Academic journal article Alcohol Health & Research World

Psychopathology in Adolescent Alcohol Abuse and Dependence

Academic journal article Alcohol Health & Research World

Psychopathology in Adolescent Alcohol Abuse and Dependence

Article excerpt

Adolescents who abuse or are dependent on alcohol often have coexisting mental disorders. These disorders may both precipitate alcohol use disorders and result from them. In addition, both types of disorders may arise independently in adolescents at high risk. Mental disorders that commonly co-occur with alcohol use disorders in adolescents include antisocial disorders, mood disorders, and anxiety disorders. Treatment programs for adolescents with alcohol use disorders should seek not only to eliminate alcohol and other drug use but also to improve the symptoms of other mental disorders. KEY WORDS: antisocial personality disorder; emotional and psychiatric depression; AODD (alcohol and other drug use disorder); affective psychosis; comorbidity; dual diagnosis; adolescent; psychiatric care; addiction care; patient assessment; treatment method; literature review

Adolescents with alcohol use disorders (AUDs) (e.g., alcohol abuse or dependence1) have high rates of coexisting (i.e., comorbid) psychopathology (i.e., mental disorders other than alcohol and other drug use disorders). Common comorbid psychopathologies include those that interfere with social functioning (e.g., antisocial disorders) and disorders that cause severe depression or increase anxiety (i.e., negative-affect disorders) (Bukstein et al. 1989; Clark and Neighbors 1996). One study found that more than 80 percent of adolescents who were dependent on or abused alcohol also had some other form of psychopathology (Rohde et al. 1996). Among a group of alcoholdependent adolescents participating in treatment, 89 percent also had conduct disorder (i.e., an antisocial disorder characterized by aggression, destruction of property, deceitfulness or theft, and the violation of rules), major depressive disorder (i.e., a negative-affect disorder characterized by severe bouts of depression), or both (Clark et al. 1997). Understanding the effects of comorbid psychopathology on the development and course of AUDs may enhance preventive and treatment interventions for adolescents with AUDs.

The development of an AUD in adolescence may be an important indicator of other problems. Clark and colleagues (1998c) found that compared with men who developed substance use disorders (SUDs) (i.e., alcohol and other drug use disorders) as adults, adolescent males with SUDs and male adults who developed SUDs as adolescents had higher rates of disruptive behavior disorders and major depression as well as more rapid progression from first use to substance dependence.

Theories that attempt to explain the development of AUDs in adolescents have typically proposed that the presence of psychopathology increases the adolescent's risk of developing an AUD by either precipitating the onset of an AUD in vulnerable people or exacerbating mild alcohol problems (Zucker 1987). Conversely, AUDs may influence the development of psychopathology through similar mechanisms (Martin and Bates 1998). Psychopathology and AUDs also may be indirectly linked by shared risk factors (i.e., they may coexist in a person because the person is at risk for both, not because one influences the other) (see figure).

This article reviews two types of mental disorders common in adolescents with AUDs: antisocial disorders, such as conduct disorder, and negative-affect disorders, such as major depressive disorder. (For a discussion of attentiondeficit hyperactivity disorder [ADHD], see article by Wilens, pp. 127-130.) For each disorder, this article provides definitions, discusses the observed relationships to AUDs, and offers implications for treating adolescents with the disorder.

ANTISOCIAL DISORDERS

Definitions

Antisocial disorders include conduct disorder, oppositional defiant disorder (ODD), and antisocial personality disorder. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (APA 1994) defines conduct disorder, the most common form of psychopathology seen in adolescents with AUDs, as a pattern of behaviors that violate the basic rights of others or major ageappropriate social rules. …

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