Ada C. Mezzich

Gender and Comorbid Psychopathology in Adolescents With Alcohol Dependence

OBJECTIVE Although several mental disorders have been shown to be common in adolescents with substance use disorders, prior studies have not specifically focused on alcohol dependence and have not had sufficient sample sizes to examine gender effects. This study contrasts mental disorder diagnoses and symptoms between a sample of adolescents with alcohol dependence and a community control sample of adolescents and incorporates gender analyses. METHOD Adolescents (aged 14 years 0 months to 18 years 0 months) with alcohol dependence (females: n = 55; males: n = 78) and community-dwelling control adolescents without substance use disorders (females: n = 44; males: n = 42) were assessed by means of a semistructured interview for DSM-III-R. RESULTS While cannabis and hallucinogen use disorders were common in the alcohol dependence group, females and males had similar rates. Conduct disorder (CD), oppositional defiant disorder, attention-deficit hyperactivity disorder, major depression (MD), and posttraumatic stress disorder (PTSD) had significantly higher rates in the alcohol dependence than in the community control group. Depression and PTSD symptoms were more strongly associated with alcohol dependence in females than in males. A configural frequency analysis showed that CD and MD tended to occur together in both female and male adolescents with alcohol dependence. CONCLUSIONS While alcohol-dependent females and males similarly exhibited more comorbid disorders than control adolescents, gender affects the relationship of alcohol dependence to MD and PTSD. Rather than reflecting distinct types, the comorbid disorders of CD and MD jointly characterize many adolescents with alcohol dependence.

Etiology of early age onset substance use disorder: A maturational perspective

The etiology of early age onset substance use disorder (SUD), an Axis I psychiatric illness, is examined from the perspective of the multifactorial model of complex disorders. Beginning at conception, genetic and environment interactions produce a sequence of biobehavioral phenotypes during development which bias the ontogenetic pathway toward SUD. One pathway to SUD is theorized to emanate from a deviation in somatic and neurological maturation, which, in the context of adverse environments, predisposes to affective and behavioral dysregulation as the cardinal SUD liability-contributing phenotype. Dysregulation progresses via epigenesis from difficult temperament in infancy to conduct problems in childhood to substance use by early adolescence and to severe SUD by young adulthood.

Origins and consequences of child neglect in substance abuse families.

The empirical literature pertaining to the prevalence, origins, and consequences of neglectful parenting as it relates to substance abuse is critically reviewed. Available evidence indicates that children who experience parental neglect, with or without parental alcohol or drug abuse, are at high risk for substance use disorder (SUD). The effects of parental substance abuse on substance abuse outcome of their children appear to be partly mediated by their neglectful parenting. The discussion concludes with presentation of a developmental multifactorial model in which neglect, in conjunction with other individual and environmental factors, can be integratively investigated to quantify the childs overall liability across successive stages of development as well as to map the trajectory toward good and poor outcomes.

Norms and sensitivity of the adolescent version of the drug use screening inventory

The distribution and the statistical accuracy of scores on the Drug Use Screening Inventory (DUSI) and the discriminative power of the DUSI for identifying individuals who qualify for a DSM-III-R diagnosis of Psychoactive Substance Use Disorder (PSUD) were examined in 846 adolescents. The subjects with PSUD had higher mean scores, and the distribution of their scores approximated a normal distribution in each of the 10 domains measured by the DUSI. All of the DUSI domains yielded more precise trait estimates for the subjects who had more severe PSUD. Within the normal sample, using a score of 30 on the overall problem density index as the cutoff score, the DUSI correctly classified 95% of the normal sample and 81% of the PSUD cases.

Developmental sources of variation in liability to adolescent substance use disorders

This review provides a synthesis of the literature on the complex sequence of maturational, psychosocial, and neuroadaptive processes that lead to substance use disorders (SUD) in adolescence. A brief overview introduces the concepts of liability to SUD and epigenesis. A theory is presented explaining how affective, cognitive, and behavioral dysregulation in late childhood is exacerbated during early and middle adolescence by family and peer factors, as well as puberty, leading to substance use. Continued exacerbation of the three components of dysregulation by drug and non-drug stressors during late adolescence is posited to result in neuroadaptations that increase the likelihood of developing SUD, particularly in high-risk individuals. Implications for etiologic research as well as clinical and preventive interventions are discussed.

Cognitive capacity in female adolescent substance abusers.

Female adolescents who qualified for a DSM-III-R diagnosis of psychoactive substance use disorder (n = 106) were compared to normal controls (n = 74) on a battery of cognitive, intellectual and achievement tests. It was found that the substance abuse group performed deficiently on tests requiring language skills, sustained attention and perceptual efficiency and scored lower than controls on standardized tests of intelligence and academic achievement. No relationship between magnitude of cognitive deficit and severity of substance abuse was observed. The implications of these findings are discussed with respect to the etiology and maintenance of drug use.

Patterns of Polydrug Use in Adolescent Alcohol Abusers

It is clear that alcohol abuse by adolescents rarely exists today without the concurrent use of other drugs. Little is known, however, about the extent and patterns of polydrug use in clinical samples of adolescent alcohol abusers. The present study examined patterns and correlates of polydrug use in 72 adolescents admitted to an inpatient treatment unit with a diagnosis of alcohol abuse. The degree of lifetime involvement with 10 different drug classes was assessed in a clinical interview. Ninety-six percent of subjects reported use of drugs other than alcohol, and there were substantial rates of use for most drug classes. Males and females did not differ in the percentage of subjects who used different drug classes or in severity of involvement ratings for these drug classes. The data suggest a consistent ordering of drug classes, such that the use of drug classes later in this order was rare in the absence of the use of drug classes earlier in the order. The data suggest that polydrug use characterizes the large majority of adolescent alcohol abusers, and that such use is often quite extensive. Implications for assessment and treatment are discussed.

Constructive thinking, executive functioning, antisocial behavior, and drug use involvement in adolescent females with a substance use disorder

The main aim of this study was to determine how constructive thinking (CT), executive functioning (EF), and antisocial behavior (ASB) are related to drug use involvement in 282 adolescent females, 14-18 years of age, with a substance use disorder (SUD) and in controls. CT was measured using the Constructive Thinking Inventory (S. Epstein & P. Meier, 1989), EF was measured using a battery of neuropsychological tests, and ASB was measured using the Youth Self-Report Inventory (T. Achenbach, 1991) and a psychiatric interview. Females with an SUD demonstrated lower CT and EF scores and higher ASB scores compared with the controls. Low CT and low EF were significantly related to increased drug use involvement even when controlling for age, socioeconomic status, and vocabulary level. ASB partially mediated the relation between CT and drug use involvement, and it fully mediated the relation between EF and drug use involvement. Moreover, ASB moderated the relation between EF and drug use involvement.

Self-reported health problems and physical symptomatology in adolescent alcohol abusers

PURPOSE Few studies have examined the impact of alcohol abuse on the health status of adolescents. The purpose of this investigation was to determine whether adolescents with a diagnosis of alcohol abuse differed from controls on the frequency of self-reported health problems, clinical signs and symptoms detected upon clinical examination, and liver injury test results. METHODS Cases were ascertained from in-patient drug and alcohol treatment centers. Age- and sex-matched controls were recruited from community sources. The Health Problems Checklist (HPC) was used to measure self-reported problems; the clinical examination was performed by a physician or a physicians assistant. RESULTS Alcohol-abusing adolescents reported significantly more physical symptoms than did controls as measured by the HPC. The results of the clinical examination revealed a low prevalence of overt abnormalities in both groups, however, alcohol-abusing adolescents reported a higher frequency of appetite changes, weight loss, eczema, headaches and episodes of loss of consciousness than did controls. As expected, alcohol-abusing adolescents had significantly higher levels of ALT, AST and GGTP as compared to controls. CONCLUSIONS The findings of this study are generalizable only to in-patient adolescent alcohol abusers. In this study, alcohol abuse was also associated frequently with psychiatric disorders, drug abuse, cigarette smoking, and low parental education. Future studies using larger sample sizes should address the importance of social environmental and behavioral variables in moderating the relationship between alcohol abuse and decreased health status in adolescents.

Prediction of Cannabis Use Disorder between Boyhood and Young Adulthood: Clarifying the Phenotype and Environtype

Employing a prospective paradigm, this investigation derived the childhood phenotype and the environtype associated with risk for cannabis use disorder. Two hundred and sixteen boys were evaluated between age 10-12 on a comprehensive protocol using self, mother, and teacher reports and followed-up at ages 19 and 22 to determine the presence of cannabis use disorder. The Transmissible Liability Index (TLI) and Non-Transmissible Liability Index (NTLI) were derived using item response theory. Logistic regression was conducted to evaluate the accuracy of the indexes, singly and in combination, to predict cannabis use disorder. The TLI and NTLI together predicted with 70% and 75% accuracy cannabis use disorder manifest by age 19 and age 22. Sensitivity was 75% at both ages 19 and 22, whereas specificity was respectively 51% and 64%. The findings pertaining to sensitivity indicate that SUD risk for cannabis use disorder can be screened in childhood; however, the specificity scores demonstrate that a low score on the TLI does not inevitably portend a good prognosis up to 10 years later.