions: Among patients experiencing a first episode of psychosis, CD symptoms were significantly associated with use of cannabis and with use by age 14. Among individuals vulnerable for psychosis, CD symptoms may independently increase the likelihood of cannabis use which in turn increases the risk of psychosis.

McCarty CA; Wymbs BT; King KM; Mason WA; Vander Stoep A; McCauley E et al. Developmental consistency in associations between depressive symptoms and alcohol use in early adolescence. Journal of Studies on Alcohol and Drugs 73(3): 444-453, 2012. (62 refs.)

Objective: Despite frequent theorizing, prior literature on the association between depressive symptoms and alcohol use in adolescence has been inconsistent. Yet studies have varied widely with respect to age at assessments, time frame of prediction, and controls for comorbid conditions and demographic factors. The current study examined whether the associations between depressive symptoms and alcohol use were similar in valence and magnitude over a 4-year period in early adolescence. Method: A sample of 521 young adolescents and their parents were interviewed every year from sixth (M-age = 12.0 years) through ninth grades. At each interview, symptom counts on depressive and conduct disorders were generated from the Diagnostic Interview Schedule for Children. Adolescents also reported on their alcohol use, which was converted to a binary variable. Autoregressive, cross-lagged panel models specifying depressive and conduct disorder symptoms as predictors of alcohol use I year later with equality constraints were tested and compared with models allowing path coefficients to vary over time. Results: For youth self-report, depressive symptoms were positively associated with alcohol use 1 year later over and above conduct problems and earlier alcohol use throughout early adolescence. By parental report, only very early adolescent depressive symptoms (sixth to seventh grades) were associated with alcohol use. Gender did not moderate findings for analyses with self- or parental-report data. Conclusions: These results indicate that, even in the context of conduct disorder symptoms, depressive symptoms are important indicators of risk for use of alcohol across early adolescence.

Pope HG; Kanayama G; Hudson JI. Risk factors for illicit anabolic-androgenic steroid use in male weightlifters: A cross-sectional cohort study. Biological Psychiatry 71(3): 254-261, 2012. (57 refs.)

Background: Illicit anabolic-androgenic steroid (AAS) abuse, though an important public health problem, remains inadequately studied. Almost all AAS abusers are male and lift weights, but the risk factors for AAS use among male weightlifters remain poorly understood. Methods: We recruited 233 experienced male weightlifters, of whom 102 (44%) reported lifetime AAS use, and assessed their childhood and adolescent attributes retrospectively, using structured clinical interviews and computerized questionnaires. This cross-sectional cohort approach -- a design that we have formally presented in the recent methodological literature -- utilizes a study cohort, not selected for outcomes of interest, and assesses exposures and outcomes retrospectively. We hypothesized that conduct disorder and body-image concerns would be major risk factors for subsequent AAS use among male weightlifters. Results: Within our study population, many attributes showed little association with AAS use, but conduct disorder and body-image concerns showed strong associations. For individuals with prior conduct disorder versus those without, the hazard ratio (95% confidence interval) for subsequent AAS use was 2.2 (1.5, 3.4). For individuals in the middle versus lowest tertile of scores on a retrospective adolescent muscle-dysmorphia scale, the hazard ratio was 1.5 (. 84, 2.6); for the highest versus lowest tertile, the hazard ratio was 3.3 (2.0, 5.3); and for the linear trend of hazard ratios, p < .001. Conclusions: Conduct disorder and body-image concerns represent important risk factors for AAS use among male weightlifters. Thus, assessment of these attributes may help to identify individuals most likely to require interventions to discourage this form of substance abuse.

Ridenour TA; Caldwell LL; Coatsworth JD; Gold MA. Directionality between tolerance of deviance and deviant behavior is age-moderated in chronically stressed youth. Journal of Child & Adolescent Substance Abuse 20(2): 184-204, 2011. (73 refs.)

Problem behavior theory posits that tolerance of deviance is an antecedent to antisocial behavior and substance use. In contrast, cognitive dissonance theory implies that acceptability of a behavior may increase after experiencing the behavior. Using structural equation modeling, this investigation tested whether changes in tolerance of deviance precede changes in conduct disorder criteria or substance use or vice versa, or if they change concomitantly. Two-year longitudinal data from 246 8- to 16-year-olds suggested that tolerance of deviance increases after conduct disorder criteria or substance use in 8-to-10- and 11-to-12-year-olds. These results were consistent with cognitive dissonance theory. In 13-to-16-year-olds, no directionality was suggested, consistent with neither theory. These results were replicated in boys and girls and for different types of conduct disorder criteria aggression (covert behavior), deceitfulness and vandalism (overt behavior), and serious rule-breaking (authority conflict). The age-specific directionality between tolerance of deviance and conduct disorder criteria or substance use is consistent with unique etiologies between early onset versus adolescent-onset subtypes of behavior problems.

Sakai JT; Stallings MC; Crowley TJ; Gelhorn HL; McQueen MB; Ehringer MA. Test of association between GABRA2 (SNP rs279871) and adolescent conduct/alcohol use disorders utilizing a sample of clinic referred youth with serious substance and conduct problems, controls and available first degree relatives. Drug and Alcohol Dependence 106(2): 199-203, 2010. (22 refs.)

Recent findings have linked the GABRA2 gene with antisocial personality disorder and alcohol dependence (AD) in adults and conduct disorder (CD), but not AD symptoms, in children and adolescents. We sought to replicate previous findings and test for an association between a single nucleotide polymorphism (SNP) in the GABRA2 gene (rs279871) and CD among adolescents. Methods: Adolescent patients (n=371), 13-18 years old, were recruited from a university substance abuse treatment program. Patient siblings (n=245), parents of patients (n=355), adolescent controls (n=185). siblings of controls (n=163) and parents of controls (n=263) were included in these analyses (total sample n = 1582). Case-control (using only Caucasian and Hispanic probands) and family-based association tests were completed to test for association between rs279871 and several a priori CD and AD phenotypes. Results: For case-control association tests, rs279871 was significantly associated with CD (p=0.02) but not AD phenotypes; the result did not survive strict correction for multiple testing. All family-based association tests were non-significant (CD p=0.48: CD symptom count age corrected within sex p=0.91: AD p=0.84; alcohol use disorder p=0.52). Conclusions: Consistent with previous findings, the results do not support the association between GABRA2 SNP rs279871 and AD in adolescents. Our results also do not Support an association between rs279871 and CD; the study limitations are reviewed.

Skeer MR; McCormick MC; Normand SLT; Mimiaga MJ; Buka SL; Gilman SE. Gender differences in the association between family conflict and adolescent substance use disorders. Journal of Adolescent Health 49(2): 187-192, 2011. (40 refs.)

Purpose: The objectives of this study were (1) to examine whether the association between childhood family conflict and the risk of substance use disorders (SUDs) in adolescence differs by gender, and (2) to determine whether anxious/depressive symptoms and conduct problems explain this association among adolescent males and females. Methods: Data were obtained from 1,421 children aged 10-16 years at the time of enrollment in the Project on Human Development in Chicago Neighborhoods. We assessed gender differences in the association between childhood family conflict and adolescent SUDs by fitting a logistic regression model that included the interaction of gender and family conflict. We also investigated whether conduct problems and anxious/depressive symptoms explained the association between family conflict and SUDs differently for males and females through gender-specific mediation analyses. Results: The association between childhood family conflict and SUDs in adolescence differed by gender (p = .04). Family conflict was significantly associated with SUDs among females (OR: 1.61; CI: 1.20-2.15), but not among males (OR: 1.00; CI:.76-1.32). The elevated risk of SUDs among females exposed to family conflict was partly explained by girls' conduct problems, but not by anxious/depressive symptoms. Conclusions: Females living in families with elevated levels of conflict were more likely to engage in acting out behaviors, which was associated with the development of SUDs. Future epidemiologic research is needed to help determine when this exposure is most problematic with respect to subsequent mental health outcomes and the most crucial time to intervene.

Vrieze SI; Perlman G; Krueger RF; Iacono WG. Is the continuity of externalizing psychopathology the same in adolescents and middle-aged adults? A test of the externalizing spectrum's developmental coherence. Journal of Abnormal Child Psychology 40(3): 459-470, 2012. (63 refs.)

Externalizing psychopathology (EXT) is a framework for understanding diagnostic co-morbidity and etiology of antisocial and substance-use behaviors. EXT indicates continuity in adulthood but the structure of adolescent EXT is less clear. This report examines whether adolescent EXT is trait-like, as has been found with adults, or categorical. We use tests of measurement invariance to determine how diagnostic indicators of EXT differ in adolescents compared to adults. The EXT measures employed were DSM-IIIR diagnoses of adult antisocial behavior, conduct disorder, and alcohol, marijuana, and drug dependence. Latent trait, latent class, and hybrid models were fit to two separate data sets: 2,769 seventeen-year-old adolescents and 2,619 adults from the Minnesota Twin Family Study. The best model in both samples was a single-trait LT model. Parameters from the adolescent and adult models were equivalent for all disorders except alcohol dependence. It appears that EXT in adolescence can be accurately represented by a single-trait model, and the measurement properties of EXT are similar during these time periods with the exception of alcohol dependence.

Welte JW; Barnes GM; Tidwell MCO; Hoffman JH. Association between problem gambling and conduct disorder in a national survey of adolescents and young adults in the United States. Journal of Adolescent Health 45(4): 396-401, 2009. (29 refs.)

Purpose: The purpose of this analysis is to examine the relationship between current problem gambling and current conduct disorder. Methods: Data were analyzed for a U.S. national survey of respondents aged 14-21 years. Results: A strong co-morbidity between current problem gambling and current conduct disorder was found. However, this co-morbidity was much stronger among younger respondents, declined in strength with increasing age, and was absent among the oldest respondents. Further analyses showed that early-onset problem gamblers had a higher risk for conduct disorder than late-onset problem gamblers. Conclusions: Gambling problems that emerge early are likely to be part of a general pattern of problem behavior, whereas gambling problems that emerge later may have an etiology unique to gambling.

Wu J; Witkiewitz K; McMahon RJ; Dodge KA. A parallel process growth mixture model of conduct problems and substance use with risky sexual behavior. Drug and Alcohol Dependence 111(3): 207-214, 2010. (53 refs.)

Conduct problems substance use and risky sexual behavior have been shown to coexist among adolescents which may lead to significant health problems The current study was designed to examine relations among these problem behaviors in a community sample of children at high risk for conduct disorder. A latent growth model of childhood conduct problems showed a decreasing trend from grades K to 5. During adolescence four concurrent conduct problem and substance use trajectory classes were identified (high conduct problems and high substance use increasing conduct problems and increasing substance use minimal conduct problems and increasing substance use and minimal conduct problems and minimal substance use) using a parallel process growth mixture model. Across all substances (tobacco binge drinking and marijuana use) higher levels of childhood conduct problems during kindergarten predicted a greater probability of classification into more problematic adolescent trajectory classes relative to less problematic classes. For tobacco and binge drinking models Increases in childhood conduct problems over time also predicted a greater probability of classification into more problematic classes. For all models individuals classified into more problematic classes showed higher proportions of early sexual intercourse infrequent condom use receiving money for sexual services and ever contracting an STD. Specifically tobacco use and binge drinking during early adolescence predicted higher levels of sexual risk taking into late adolescence. Results highlight the importance of studying the conjoint relations among conduct problems substance use and risky sexual behavior in a unified model.