Externalizing Disorders in Adolescence Mediate the Effects of Maternal Depression on Substance Use Disorders

Maternal depression has been linked to increased risk of substance use disorders (SUDs) in offspring. Cross-sectional studies have identified relationships among maternal depression, externalizing disorders and SUDs, but no longitudinal examination of causality has been undertaken. In order to address this gap in the literature, depression and externalizing disorders at or prior to age 15 were tested as mediators of the relationship between maternal depression and SUDs diagnosed between ages 16 and 20 in a sample of 702 Australian youth (363 women) using path models. Mothers’ and fathers’ substance diagnoses and earlier onset of substance abuse in youth were controlled for in all analyses. Consistent with previous work, maternal depression predicted SUDs between ages 16 and 20. An indirect effect of maternal depression through youth externalizing disorders diagnosed by age 16 was detected for alcohol and cannabis use disorders, but not drug disorders. Early adolescent depression was not a mediator of the relationship between maternal depression and any of the substance outcomes measured. To our knowledge, this study is the first to examine depression and externalizing disorders in early adolescence as mediators of the effect of maternal depression on psychopathology in later adolescence. Further work is needed to understand how family environment and genetic factors may explain the mediation by externalizing disorders.     

A longitudinal study of antisocial behaviors in early adolescence as predictors of late adolescent substance use: gender and ethnic group differences

Data from the National Longitudinal Youth Survey (NLSY) were analyzed to study interrelationships between antisocial behaviors in early adolescence (ages 14-15) and late adolescent alcohol and drug use 4 years later (when adolescents were 18-19). Correlations between classes of antisocial behaviors in early adolescence and substance use in late adolescence were of higher magnitude and more uniform for men than for women; for women, property offenses (e.g., vandalism) in early adolescence were more highly associated with alcohol use, alcohol-related problems, and illicit drug use in late adolescence than with either status offenses or transgressions against persons. Multiple regression analyses indicated that early-adolescent substance involvement was a significant predictor of late-adolescent alcohol and drug use. Additional significant predictors included early adolescent general delinquency, male gender, and non-Black ethnicity.     

Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD

Children diagnosed with attention-deficit/hyperactivity disorder (ADHD; n = 142) were prospectively monitored into adolescence (13-18 years old) to evaluate their risk for elevated substance use relative to same-aged adolescents without ADHD (n = 100). Probands reported higher levels of alcohol, tobacco, and illicit drug use than did controls. Group differences were apparent for alcohol symptom scores but not for alcohol or marijuana disorder diagnoses. Within probands, severity of childhood inattention symptoms predicted multiple substance use outcomes: childhood oppositional defiant disorder/conduct disorder (ODD/CD) symptoms predicted illicit drug use and CD symptoms. Persistence of ADHD and adolescent CD were each associated with elevated substance use behaviors relative to controls. Further study of the mediating mechanisms that explain risk for early substance use and abuse in children with ADHD is warranted.     

Reasons for substance use among people with psychotic disorders: method triangulation approach

Substance use disorders (SUD) are common among people with psychotic disorders and are associated with many negative consequences. Understanding the reasons for substance use in this population may allow for the development of more effective prevention and intervention strategies. We examined reasons for tobacco, alcohol, or cannabis use among people with psychotic disorders. Sixty-four participants with a diagnosed psychotic disorder completed a self-report reasons for use questionnaire. A subset of eight participants completed semi-structured qualitative interviews. Both the qualitative and quantitative data indicated that reasons for use of tobacco, alcohol, and cannabis differed considerably. Tobacco was primarily used for coping motives, alcohol for social motives, and cannabis for pleasure enhancement motives. Prevention and intervention strategies targeting coexisting psychotic disorders and SUD may improve in effectiveness if they address the perceived beneficial effects of tobacco use, the strong social pressures influencing alcohol use and if they encourage cannabis users to seek alternative pleasurable activities.     

Developmental trajectories of co-occurring depressive, eating, antisocial, and substance abuse problems in female adolescents

Growth trajectories of co-occurring symptomatology were examined in a community sample of 493 female adolescents who were followed annually from early to late adolescence. On average, depression, eating disorder, and substance abuse symptoms increased over time, whereas antisocial behavior decreased. Increases in each symptom domain were associated with relative increases in all other domains. Initial depressive and antisocial behavior symptoms predicted future increases in the other; substance abuse and antisocial behavior symptoms also showed prospective reciprocal relations. Initial depression predicted increases in eating disorder and substance abuse symptoms. Initial eating disorder symptoms predicted increases in substance abuse problems. Finally, the results suggest that the developmental covariation between depressive and eating disorder symptoms and between antisocial behavior and substance abuse symptoms was accounted for by distinct but related 2nd-order growth parameters.     

Parental Psychopathology and Paternal Child Neglect in Late Childhood

We aimed at determining the association of both severity of paternal and maternal substance use disorder (SUD) and psychiatric disorders with paternal child neglect severity during late childhood. The sample comprised 146 intact SUD (n=71) and non SUD (n=75) families with a 10–12 year old female or male biological offspring. The average age of fathers, mothers, and children was 44 (SD=5.9), 42 (SD=4.78), and 11 (SD=.79) years, respectively. The ethnic composition was 85% Caucasian and 15% African American. The results showed that paternal and maternal SUD and psychiatric disorders severity was correlated with paternal child neglect severity. However, paternal psychopathology failed to achieve significance in the regression analyses. Severity of maternal, especially severity of antisocial personality disorder symptoms was associated with paternal child neglect. These results are discussed within the framework of evolutionary psychology research examining paternal investment in the offspring. Implications for the necessity of identifying parental psychopathology and an integrated treatment approach are discussed.     

Adolescent socialization and use of licit and illicit substances: Impact on adult health

Abstract

This study examined the impact of adolescent substance use on young adult health. Longitudinal data from 825 participants were assessed when the participants were junior high school and high school students (1969-1973) and again in 1981. Latent variable models were used to determine what effect adolescent drug use had on later health. General substance use, which included tobacco, alcohol, stimulants, sedatives, and other hard drugs, had a small effect on adult health problems associated with substance use, and also predicted accidents related to substance use. In addition, the specific use of tobacco and cannabis in adolescence predicted later respiratory problems, while cigarette smoking during adolescence also predicted decreased physical hardiness. Lower adolescent socialization predicted post high school accidents (automobile and other) serious enough to require medical attention, and predicted increased psychosomatic and seizure symptoms, as well as general psychiatric distress. Implications of these results for the successful prevention or intervention of drug use are discussed. In addition to these results, gender differences are also examined.     

Predicting Transitions in Low and High Levels of Risk Behavior from Early to Middle Adolescence: The TRAILS Study

The present study examined the joint development of substance use and externalizing problems in early and middle adolescence. First, it was tested whether the relevant groups found in previous studies i.e., those with an early onset, a late onset, and no onset or low levels of risk behavior could be identified, while using a developmental model of a single, underlying construct of risk behavior. Second, departing from Moffitt's taxonomy of antisocial behavior, it was tested if early, but not late, onset risk behavior is predicted by a problematic risk profile in childhood. Data were used from TRAILS, a population based cohort study, starting at age 11 with two follow-ups at mean ages of 13.6 and 16.3 years. Latent transition analyses demonstrated that, both in early and middle adolescence, a single underlying construct of risk behavior, consisting of two classes (labeled as low and high risk behavior), adequately represented the data. Respondents could be clearly classified into four possible transition patterns from early to middle adolescence, with a transition from high to low being almost non-existent (2.5 %), low to low (39.4 %) and low to high (41.8 %) being the most prevalent, and high to high (16.2 %) substantial. As hypothesized, only the high-high group was characterized by a clear adverse predictor profile in late childhood, while the low-high group was not. This study demonstrates that the development of substance use is correlated with externalizing problems and underscores the theory that etiologies of early and later onset risk behavior are different.     

Beyond social deviance: substance use disorders and the dimensions of psychopathy

High rates of comorbidity between psychopathy and substance use disorders (SUD) have long been recognized. However, the extent to which relationships between SUD and psychopathy extends beyond shared relationship with general antisociality remains undetermined. We examined zero-order and unique relationships between the elements of psychopathy and four categories of SUD; alcohol, cannabis, cocaine, and opioid dependence. The sample consisted of 399 European American and African American male county jail inmates. The relationship between psychopathy and SUD extended beyond general antisociality to core features of the psychopathic personality. Relationships were relatively stable across ethnicity but were more generalized across SUD categories for European American inmates. The relationship between SUD and impulsive and irresponsible behavior was most consistent across categories of SUD; relationships with other elements of psychopathy varied according to category of SUD.     

Borderline personality features predict alcohol use problems

This study assessed the relation between BPD features and problems associated with alcohol use 2 years later in young adults. Approximately 5,000 nonclinical young adults were screened for BPD features, and two cohorts of participants completed the laboratory phase of the study at Time 1 (total N = 421) and then again 2 years later at Time 2 (total N = 356). Measures included self-report and interview-based assessments of personality disorders, psychopathology in biological parents, Axis I psychopathology, and alcohol use problems. BPD features were found to significantly predict alcohol use problems 2 years later after controlling for parents' substance use disorders, Axis I psycho-pathology (including alcohol abuse/dependence), and non-BPD personality disorders. In addition, the BPD subscale that assesses impulsivity was found to be significantly associated with alcohol use problems once all predictors were entered into the model.     

The Network Constellation of Personality and Substance Use: Evolution from Early to Late Adolescence

There is a well-established link between substance use and four personality traits of anxiety–sensitivity, hopelessness, impulsivity, and sensation-seeking. However, construct-level models of personality may conceal indicator-level personality–outcome associations. The current study aims to investigate evolution of the network constellation of personality and cannabis/alcohol use from early to late adolescence. Data comes from the longitudinal Co-Venture cohort (N = 3800). Personality indicators, measured by Substance Use Risk Profile Scale (SURPS) items, and the frequency of cannabis/alcohol use were assessed at four consecutive years (13–17 years old). Network constellations of the SURPS items and cannabis/alcohol use were estimated using Bayesian Gaussian graphical models at four time points. Results highlighted the age-specific associations between personality indicators and substance use. The positive role of the sensation-seeking trait (e.g. attitude towards transgression) was constant, whereas the positive role of hopelessness indicators (e.g. not being enthusiastic about future) and the negative role of anxiety–sensitivity indicators (e.g. fear of having unusual body sensations) were more prominent at early adolescence. The current study provides a novel perspective on the network structure of personality and substance use in adolescence and suggests substance-specific and age-adjusted targets in intervention efforts. © 2020 European Association of Personality Psychology     

Stationäre Kinder- und Jugendpsychiatrie sowie Psychotherapie bei substanzabhängigen Jungen und Mädchen

This study examines post-treatment outcomes (6 and 12 months post-release) of a multimodal child and adolescent psychiatric and psychotherapeutic inpatient treatment program for boys and girls diagnosed with substance use disorders (n=71) in 2 centres. Up to now there has been a lack of outcome research in this field in Germany. Outcome measures included drug use patterns and psychopathology. The greatest reductions in prevalence at 1 year follow-up occurred for cannabis, methamphetamine, cocaine and heroin use. Additionally the patients and their parents also reported significant improvements in adolescent’s psychopathology at the 1 year follow-up. The results underline the importance of disorder-specific, multimodal inpatient programs for the treatment of children and adolescents with substance use disorders.     

Personality disorders associated with substance use among American and Greek adolescents

A study was conducted to investigate the association between personality disorder (PD) symptomatology and substance use among adolescents in community settings in the United States and Greece. The Structured Clinical Interview for DSM-IV Personality Disorders and the Adolescent Health Behavior Survey were completed by 37 male and 84 female adolescents, ages 15 to 18, who were recruited from an adolescent medical clinic and schools in and near New York City (n = 71) and Heraklion, Greece (n = 50). Results indicated that: (1) adolescents with PDs reported more frequent alcohol consumption during the past year than did those without PDs; (2) adolescents with borderline PD reported more cigarette smoking and heavy alcohol consumption than did those without borderline PD; (3) adolescents with antisocial PD symptomatology reported greater alcohol, cigarette, and illicit drug use than did those without antisocial PD symptomatology; and (4) although more American (30%) than Greek (4%) adolescents reported illicit substance use, differences were not observed in the prevalence of alcohol use, cigarette use, or personality disorders as a function of nationality.     

Callous-Unemotional Traits as Unique Prospective Risk Factors for Substance Use in Early Adolescent Boys and Girls

Youth with elevated conduct disorder (CD) symptoms who also have callous-unemotional (CU) traits exhibit more antisocial behavior than youth without CU traits. However, evidence regarding whether CU traits increase risk of substance use over and above CD symptoms, and whether these associations differ for boys and girls, is scarce. Using the Developmental Pathways Project sample of 521 middle school students, we examined whether adolescent- and parent-reported CU traits measured in 6th grade prospectively predicted the onset and recurrence of substance use and use-related impairment by 9th grade. We also examined the degree to which CU traits uniquely predicted substance use and impairment over and above CD symptoms, as well as whether gender moderated these associations. Results indicated that adolescent-reported CU traits increased the likelihood of substance use and impairment onset and recurrence by 9th grade. Analyses revealed that CD symptoms accounted for prospective associations between adolescent-reported CU and substance use, but gender moderated these associations. Boys with elevated CU traits and CD symptoms were not more likely to report alcohol use onset or recurrence, but they were at highest risk of recurrent marijuana use, use of both alcohol and marijuana, and use-related impairment by 9th grade. Girls with low CU traits and high CD symptoms were most likely to report onset and recurrent use of alcohol, as well as recurrent marijuana use, use of both substances and impairment. Study findings highlight the importance of accounting for CD symptoms and gender when examining links between CU traits and substance use in early adolescence.     

Associations Between Lower Order Facets of Personality and Dimensions of Mental Disorder

Although there is a plethora of research documenting the relations between broad personality traits and psychopathology, there is decidedly less on the relations between lower order facets and psychopathology. In the current study, we explored the associations between lower order personality traits and dimensions of mental disorder. A combined sample of undergraduates and outpatients completed self-reports of personality and mental disorder. Symptom counts of mental disorders were factor analyzed, and a higher order three-factor solution emerged. One factor was substance use disorder (SUD), and internalizing branched into distress and fear. These dimensions were regressed on facets from the Big Five model of personality. SUD was significantly predicted by high excitement-seeking from the extraversion domain and low self-discipline from conscientiousness. Distress and fear were indistinguishable from one another but showed a different pattern of relations from SUD. High anxiety and depression from neuroticism, low gregariousness from extraversion, high aesthetics and low actions from openness, low trust and high tender-mindedness from agreeableness, and low self-discipline from conscientiousness significantly predicted distress and fear. The findings demonstrate that lower order traits within a single domain have complex relations with psychopathology, which are shrouded when examining broad, higher order traits. Assessment and treatment implications are discussed.     

Disinhibitory trait profile and its relation to Cluster B personality disorder features and substance use problems

Certain personality and motivational traits may present vulnerability towards disinhibitory psychopathology (e.g. antisocial personality disorder, substance abuse). Cluster analysis was used to separately group 306 women and 274 men on impulsivity, Constraint, Negative Emotionality, behavioural activation system (BAS), and behavioural inhibition system (BIS) scores. As expected, a ‘disinhibited’ group with low Constraint, high impulsivity, weak BIS, and strong BAS emerged that showed elevated drug use problems, and histrionic and antisocial personality disorder features across gender. A ‘high affectivity’ group with high Negative Emotionality and strong BIS also showed elevated drug use problems and personality disorder features. Results suggested that two different trait profiles are associated with disinhibitory psychopathology and both may present vulnerability toward the development of such disorders. Copyright © 2006 John Wiley & Sons, Ltd.     

Psychiatric Disorders Associated with Substance Use Among Children and Adolescents: Findings from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study

The relationships between specific quantities and frequencies of alcohol, cigarette, and illicit substance use and substance use (SUD) and other psychiatric disorders were investigated among 1,285 randomly selected children and adolescents, aged 9 to 18, and their parents, from the Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study. Logistic regressions indicated that daily cigarette smoking, weekly alcohol consumption, and any illicit substance use in the past year were each independently associated with an elevated likelihood of diagnosis with SUD and other psychiatric disorders (anxiety, mood, or disruptive behavior disorders), controlling for sociodemographic characteristics (age, gender, ethnicity, family income). The associations between the use of specific substances and specific psychiatric disorders varied as a function of gender.     

Is the Continuity of Externalizing Psychopathology the Same in Adolescents and Middle–Aged Adults? A Test of the Externalizing Spectrum’s Developmental Coherence

Externalizing psychopathology (EXT) is a framework for understanding diagnostic comorbidity 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.     

An invariant dimensional liability model of gender differences in mental disorder prevalence: evidence from a national sample

Epidemiological studies of categorical mental disorders consistently report that gender differences exist in many disorder prevalence rates and that disorders are often comorbid. Can a dimensional multivariate liability model be developed to clarify how gender impacts diverse, comorbid mental disorders? We pursued this possibility in the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; N = 43,093). Gender differences in prevalence were systematic such that women showed higher rates of mood and anxiety disorders, and men showed higher rates of antisocial personality and substance use disorders. We next investigated patterns of disorder comorbidity and found that a dimensional internalizing-externalizing liability model fit the data well, where internalizing is characterized by mood and anxiety disorders, and externalizing is characterized by antisocial personality and substance use disorders. This model was gender invariant, indicating that observed gender differences in prevalence rates originate from women and men's different average standings on latent internalizing and externalizing liability dimensions. As hypothesized, women showed a higher mean level of internalizing, while men showed a higher mean level of externalizing. We discuss implications of these findings for understanding gender differences in psychopathology and for classification and intervention.     

Development of psychiatric comorbidity with substance abuse in adolescents: effects of timing and sex.

Examined the impact of childhood psychiatric disorders on the prevalence and timing of substance use and abuse and tested for sex differences. A representative population sample of 1,420 children, ages 9, 11, and 13 at intake, were interviewed annually. American Indians and youth with behavioral problems were oversampled; data were weighted back to population levels for analysis. By age 16, more than half the sample reported substance use, and 6% had abuse or dependence. Alcohol use began by age 9, and smoking in the 13th year. Mean onset of dependence was 14.8 years, and mean onset of abuse was 15.1 years. Substance use began earlier in boys, but not girls, who later developed abuse or dependence. Disruptive behavior disorders and depression were associated with a higher rate and earlier onset of substance use and abuse in both sexes, but anxiety predicted later onset of smoking. Family drug problems were the strongest correlate of early onset. Despite differences in prevalence of psychopathology, boys and girls showed more similarities than differences in the course of early substance use and abuse, and its associations with psychopathology.