Substance-dependent, conduct-disordered adolescent males: severity of diagnosis predicts 2-year outcome1
Introduction
Does diagnostic severity predict prognosis in substance-involved, delinquent adolescents? Adolescent substance use disorder (SUD) often is comorbid with and worsened by CD, mood disorder and attention-deficit/hyperactivity disorder (ADHD) (Bukstein et al., 1989, Crowley and Riggs, 1995, Grilo et al., 1995, Riggs et al., 1995, Young et al., 1995, Thompson et al., 1996). CD or SUD in adolescence may impair performance later in life (Kessler et al., 1995), but the impact of the severity of comorbid CD, SUD, ADHD and mood disorders is poorly understood.
Many children with CD later develop persisting antisocial personality disorder (ASPD) (Robins, 1978). Earlier CD onset (Moffitt, 1990), more CD symptoms (Feehan et al., 1993), or associated ADHD (Moffitt, 1990) may predict such persistence. Childhood CD also predicts substance problems in adolescence and adulthood (Robins and McEvoy, 1990, Lynskey and Fergusson, 1995). Among adults, antisocial behavior and fully developed ASPD are highly associated with substance problems (Kandel and Raveis, 1989, Regier et al., 1990).
Despite those associations, in adolescents CD and SUD may follow different temporal courses. The prevalence of CD and delinquent behavior peaks in mid-adolescence, declining in later adolescence (Elliott and Huizinga, 1984, Feehan et al., 1993). Meanwhile, drug-use prevalence rises throughout that time (Elliott and Huizinga, 1984).
Controlled evidence for treatment efficacy in either CD or SUD among adolescents is very limited (Offord and Bennett, 1994). Among both hospitalized and community-treated adolescents, the prevalence of CD, SUD, ADHD and mood disorders did decline significantly from intake to follow-up 18–24 months later (Moretti et al., 1994, Mattanah et al., 1995), although SUD persisted more often than the other diagnoses (Mattanah et al., 1995). Those investigators did not report whether diagnostic severity predicted persistence.
The relationship between diagnosis and prognosis remains uncertain in CD and SUD. Diagnoses either were not reported, or were not examined as predictors, in numerous studies of adolescent substance outcome (Myers and Brown, 1994, Greiner, 1985, Friedman and Glickman, 1987, Brown et al., 1989, Alford et al., 1991, Myers et al., 1993, Blood and Cornwall, 1994, Brown et al., 1994). Two large studies, the Drug Abuse Reporting Program (DARP; Sells and Simpson, 1979) and the Treatment Outcome Prospective Study (TOPS; Hubbard et al., 1985) made no formal diagnoses. Despite somewhat inconsistent results (Catalano et al., 1990–1991), they generally found weak to modest improvements in marijuana and alcohol use. In those studies better prognoses were predicted by later drug-use onset, less criminality, fewer arrests and fewer psychiatric complaints.
Our treatment-demonstration project assessed adolescents with severe CD and SUD at treatment admission and 2 years later. The evaluations had the rigor of clinical research, although demonstration projects lack control groups. This paper reports on males’ 2-year outcomes for SUD, CD, ADHD and mood disorders, and it examines whether intake diagnostic characteristics predict persistence of antisocial problems and SUD. Follow-ups of female patients will be reported separately.
Section snippets
Source
Subjects were males aged 13–19 years at Synergy, a treatment program for delinquent, substance-involved youths. Synergy patients were described earlier (Riggs et al., 1995, Young et al., 1995, Thompson et al., 1996); this sample overlaps those samples. Juvenile justice or social service agencies referred most patients. Treatment admissions had: (a) serious antisocial problems (usually including arrest) and substance problems (usually including substance-related treatment, arrests, or
Intake status: followed and non-followed subjects
The followed and non-followed groups did not differ significantly in demographics, although racial/ethnic distributions approached significance (Table 1). Mean social class scores corresponded to class IV (V is lowest).
Alcohol and cannabis dependence each occurred in over 80% of followed and non-followed groups, nicotine dependence in over half, with the boys being dependent on a mean of nearly 3.5 different drugs. A greater prevalence of opioid-dependence in the non-followed group is the only
Discussion
We studied the course of delinquent, substance-dependent boys during 2 years following admission to a residential treatment program. This report is unique for examining presence and severity of intake psychiatric diagnoses as predictors of later antisocial behavior and substance use, and for validating self-reports of substance use with urine and breath tests. Five important observations emerge:
Acknowledgements
The work was supported by grants DA06941 and DA09842 from the National Institute on Drug Abuse. The following persons assisted: L. Coffman, A. Crowl, K. Ehlers, S. Hall, D. Hernandez, B. Johnson, C. Martin, J. Silverthorne, J. Stout and E. Williams.
References (66)
- et al.
The characterization of depressive disorders in serious juvenile offenders
J. Affect. Disord.
(1984) - et al.
A controlled study of inpatient vs. outpatient treatment of delinquent drug abusing adolescents: 1 year results
Compr. Psychiatry
(1982) - et al.
Longitudially predicting late adolescent and young adult drug use: childood and adolescent precursors
J. Am. Acad. Child Adolesc. Psychiatry
(1995) - et al.
Correlates of success following treatment for adolescent substance abuse
Appl. Prev. Psychol.
(1994) - et al.
Characteristics of relapse following adolescent substance abuse treatment
Addict. Behav.
(1989) - et al.
The DSM-IV field trial for substance use disorders: major results
Drug Alcohol Depend.
(1995) - et al.
Carbon monoxide assessment of smoking in chronic obstructive pulmonary disease
Addict. Behav.
(1989) - et al.
Mental health disorders from age 15 to age 18 years
J. Am. Acad. Child Adolesc. Psychiatry
(1993) - et al.
Sensitivity of the diagnostic interview schedule for children, 2nd edition (DISC 2.1) for specific diagnoses of children and adolescents
J. Am. Acad. Child Adolesc. Psychiatry
(1993) - et al.
Psychiatric comorbidity in adolescent inpatients with substance use disorders
J. Am. Acad. Child Adolesc. Psychiatry
(1995)
The development of the comprehensive addiction severity index for adolescents (CASI-A): An interview for assessing multiple problems of adolescents
J. Subst. Abuse Treat.
Coping as a predictor of adolescent substance abuse treatment outcome
J. Subst. Abuse
Conduct disorder: long-term outcomes and intervention effectiveness
J. Am. Acad. Child Adolesc. Psychiatry
The diagnostic interview schedule for children—revised version (DISC-R): III. Concurrent criterion validity
J. Am. Acad. Child Adolesc. Psychiatry
Depression in substance dependent delinquents
J. Am. Acad. Child Adolesc. Psychiatry
The diagnostic interview schedule for children—revised version (DISC-R): II. Test–retest reliability
J. Am. Acad. Child Adolesc. Psychiatry
The diagnostic interview schedule for children—revised version (DISC-R): I. Preparation, field testing, interrater reliability, and acceptability
J. Am. Acad. Child Adolesc. Psychiatry
Treated delinquent boys' substance use: onset, pattern, relationship to conduct and mood disorders
Drug Alcohol Depend.
Alcoholics Anonymous–Narcotics Anonymous model inpatient treatment of chemically dependent adolescents: A 2-year outcome study
J. Stud. Alcohol
Pretreatment variables that predict completion of an adolescent substance abuse treatment program
J. Nerv. Ment. Dis.
Violence by young people: Why the deadly nexus?
Nat. Inst. Justice J.
Effects of community-based group–home treatment program on male juvenile offenders' use and abuse of drugs and alcohol
Am. J. Drug Alcohol Abuse
Comorbidity of substance abuse and other psychiatric disorders in adolescents
Am. J. Psychiatry
The Carroll rating scale for depression. I. Development, reliability and validation
Br. J. Psychiatry
Evaluation of the effectiveness of adolescent drug abuse treatment, assessment of risks for relapse, and promising approaches for relapse prevention
Int. J. Addict.
Inheritance of alcohol abuse: cross-fostering analysis adopted men
Arch. Gen. Psychiatry
The reliability of the SAM
Br. J. Addict.
Adolescent substance use disorder with conduct disorder, and comorbid conditions
NIDA Res. Monogr.
Identifying career offenders using self-reported data
J. Res. Crime Delinq.
Effects of psychiatric symptomatology on treatment outcome for adolescent male drug abusers
J. Nerv. Ment. Dis.
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Presented in part to the Research Society on Alcoholism, Steamboat Springs, CO, 19 June 1995.