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Assessing the Impact of Childhood Interventions on Subsequent Drug Use Home
Assessing the Impact of Childhood Interventions
on Subsequent Drug Use
skip navigation About the Conference
Agenda
Commissioned Papers
Barbara J. Burns, Ph.D.
Scott N. Compton, Ph.D.
Helen L. Egger, M.D.
Elizabeth M.Z. Farmer, Ph.D.
E. Jane Costello
Tonya D. Armstrong
Alaattin Erkanli
Paul E. Greenbaum
Chi-Ming Kam
Linda M. Collins
Selected Bibliography
Program Contacts

Report on the Developmental Epidemiology of Comorbid Psychiatric and Substance Use Disorders

Costello, Armstrong & Erkanli

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Appendix A: Bibliography of articles reviewed for meta-analysis

Anderson, J. C., Williams, S., McGee, R., & Silva, P. A. (1987). DSM-III disorders in preadolescent children: Prevalence in a large sample from the general population. Archives of General Psychiatry, 44, 69-77.

Andreasson, S., Allebeck, P., Brandt, L., & Romelsjo, A. (1992). Antecedents and covariates of high alcohol consumption in young men. Alcoholism: Clinical and Experimental Research, 16, 708-713.

Angold, A., & Costello, E. J. (1993). Depressive comorbidity in children and adolescents: Empirical, theoretical, and methodological issues. American Journal of Psychiatry, 150, 1779-1791.

Angold, A., Costello, E. J., & Erkanli, A. (1999). Comorbidity. Journal of Child Psychology and Psychiatry, 40, 57-87.

Anthony, J. C., & Petronis, K. R. (1995). Early-onset drug use and risk of later drug problems. Drug and Alcohol Dependence, 40, 9-15.

Anthony, J. C., Warner, L. A., & Kessler, R. C. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey. Experimental and Clinical Psychopharmacology, 2, 244-268.

Barkley, R. A. (1990). The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 546-557.

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, 312-321.

Biederman, J., Faraone, S. V., & Kiely, K. (1996). Comorbidity in outcome of attention-deficit/hyperactivity disorder. In L. T. Hechtman (Ed.), Do They Grow Out of It? Long-term Outcomes of Childhood Disorders (pp. 39-75). Washington, DC: American Psychiatric Press.

Biederman, J., Wilens, T., Mick, E., Faraone, S., Weber, W., Curtis, S., Thornell, A., Pfister, K., Jetton, J., & Sorlano, J. (1997). Is ADHD a risk factor for psychoactive substance use disorders? Findings from a Four-Year Prospective Follow-up Study. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 21-29.

Bird, H. R., Gould, M. S., & Staghezza, B. M. (1993). Patterns of diagnostic comorbidity in a community sample of children aged 9 through 16 years. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 361-368.

Boyle, M. H., & Offord, D. R. (1991). Psychiatric disorder and substance use in adolescence. Canadian Journal of Psychiatry, 36, 699-705.

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 study of co-occurring psychiatric disorders and substance use. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 322-330.

Brook, J. S., Whiteman, M. M., & Finch, S. (1992). Childhood aggression, adolescent delinquency, and drug use: A longitudinal study. Journal of Genetic Psychology, 153, 369-384.

Brook, J. S., Whiteman, M., Finch, S., & Cohen, P. (1995). Aggression, intrapsychic distress, and drug use: Antecedent and intervening processes. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 1076-1084.

Brown, J. H., & Horowitz, J. E. (1993). Deviance and deviants: Why adolescent substance use prevention programs do not work. Evaluation Review, 17, 529-555.

Brown, S. A., Mott, M. A., & Stewart, M. A. (1992). Adolescent alcohol and drug abuse. In C. E. Walker & M. C. Roberts (Eds.), The Handbook of Clinical Child Psychology (pp. 677-693). New York: Wiley.

Bry, B. H., McKeon, P., & Pandina, R. J. (1982). Extent of drug use as a function of number of risk factors. Journal of Abnormal Psychology, 91, 273-279.

Bukstein, O. G., Brent, D. A., & Kaminer, Y. (1989). Comorbidity of substance abuse and other psychiatric disorders in adolescents. American Journal of Psychiatry, 146, 1131-1141.

Bukstein, O. G., Glancy, L. J., & Kaminer, Y. (1992). Patterns of affective comorbidity in a clinical population of dually diagnosed adolescent substance abusers. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1041-1045.

Cadoret, R. J., Troughton, E., O'Gorman, T. W., & Heywood, E. (1986). An adoption study of genetic and environmental factors in drug abuse. Archives of General Psychiatry, 43, 1131-1136.

Cadoret, R. J., Yates, W. R., Troughton, E., Woodworth, G., & Stewart, M. A. (1995). Adoption study demonstrating two genetic pathways to drug abuse. Archives of General Psychiatry, 52, 42-52.

Capaldi, D. M. (1992). Co-occurrence of conduct problems and depressive symptoms in early adolescent boys: II. A 2-year follow-up at grade 8. Development and Psychopathology, 4, 125-144.

Caron, C., & Rutter, M. (1991). Comorbidity in child psychopathology: Concepts, issues and research strategies. Journal of Child Psychology and Psychiatry, 32, 1063-1080.

Caton, C. L. M., Gralnick, A., Bender, S., & Simon, R. (1989). Young chronic patients and substance abuse. Hospital and Community Psychiatry, 40, 1037-1040.

Chassin, L., Curran, P. J., Husson, A. M., & Colder, C. R. (1996). The relation of parent alcoholism to adolescent substance use: A longitudinal follow-up study. Journal of Abnormal Psychology, 105, 70-80.

Chassin, L., Pillow, D. R., Curran, P. J., Molina, B. S. G., & Barrera, M., Jr. (1993). Relation of parental alcoholism to early adolescent substance use: A test of three mediating mechanisms. Journal of Abnormal Psychology, 102, 3-19.

Chassin, L., Pitts, S. C., DeLucia, C., & Todd, M. (1999). A longitudinal study of children of alcoholics: Predicting young adult substance use disorders, anxiety, and depression. Journal of Abnormal Psychology, 108, 106-119.

Chassin, L., Rogosch, F., & Barrera, M. (1991). Substance 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.

Chong, M.-Y., Chan, K.-W., & Cheng, A. T. A. (1999). Substance use disorders among adolescents in Taiwan: Prevalence, sociodemographic correlates and psychiatric co-morbidity. Psychological Medicine, 29, 1387-1396.

Christie, K. A., Burke, J. D., Regier, D. A., Rae, D. S., Boyd, J. H., & Locke, B. Z. (1988). Epidemiologic evidence for early onset of mental disorders and higher risk of drug abuse in young adults. American Journal of Psychiatry, 145, 971-975.

Cicchetti, D., & Rogosch, F. A. (1999). Psychopathology as risk for adolescent substance use disorders: A developmental psychopathology perspective. Journal of Clinical Child Psychology, 28, 355-365.

Clark, D. B., & Neighbors, B. (1996). Adolescent substance abuse and internalizing disorders. Child and Adolescent Psychiatric Clinics of North America, 5, 45-57.

Clark, D. B., Parker, A. M., & Lynch, K. G. (1999). Psychopathology and substance-related problems during early adolescence: A survival analysis. Journal of Clinical Child Psychology, 28, 333-341.

Clark, D. B., Pollock, N., Bukstein, O. G., Mezzich, A. C., Bromberger, J. T., & Donovan, J. E. (1997). Gender and comorbid psychopathology in adolescents with alcohol dependence. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1195-1203.

Clark, D. B., Smith, M. G., Neighbors, B. D., Skerlec, L. M., & Randall, R. (1994). Anxiety disorders in adolescence: Characteristics, prevalence, and comorbidities. Clinical Psychology Review, 14, 113-137.

Cohen, P., Cohen, J., & Brook, J. (1993a). An epidemiological study of disorders in late childhood and adolescence: 2. Persistence of disorders. Journal of Child Psychology and Psychiatry, 34, 869-877.

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 and Psychiatry and Allied Disciplines, 34, 851-867.

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 of DSM-III-R disorders. Archives of General Psychiatry, 53, 1129-1136.

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 Psychology, 28, 298-311.

Costello, E. J., Farmer, E. M. Z., & Angold, A. (1999b). Same place, different children: White and American Indian children in the Appalachian Mountains. In P. Cohen, L. Robins, & C. Slomkowski (Eds.), Where and When: Historical and Geographical Aspects of Psychopathology (pp. 279-298). NJ: Lawrence Erlbaum Associates.

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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 (pp. 49-111). Rockville, MD: National Institutes of Health.

DeMilio, L. (1989). Psychiatric syndromes in adolescent substance abusers. American Journal of Psychiatry, 146, 1212-1214.

Deykin, E. Y., Buka, S. L., & Zeena, T. H. (1992). Depressive illness among chemically dependent adolescents. American Journal of Psychiatry, 149, 1341-1347.

Deykin, E. Y., Levy, J. C., & Wells, V. (1987). Adolescent depression, alcohol and drug abuse. American Journal of Public Health, 77, 178-181.

Disney, E. R., Elkins, I. J., McGue, M., & Iacono, W. G. (1999). Effects of ADHD, conduct disorder, and gender on substance use and abuse in adolescence. American Journal of Psychiatry, 156, 1515-1521.

Eisen, S. V., Youngman, D. J., Grob, M. C., & Dill, D. L. (1992). Alcohol, drugs, and psychiatric disorders: A current view of hospitalized adolescents. Journal of Adolescent Research, 7, 250-265.

Famularo, R., Kinscherff, R., & Fenton, T. (1992). Parental substance abuse and the nature of child maltreatment. Child Abuse and Neglect, 16, 475-483.

Federman, E. B., Costello, E. J., Angold, A., Farmer, E. M. Z., & Erkanli, A. (1997). Development of substance use and psychiatric comorbidity in an epidemiologic study of white and American Indian young adolescents: The Great Smoky Mountains Study. Drug and Alcohol Dependence, 44, 69-78.

Feehan, M., McGee, R., Raja, S. N., & Williams, S. M. (1994). DSM-III-R Disorders in New Zealand 18-year-olds. Australian and New Zealand Journal of Psychiatry, 28, 87-99.

Fergusson, D. M., Horwood, L. J., & Lynskey, M. T. (1993a). Prevalence and comorbidity of DSM-III-R diagnoses in a birth cohort of 15 year olds. Journal of the American Academy of Child and Adolescent Psychiatry, 32, 1127-1134.

Fergusson, D. M., Lynskey, M. T., & Horwood, L. J. (1993b). Conduct problems and attention deficit behaviour in middle childhood and cannabis use by age 15. Australian and New Zealand Journal of Psychiatry, 27, 673-682.

Gabel, S., & Shindledecker, R. (1991). Aggressive behavior in youth: Characteristics, outcome, and psychiatric diagnoses. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 982-988.

Gilvarry, E. (1999). Substance use and misuse by children and adolescents. Current Opinion in Psychiatry, 12, 409-413.

Glantz, M. D. (1992). A developmental psychopathology model of drug abuse vulnerability. In M. Glantz & R. Pickens (Eds.), Vulnerability to Drug Abuse (pp. 389-418). Washington, DC: American Psychological Association.

Grant, B. F., & Harford, T. C. (1995). Comorbidity between DSM-IV alcohol use disorders and major depression: Results of a national survey. Drug and Alcohol Dependence, 39, 197-206.

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Greenbaum, P. E., Foster-Johnson, L., & Petrila, A. (1996). Co-occurring addictive and mental disorders among adolescents: Prevalence research and future directions. American Journal of Orthopsychiatry, 66, 52-60.

Greenbaum, P. E., Prange, M. E., Friedman, R. M., & Silver, S. E. (1991). Substance abuse prevalence and comorbidity with other psychiatric disorders among adolescents with severe emotional disturbances. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 575-583.

Greene, R. W., Biederman, J., Faraone, S. V., Sienna, M., & Garcia-Jetton, J. (1997). Adolescent outcome of ADHD boys with social disability: Results from a four-year longitidinal follow-up study. Journal of Consulting and Clinical Psychology, 65, 758-767.

Groves, J. B., Batey, S. R., & Wright, H. H. (1986). Psychoactive-drug use among adolescents with psychiatric disorders. American Journal of Hospital Pharmacy, 43, 1714-1718.

Guzder, J., Paris, J., Zelkowitz, P., & Marchessault, K. (1996). Risk factors for borderline pathology in children. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 26-33.

Hawkins, J. D., Catalano, R. F., & Miller, J. Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin, 112, 64-105.

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Rounsaville, B. J., Kranzler, H. R., Ball, S., Tennen, H., Poling, J., & Triffleman, E. (1998). Personality disorders in substance abusers: Relation to substance use. Journal of Nervous and Mental Disease, 186, 87-95.

SAMHSA (1996). Mental Health Estimates from the 1994 National Household Survey on Drug Abuse. Rockville, MD: Office of Applied Studies.

SAMHSA (1993). National Household Survey on Drug Abuse: Population Estimates 1992. Rockville, MD: U.S. Department of Health and Human Services.

SAMHSA (1999). The Relationship Between Mental Health and Substance Abuse Among Adolescents. Rockville, MD: U. S. Department of Health and Human Services.

Shedler, J., & Block, J. (1990). Adolescent drug use and psychological health: A longitudinal inquiry. American Psychologist, 45, 612-630.

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Sullivan, T. N., & Farrell, A. D. (1999). Identification and impact of risk and protective factors for drug use among urban African American adolescents. Journal of Clinical Child Psychology, 28, 122-136.

Sussman, S., Dent, C. W., Stacy, A. W., Burciaga, C., Raynor, A., Turner, G. E., Charlin, V., Craig, S., Hansen, W. B., Burton, D., & Flay, B. R. (1990). Peer-group association and adolescent tobacco use. Journal of Abnormal Psychology, 99, 349-352.

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Van Kammen, W. B., Loeber, R., & Stouthamer-Loeber, M. (1991). Substance use and its relationship to conduct problems and delinquency in young boys. Journal of Youth and Adolescence, 20, 399-413.

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Whitmore, E. A., Mikulich, S. K., Thompson, L. L., Riggs, P. D., Aarons, G. A., & Crowley, T. J. (1997). Influences on adolescent substance dependence: Conduct disorder, depression, attention deficit hyperactivity disorder, and gender. Drug and Alcohol Dependence, 47, 87-97.

Wilens, T. E., & Biederman, J. (1993). Psychopathology in preadolescent children at high risk for substance abuse: A review of the literature. Harvard Review of Psychiatry, 1, 207-218.

Wilens, T. E., Biederman, J., Mick, E., Faraone, S. V., & Spencer, T. (1997). Attention deficit hyperactivity disorder (ADHD) is associated with early onset of substance use disorders. Journal of Nervous and Mental Disease, 185, 475-482.

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Zeitlin, H. (1999). Psychiatric comorbidity with substance misuse in children and teenagers. Drug and Alcohol Dependence, 55, 225-234.

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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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