Appendix A: Bibliography
of articles reviewed for meta-analysis
Anderson, J. C., Williams, S., McGee, R., & Silva,
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40, 9-15.
Anthony, J. C., Warner, L. A., & Kessler, R. C. (1994).
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Barkley, R. A. (1990). The adolescent outcome of hyperactive
children diagnosed by research criteria: I. An 8-year prospective follow-up
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Beitchman, J. H., Douglas, L., Wilson, B., Johnson, C.,
Young, A., Atkinson, L., Escobar, M., & Taback, N. (1999). Adolescent
substance use disorders: Findings from a 14-year follow-up of speech/language-impaired
and control children. Journal of Clinical Child Psychology, 28,
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Biederman, J., Faraone, S. V., & Kiely, K. (1996).
Comorbidity in outcome of attention-deficit/hyperactivity disorder.
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Press.
Biederman, J., Wilens, T., Mick, E., Faraone, S., Weber,
W., Curtis, S., Thornell, A., Pfister, K., Jetton, J., & Sorlano,
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Bird, H. R., Gould, M. S., & Staghezza, B. M. (1993).
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Boyle, M. H., Offord, D. R., Racine, Y. A., Szatmari,
P., Fleming, J. E., & Links, P. S. (1992). Predicting substance
use in late adolescence: Results from the Ontario Child Health Study
Follow-up. American Journal of Psychiatry, 149, 761-767.
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Brook, J. S., Cohen, P., & Brook, D. W. (1998). Longitudinal
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of the American Academy of Child and Adolescent Psychiatry, 37,
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Cadoret, R. J., Troughton, E., O'Gorman, T. W., &
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Cadoret, R. J., Yates, W. R., Troughton, E., Woodworth,
G., & Stewart, M. A. (1995). Adoption study demonstrating two genetic
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Chassin, L., Pillow, D. R., Curran, P. J., Molina, B.
S. G., & Barrera, M., Jr. (1993). Relation of parental alcoholism
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use and symptomatology among adolescent children of alcoholics. Journal
of Abnormal Psychology, 100, 449-463.
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Chatlos, J. C. (1997). Substance use and abuse and the
impact on academic difficulties. Child and Adolescent Psychiatric
Clinics of North America, 6, 545-568.
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333-341.
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C., Bromberger, J. T., & Donovan, J. E. (1997). Gender and comorbid
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of disorders. Journal of Child Psychology and Psychiatry, 34,
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Cohen, P., Cohen, J., Kasen, S., Velez, C. N., Hartmark,
C., Johnson, J., Rojas, M., Brook, J., & Streuning, E. L. (1993b).
An epidemiological study of disorders in late childhood and adolescence:
1. Age- and gender-specific prevalence. Journal of Child Psychology
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Costello, E. J., Angold, A., Burns, B. J., Erkanli, A.,
Stangl, D. K., & Tweed, D. L. (1996a). The Great Smoky Mountains
Study of Youth: Functional impairment and severe emotional disturbance.
Archives of General Psychiatry, 53, 1137-1143.
Costello, E. J., Angold, A., Burns, B. J., Stangl, D.
K., Tweed, D. L., Erkanli, A., & Worthman, C. M. (1996b). The Great
Smoky Mountains Study of Youth: Goals, designs, methods, and the prevalence
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Costello, E. J., Erkanli, A., Federman, E., & Angold,
A. (1999a). Development of psychiatric comorbidity with substance abuse
in adolescents: Effects of timing and sex. Journal of Clinical Child
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Costello, E. J., Farmer, E. M. Z., & Angold, A. (1999b).
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Crowley, T. J., & Riggs, P. D. (1995). Adolescent
substance use disorder with conduct disorder and comorbid conditions.
In E. Rahdert & D. Czechowicz (Eds.), NIDA Research Monograph
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Appendix B: Summary
of the studies used in the meta-analysis
Beitchman et al. (1999) studied a one-in-three
random sample of all 5-year-old English-speaking kindergarten children
in Ontario, Canada. They administered a multistage speech and language
screening procedure that resulted in 284 participants at time 1 and
258 participants at time 2 (age 19; 6.4 percent lost to followup, 2.1
percent refused, 0.7 percent died). At age 19, psychiatric status and
Substance abuse/dependence for the 12-month period preceding the interview
date were measured using the University of Michigan modification of
the Composite International Diagnostic Interview (UM-CIDI; American
Psychiatric Association, 1994; Kessler et al., 1994) using DSM-III-R
criteria. Additionally, functional impairment was measured using the
Global Assessment of Functioning (GAF). More than 90 percent of the
sample identified themselves as "Caucasian."
Boyle and Offord (1991) used data from the Ontario
Child Health Study (OCHS), a cross-sectional community study investigating
the epidemiology of childhood psychiatric disorder and adolescent substance
use (SU). The study targeted all children between the ages of 12 and
16 with a household residence in Ontario between January and February
of 1983. The sampling frame was based on the 1981 Canada Census. Data
on CD, ADD, and emotional problems were collected from 1,265 (97 percent)
adolescents and their parents (female head of household) using structured,
self-administered questionnaires, while data on SU (use of tobacco,
alcohol, cannabis, and hard drugs) were collected from adolescents only.
Diagnoses were made according to DSM-III criteria and referred to the
preceding 6-month period.
In a longitudinal study of comorbid psychiatric disorder
and SU, Brook, Cohen, & Brook (1998) followed a random sample
of families with children ages 1-10 in two counties of upstate New York
in 1975. The current study reflects data from 698 (72-percent retention)
children who were followed prospectively into adulthood at timepoints
in 1983, 1986, and 1992. No significant group differences were noted
with regard to retention/attrition rates. Ninety-two percent of the
sample was White. Information from mothers and adolescents on psychiatric
diagnoses and SU (of tobacco, alcohol, cannabis, and illicit drugs)
and substance abuse/dependence was collected using the Diagnostic Interview
for Children Version 1 (DISC-1; Costello, Edelbrock, Kalas, Kessler,
& Klaric, 1982), with computer algorithms based on DSM-III-R criteria.
Additionally, adolescents completed a paper-and-pencil assessment of
SU.
Cross-sectional data from the Project on Adolescent Substance
Use Disorders in Taiwan (PAST) were reported by Chong, Chan, and
Cheng (1999). The PAST is a 3-year longitudinal survey of 774 (99.2
percent participation) 9th-graders (411 males and 363 females)
from rural, urban, and suburban schools that assesses the prevalence
of substance use disorders (SUDs) and psychiatric comorbidity. Substance
abuse/dependence (e.g., alcohol, cigarettes, betel, prescribed and illicit
drugs) was measured using a brief questionnaire, and psychiatric status
was assessed using the Chinese version of the Kiddie Epidemiologic Version
of the Schedule for Affective Disorders and Schizophrenia (K-SADS-E;
Puig-Antich, 1978) using DSM-III-R criteria.
The Great Smoky Mountains Study (GSMS; Costello et
al., 1999) is a longitudinal study of the development of SU, substance
abuse/dependence (tobacco, alcohol, cannabis, and other illicit drugs),
and psychiatric disorder within a sample of 1,420 (80-95 percent retention)
9-, 11-, and 13-year-olds followed since 1993. Adolescents and their
parents recruited from a predominantly rural area in western North Carolina
were interviewed separately using the Child and Adolescent Psychiatric
Assessment (CAPA; Angold & Costello, 1995), with diagnoses based
on DSM-III-R and DSM-IV psychiatric symptoms occurring during the previous
3 months. In terms of ethnic diversity, American Indians were oversampled
and thus represented 25 percent of the entire sample; African Americans
comprised less than 10 percent of the sample, and Hispanics comprised
less than 1 percent of the sample.
Deykin, Levy, and Wells (1987) interviewed 424
(271 females, 153 males; 42 percent participation) college students
aged 16 to 19 in the Boston area as part of a cross-sectional study
designed to identify the manifestations and correlates of adolescent
major depressive disorder (MDD). Data on lifetime prevalence of MDD
and alcohol or drug abuse were collected from participants using the
Diagnostic Interview Schedule (DIS; Robins, Helzer, Croughan, &
Ratcliff, 1981) based on DSM-III criteria. The sample was predominantly
White (94 percent) and upper class (based on Hollingshead classification
of paternal occupation).
Disney, Elkins, McGue, & Iacono (1999) reported
data from the Minnesota Twin Family Study, a longitudinal study of genetic
and environmental factors influencing the development of substance abuse
and associated psychological disorders. All twins born in the State
of Minnesota were identified by public birth records. A sample of 626
reared-together twin pairs (674 girls, 578 boys; 83 percent participation
of eligible families) at age 17 and their mothers were interviewed separately
regarding ADHD, CD, and substance disorder symptoms (use, abuse, or
dependence of tobacco, alcohol, or cannabis) using the Diagnostic Interview
for Children and Adolescents-Revised (DICA-R; Reich & Weiner, 1988),
an additional structured interview, the substance abuse module from
the CIDI, and a computer-administered SU and abuse questionnaire. Diagnoses
were based on DSM-III-R criteria. Ninety-eight percent of respondents
were White.
Fergusson and colleagues (1993a, 1993b) reported
on data from the Christchurch Health and Development Study (CHDS), a
longitudinal study of a birth cohort of 1,265 children born in the Christchurch
urban region during mid-1977. From this sample, 875 (69.2 percent overall,
78.7 percent of all cohort members alive and resident in New Zealand)
children at age 15 were assessed for psychiatric disturbance and SU
(tobacco, alcohol, cannabis, and illicit drugs) using the DISC (based
on DSM-III-R criteria), portions of the DIS, the Self-Report Early Delinquency
(SRED) scale (Moffitt & Silva, 1988), survey questions regarding
substance abuse behaviors, and the Rutgers Alcohol Problems Index (White
& Labouvie, 1989). In addition to these measures, mothers of each
adolescent also completed the Revised Behavior Problems Checklist (RBPC;
Quay & Petersen, 1987).
Another birth cohort from New Zealand was studied by Henry
et al. (1991) as part of the Dunedin Multidisciplinary Health and
Development Study. This longitudinal study of 1,037 children born in
Dunedin between April 1972 and March 1973 and living in the province
of Otago at the onset of the study has been followed every 2 years since
1975. Data collected when the respondents were ages 11 (n=752, 72.5
percent; 355 females, 397 males) and 15 (n=956, 92.2 percent; 464 females,
492 males) assessed depressive symptomatology, conduct problems, and
SU (alcohol, cannabis, glue, and other drugs) using the DISC-Child Version
(DSM-III criteria) and the SRED.
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In a cross-sectional study occurring between April 1990
and June 1991, Feehan, McGee, Raja, and Williams (1994) assessed
the same New Zealander participants at age 18 (n=930, 454 females, 476
males; 91 percent participation of survivors) using the DIS (DSM-III-R
criteria), the Denver Youth Survey Youth Interview Schedule (Huizinga,
1989), and the Health Services Utilization questionnaire (Shapiro, 1984).
Eight hundred thirty of the participants also had data from "significant-other"
informants. Diagnoses were made on the basis of DSM-III-R symptoms in
the last 12 months as well as a disturbance in life functioning (as
indicated by interference in daily functioning, help seeking, or police
contact). Data were also collected on economic disadvantage, social
competence, self-perceived physical health status, self-medication,
and suicidal ideation. In terms of the ethnic origin of the participants,
93 percent identified themselves as "European," 3 percent
as "New Zealand Maori," and 4 percent as "other."
Kandel and colleagues (1997, 1999) reported findings
from the Methods for the Epidemiology of Child and Adolescent Mental
Disorders (MECA) study, a cross-sectional study of 1,285 (604 females,
681 males) children and adolescents ages 9 to 18 investigating the extent
of substance abuse/dependence (of cigarettes, alcohol, and illicit drugs)
and other psychiatric disorders among adolescents in the general population.
Probability samples were drawn from four geographic regions of the United
States in 1992: Connecticut, Georgia, New York, and Puerto Rico. Non-White
samples ranged from 22-37 percent, except in Puerto Rico, where the
sample was 100 percent Hispanic. Adult caretakers were also interviewed
in 77 percent of the households. Psychiatric symptoms during the prior
6 months were assessed using computer-assisted parent and child versions
of the DISC-2.3 (DSM-III-R criteria), and functional impairment was
assessed using the Service Utilization and Risk Factors Interview (SURF;
Goodman et al., 1994) and a lay interview version (Bird, 1996 #10810)
of the Children's Global Assessment Scale (CGAS; Shaffer et al., 1983).
A study examining adolescent SUDs and comorbid psychiatric disorders
used a subsample of 401 adolescents (190 females, 211 males) ages 14
to 17. Puerto Rican adolescents were excluded from this study given
significantly lower rates of SU compared to the adolescents from the
three other samples.
In an investigation of the prevalence, incidence, and
comorbidity for affective, SU (alcohol and other psychoactive substance
use, abuse, and dependence disorders using DSM-III-R and DSM-IV criteria),
and other psychiatric disorders in adolescents ages 14 to 18, Lewinsohn,
Rohde, and colleagues (1991, 1993, 1995, 1996) report findings from
the Oregon Adolescent Depression Project (OADP). The OADP is a large-scale,
community-based epidemiological survey with a prospective, longitudinal
design. The population was drawn from the high schools of two urban
communities and three rural communities in west central Oregon. Each
adolescent was assessed at two timepoints (approximately 1 year apart)
using the K-SADS (combined features of both the Epidemiologic and Present
Episode Versions), the Hamilton Rating Scale for Depression (Hamilton,
1960), the Center for Epidemiologic Studies-Depression Scale (CES-D;
Radloff, 1977), the Beck Depression Inventory (BDI; Beck, Ward, Mendelson,
Mock, & Erbaugh, 1961), and the LIFE (Shapiro & Keller, 1979)
interview, an instrument that yields information about the longitudinal
course of all DSM disorders. Three cohorts were recruited in 1987, 1988,
and 1989, consisting of 352, 864, and 494 students, respectively. The
sample size at time 1 was 1,709 adolescents, and 1,507 adolescents at
time 2 (overall participation rate was 61 percent). At time 1, 91.1
percent of the sample was White. Lewinsohn, Rohde, et al. (1995) additionally
assessed mental health treatment utilization, global adjustment of functioning,
history of suicide attempts, elevated physical symptoms, academic problems,
and conflict with parents. Rohde et al. (1991) included a sample of
2,060 adults selected from three separate longitudinal studies.
Substance Abuse and Mental Health Services Administration
(SAMHSA; 1996) reported estimates on psychosocial problems and SU
from the 1994 National Household Survey on Drug Abuse (NHSDA) from a
nationally representative sample of 21,773 adolescents ages 12 to 17.
This cross-sectional study assessed the extent of emotional and behavioral
problems during the prior 6 months using the Youth Self-Report (YSR;
Achenbach, 1991) and any use of cigarettes, cannabis, illicit drugs,
or "binge" alchohol use in the last 30 days. Blacks and Hispanics
were oversampled and represented 26.5 percent of the sample. SAMHSA
(1999) used data from the 1994-1996 NHSDA among 13,831 adolescents
ages 12 to 17 and assessed 30-day use of cigarettes, alcohol, illicit
drugs, as well as alcohol or illicit drug dependence (DSM-IV criteria).
Data from the older adolescents (ages 16 to 17) were used for the purposes
of this meta-analysis.
Windle and Windle (1993) studied 1,067 (519 males,
548 females; 74 percent participation) from the Middle Adolescent Vulnerability
Study (MAVS), a study of vulnerability factors and adolescent SU that
incorporates a four-wave longitudinal design. This study represented
data from suburban high school juniors and seniors on the cross-sectional,
retrospective portion of the MAVS collected at time 4. Two percent of
the sample was non-White. The Retrospective Childhood Problems (RETROPROB;
Windle, 1993) scale and a delinquency measure were used to measure symptoms
of ADHD, ODD, CD, and avoidant personality disorder (DSM-III-R criteria).
The CES-D was used to measure depressive symptoms. SU was measured with
questions regarding alcohol use, onset of drinking behavior, and other
SU (cigarettes, cannabis, and nonprescribed hard drugs) during the last
30 days and last 6 months. Windle and Davies (1999) examined
relationships between depression and heavy alcohol use focusing on the
second and fourth timepoints (separated by 1 year) of the same data
set with 1,094 adolescents (533 males, 561 females; retention above
90 percent). Surveys on depression (CES-D), alcohol consumption (Quantity-Frequency
Index; Armor & Polich, 1982), childhood problems (RETROPROB), and
other variables were administered to the adolescents in their high school
settings.
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Appendix C: Summary
of the results of the studies used in the analyses
Results from individual studies
Comorbidity of substance use and CD/ODD.
Henry et al. (1993) discovered a strong association between conduct
problems at age 15 and use of multiple substances. They found no evidence
for an association between conduct disorder and later SU after controlling
for depressive symptomatology. Boyle & Offord (1991) demonstrated
that adolescent SU was strongly associated with CD. Additionally, they
found that parent report of CD symptoms produced no significant predictive
value beyond adolescent self-report of CD symptoms. They concluded from
their data that CD precedes rather than follows the onset of SU. Brook
et al. (1998) reported that adolescent SU was associated with higher
rates of CD over extended periods. However, they found no evidence that
CD has an influence on later drug use when earlier drug use is accounted
for. Specifically, SU activity following the onset of SU does not appreciably
affect later drug use, although earlier psychopathology may. Disney
et al. (1999) found evidence for an association between CD and early
onset of substance problems in both males and females, particularly
among those adolescents exhibiting delinquent behaviors after age 15.
Data from Lewinsohn, Rohde, et al. (1995) indicated that males and females
receiving diagnoses of both CD and ODD revealed the highest levels of
delinquent behavior and comorbid SU, with or without the additional
diagnosis of ADHD.
Fergusson, Lynskey, and Horwood (1993) reported that conduct
problems at all ages were significantly related to early cannabis use.
These authors found that CD was related to the development of social
adjustment and conformity problems. Risk factors associated with higher
rates of CD included lower socioeconomic status, higher parental conflict,
less nurturing and more punitive parenting, and instability in the parent
structure of the family. They concluded that their data suggested that
cannabis use often operates as a covert symptom for CD among adolescents.
With respect to substance abuse/dependence criteria, Chong,
Chen, & Chang (1999) reported prevalence rates of 45-91 percent
for CD among adolescents with SUDs, but no CD diagnoses among adolescents
without SUDs. In terms of additional comorbidities, 60 percent of adolescents
with ADHD and SUD also had a diagnosis of CD. Fifty percent of adolescents
with SUD and depression also met criteria for CD. Lewinsohn, Hops, et
al. (1993) reported significant rates of adolescent SUDs with any disorder,
particularly disruptive behavior disorders (DBDs). In fact, they reported
that SUDs were third highest in prevalence after MDD and anxiety disorders.
In their paper on clinical consequences, Lewinsohn, Rohde, et al. (1995)
reported that psychiatric comorbidity had the least impact on SUDs;
that is, adolescents with SUD and a comorbid psychiatric condition were
less likely to receive mental health treatment compared to adolescents
with two or more comorbid psychiatric conditions, neither of which was
SUD. Adolescents with a DBD and SUD were significantly more likely to
experience serious academic problems.
Comorbidity of substance use and ADHD. Disney
et al. (1999) concluded from their data that a diagnosis of ADHD has
little effect on SU outcomes in males or females independent of the
effects of CD. However, they provided evidence for a possible effect
of ADHD on nicotine dependence. SAMHSA (1999) reported that attentional
problems, along with social problems and delinquent behavior, best predicted
SU. In terms of findings on substance abuse/dependence, Windle and Windle
(1993) demonstrated that adolescents were at increased risk for SUDs
when an externalizing disorder such as ADHD occurs with a comorbid internalizing
disorder.
Comorbidity of substance use and depression.
Kandel et al. (1997) reported that use of illicit substances during
the past year was associated with increased risk for mood disorders.
Boyle and Offord (1991) also found that emotional disorders were related
to SU (with the exception of cannabis use). In fact, parent report of
emotional disorder was a more significant predictor for SU than adolescent
self-report of emotional disorder. Their data revealed findings of subjective
turmoil based on the degree of SU and of associations between depression
and cigarette smoking. Similarly, Brook et al. (1998) reported that
adolescent cigarette smoking was associated with later depression. With
regard to timing of comorbidity, Brook et al. found no evidence that
depression has an influence on later SU after the onset of SU. They
further noted that early SU is associated with later psychiatric disorder,
especially depression. While Deykin, Levy, and Wells (1987) showed that
the onset of depression as well as other psychiatric disorders preceded
the development of SUD, Costello et al. (1999) demonstrated that the
onset of psychiatric disorder preceded the onset of SU except with respect
to depression, which tended to occur 1 year after the onset of alcohol
use and 2 years after the onset of cigarette use. Notably, 79 percent
of substance abusers from Deykin et al.'s study developed an additional
psychiatric disorder following the SUD diagnosis. Windle & Davies
reported that the prevalence of comorbid depression and heavy drinking
was similar across gender groups. Between 24 and 27 percent of depressed
adolescents met criteria for a lifetime alcohol or other SUD, and 23
to 27 percent of heavy drinkers also met criteria for depression. Furthermore,
adolescents with depression and comorbid heavy drinking had the highest
levels of childhood externalizing as well as avoidance problems, temperamentally
inflexible, lowest levels of family support, highest levels of stressful
life events, high levels of SU and delinquency, and the lowest GPA.
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With respect to studies measuring substance abuse/dependence,
Rohde et al. (1991) provided evidence for a high degree of comorbidity
among depressed adolescents, with SUD being the most common comorbidity
after eating disorders. They further found that adolescents diagnosed
with depression and a comorbid psychiatric disorder were at greatest
risk for suicide. Rohde et al. (1996) reported that depression was significantly
associated with adolescent SUD, with over 80 percent of adolescents
with alcohol SUD having a comorbid psychiatric disorder, 20 percent
of which were internalizing disorders and 45 percent more were mixed
internalizing and externalizing disorders.
Comorbidity of substance use and anxiety. Interestingly,
virtually all findings of SU and comorbid anxiety involved cigarette
use. Brook et al. (1998) found that adolescent cigarette smoking was
associated with later anxiety. Anxiety problems were found to be associated
with a later onset of cigarette smoking (Costello et al., 1999). According
to Kandel et al. (1997), daily cigarette smoking was associated with
increased risk for anxiety disorders. Chong, Chan, and Cheng (1999)
found that adolescents who were diagnosed with SUD and comorbid anxiety
often demonstrated additional comorbidities, making it difficult to
understand the nature of the individual diagnoses.
Comorbidity of substance use and other disorders.
In their community sample, Beitchman et al. (1999) reported that individuals
in the speech- and language-impaired group diagnosed with SUD demonstrated
higher frequencies of Antisocial Personality Disorder (ASPD) than individuals
in the control group diagnosed with a SUD (80 percent vs. 43.8 percent).
For this sample, there was on average a 4- to 5-year gap between the
onset of SU and the development of SUD. Fergusson et al. (1993) concluded
that their data on cannabis use among New Zealand adolescents provides
evidence of substantial continuities in antisocial behavior from middle
childhood to adolescence. Brook et al. (1998) reported the finding that
adolescent cigarette smoking was associated with later antisocial personality
disorder. Windle and Windle (1993) reported that the avoidant personality
subtype served as a protective factor against certain externalizing
behaviors, which decreased the risk of developing SUD.
Rohde et al. (1996) found that bipolar disorder was the
only psychiatric disorder not significantly associated with adolescent
alcohol use group status. SAMHSA (1999) reported that elevated scores
on the YSR's delinquent behavior subscale were among the best predictors
of adolescent SU. The severity of behavioral problems was associated
with an increased likelihood of SU as well as substance dependence.
Gender differences. Henry et al. (1993) found
that, for males, the relationship between early conduct problems and
SU was mediated by the effects of depressive symptoms. Conversely, the
association between depressive symptoms and SU were mediated by the
effects of conduct problems. Depressive symptoms predicted later SU
in males, but there was a contemporaneous association between conduct
problems and SU in females. Furthermore, females with conduct problems
appeared to self-medicate, independent of their depressive symptomatology.
Kandel et al. (1997) found that the use of illicit substances was significantly
associated with DBDs in females only. Windle & Davies showed that
depressed boys (33 to 37 percent) were more likely to meet criteria
for heavy drinking compared to girls (16 to 18.5 percent). Conversely,
heavy drinking girls (27 to 33 percent) were more likely than heavy
drinking boys (18 to 20 percent) to meet criteria for depression.
Lewinsohn et al. (1995) reported that comorbid DBDs and
SUDs were much more prevalent among males compared to females in their
sample. Males were also more likely to experience academic problems
associated with such comorbidity, while females were more likely to
have reported elevated physical symptoms, to have attempted suicide,
and to have received treatment. Additionally, they reported that 75
percent of adolescents with SUD and a comorbid anxiety disorder were
females. Costello et al. (1999) also found that substance abuse/dependence
was more common among males reporting depressive symptoms compared to
males not reporting depressive symptoms, and more common among females
diagnosed with a behavior disorder. Disney et al. (1999) reported that
ADHD may put adolescent females at slightly higher risk for developing
SUD.
Demographic differences. Kandel et al. (1999)
concluded from their data that adolescents in the general population
with a lifetime prevalence of SUD have as great a risk for psychiatric
comorbidity as adults. Moreover, those adolescents with a current SUD
have a greater risk than adults for psychiatric comorbidity. SAMHSA
(1996) reported no significant differences in reported SU by race or
ethnicity, although Whites were more likely to receive outpatient mental
health treatment compared to Blacks and Hispanics. Chong et al. (1999)
reported a higher prevalence of substance use disorders and comorbid
depression among adolescents residing in rural households. These adolescents
tended to reveal tobacco and betel abuse much more frequently than alcohol.
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Appendix D:
Copy of form used to collect information on potentially useful data
sets
NIDA summary of data sets
available to examine the development of psychiatric comorbidity
with drug abuse
Please provide as much information
as you think would be helpful in compiling this summary.
|
Name, e-mail, and
telephone number of person completing the form |
What do you call the study or
data set?
Who funded the data collection?
NIH_____ Other _____
|
Who is the Principal
Investigator or person responsible for the data set?
If this person is not yourself,
please give e-mail and telephone number.
|
When
were the data collected? First year_____ Last year_____ Still
continuing_____ |
This data set does not meet
NIDA's requirements, for one or more of the following reasons:
Not a representative population sample_____
No participants ever assessed when under 18______
Does not provide DSM or ICD psychiatric diagnoses_____
Does not provide enough information to diagnose substance abuse
or dependence_____
Does not distinguish among substances_____
Does not provide onset dates, or permit onsets to be calculated
(e.g., over repeated waves of data)_____
Other reasons (please explain)
Signed:
Date:
|
IF YOUR DATA COULD BE HELPFUL
TO NIDA, PLEASE COMPLETE THE REST OF THIS FORM
How old were the participants at the first wave?
How many waves of data collection have there been?
When were they? (If regular, please state annual, biennial,
etc. If irregular, give years.)
If the study is ongoing, how
old were subjects at the last wave?
|
How many participants
were there at the first wave? (Participant=index child)
On how many of these do you have at least one wave of followup
data? |
What is the population
that the sample represents? (e.g., is it a random sample from
a school, city, State, whole country?) |
What is the age
range of the study to date? (age of youngest at first wave
to oldest at latest wave) |
What is the ratio
males/females? |
What are the race/ethnic
groups represented, in what proportions? |
Can you diagnose
substance abuse/dependence on all participants? |
For which drugs can you diagnose
abuse/dependence?
Snuff___ Chewing tobacco____
Cigarettes, cigars, pipes___ Any tobacco use____
Alcohol_____ Inhalants_____
Cannabis_____ Sedatives_____ Amphetamines_____ LSD_____
Cocaine_____ Crack_____
Psilocybins_____ "Club
drugs"_____ Opioids_____ Steroids_____
Other_________________________________________
Any use_____ Any use excluding
tobacco______ Any use excluding tobacco and alcohol_____
Any use excluding tobacco, alcohol, and cannabis_____
Any abuse_____ Any abuse excluding
tobacco______ Any abuse excluding tobacco and alcohol_____
Any abuse excluding tobacco, alcohol, and cannabis_____
Any dependence_____ Any dependence
excluding tobacco______ Any dependence excluding tobacco and
alcohol_____
Any dependence excluding tobacco, alcohol, and cannabis_____
Any abuse/dependence_____Any
abuse/dependence excluding tobacco______ Any abuse/dependence
excluding tobacco and alcohol_____ Any abuse/dependence excluding
tobacco, alcohol, and cannabis_____
|
Do you have onset dates for
substance use_____ abuse_____ or dependence_____?
If so, do you have it for specific
substances, or in general?
Do you have offset dates for
substance use_____ abuse_____ or dependence_____?
|
For which psychiatric disorders
can you make diagnoses?
DSM-III______ DSM-IIIR_____
DSM-IV_____ ICD-9_____ ICD-10_____
Unipolar depression_____ Bipolar
depression_____ Any depression_____
Specific anxiety diagnoses_____
Any anxiety disorder_____ Any emotional disorder (anxiety
or depression)_____
ADD/ADHD_____ Oppositional
disorder/ODD_____Conduct disorder_____ Conduct or oppositional
disorder_____
Behavioral disorder (CD,
ODD, or ADHD)_____
Schizophrenia____ Other psychotic
disorder_____ Any psychotic disorder_____ OCD_____
Tics/Tourette's?_____
Bulimia_____ Anorexia nervosa_____
Any eating disorder_____
Antisocial personality disorder_____
Other Axis II disorders (please specify)__________________
Other diagnoses (please
specify)_____________________________________
Any Axis I diagnosis_____ Any
Axis I or Axis II diagnosis_____
|
Do you have onset dates for
psychiatric symptoms_____ or diagnoses_____?
If so, are these based on asking
for onset dates or on inference from repeated assessments?
Do you have offset dates for
symptoms_______ or diagnoses_________?
|
Can you generate
the raw data for calculating odds ratios for comorbidity estimates
(e.g., N with anxiety, N with anxiety and drug abuse, N without
anxiety, N without anxiety with drug abuse)? |
Is it possible
from your data to determine whether, and which, diagnoses preceded
or followed the onset of drug use, abuse, or dependence? |
Is it possible
from your data to examine risk and protective factors for onset
of drug abuse/dependence in the presence of psychiatric comorbidity? |
Is it possible
from your data to examine functional impairment in association
with drug abuse/dependence, psychiatric disorder, and/or comorbidity? |
Assuming that NIDA
were able to provide funding for you to analyze your data set
to examine the effects of psychiatric comorbidity on the development
of drug abuse and dependence, are there any special considerations
that would affect whether you were willing to take part in a collaborative
venture of this sort? |
Any other comments?
Thank you very much
|
Please fax to Jane Costello at 919-687-4737, or send
as an e-mail attachment to Jcostell@psych.mc.duke.edu.
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