Antisocial behaviors (eg., aggression toward people and animals, destruction of property, deceitfulness, theft, and serious rule violations) and related mental disorders (ie., conduct disorder and oppositional defiant disorder) during childhood predict alcohol use disorders (AUDs) during adolescence. This sequence of disorders may reflect developmentally specific forms of deficits in the ability to control behavior. Therefore, childhood antisocial behaviors and adolescent AUDs may share common genetic and environmental influences. A comprehensive conceptual model may clarify the relationship between childhood antisocial behaviors and adolescent A UDs. A better understanding of this relationship is essential for advancing research into the causes of both behaviors and for developing prevention programs and treatment for adolescents with these problems. Prevention programs targeting childhood antisocial behaviors have met with some success. Clinical interventions for adolescents with AUDs may be improved by focusing evaluation and treatment planning on antisocial behavior. KEY WORDS: comorbidity; childhood behavioral problem; antisocial behavior; adolescent; AODD (alcohol and other drug dependence); alcoholic beverage; conduct disorder; disinhibition; genetic linkage; risk factors; prevention; patient assessment; psychosocial treatment method; literature review
Childhood antisocial behaviors are a central element in the developmental pathway leading to adolescent alcohol abuse or dependence. Theories and empirical observations indicate that childhood antisocial behaviors increase the risk for alcohol use disorders (AUDs). In its most severe forms, childhood antisocial behavior can lead to diagnoses of conduct disorder (CD) or oppositional defiant disorder (ODD). Particularly for children meeting the criteria for CD, childhood antisocial behaviors predict early initiation of alcohol use, adolescent alcohol-related problems, and the onset of AUDs (Cadoret et al. 1995; Clark et al. 1998a, 1999). (Throughout this review, the term "childhood" will refer to age 12 and younger, and "adolescence" will refer to ages 13 through 18.) Understanding the nature of the relationship between antisocial behaviors and AUDs is essential in planning interventions designed to prevent or ameliorate both types of behaviors or disorders.
This article reviews antisocial behaviors and related mental disorders commonly found in children and adolescents and describes the relationship between antisocial behaviors and alcohol problems. The article then presents a conceptual model for explaining this relationship, including genetic and environmental factors that may play a role in the process. Finally, the article summarizes the implications of the relationship between antisocial behaviors and AUDs for understanding the etiology of AUDs, for developing effective methods to prevent alcohol problems, and for evaluating and treating adolescents with AUDs.
DEFINITIONS OF ANTISOCIAL BEHAVIOR AND RELATED DISORDERS
Behaviors and Diagnoses
Antisocial behaviors are any acts that violate social rules and the basic rights of others. They include conduct intended to injure people or damage property, illegal behavior, and defiance of generally accepted rules and authority, such as truancy from school. These antisocial behaviors exist along a severity continuum. When childhood antisocial behaviors exceed certain defined thresholds-- the diagnostic criteria specified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (American Psychiatric Association 1994)-the child is considered to have CD or ODD. Together with attention deficit hyperactivity disorder (ADHD), these two disorders are classified as "disruptive behavior disorders" in the DSM-IV.
Conduct Disorder (CD). Antisocial behaviors represented in the DSM-IV diagnostic criteria for CD include aggression toward people and animals, destruction of property, deceitfulness, theft, and other serious social rule violations (see textbox, below). …