0145-6008/95/1906-1528$03.00/0 ALCOHOLISM: CLINICAL AND EXPERIMENTAL RESEARCH Vol. 19, No. 6 December 1995 zy Preadolescent Conduct Disorder Behaviors Predict Relapse and Progression of Addiction for Adolescent Alcohol and Drug Abusers zy Mark G. Myers, Sandra A. Brown, and Mariam A. Mott Increasedawareness of the heterogeneity among alcohol and drug abusers has led to examination of the influenceof concomitant psy- chopathology on the course of addiction and addictive relapse. Re- search among adult alcohol and drug abusers has found a detrimen- tal influence of comorbid psychopathology on treatment outcome. Evidence exists for prevalent comorbidity, in particular conduct dis- order (CD), among clinical samples of teen alcohol and drug abusers. However, little information is currently available on the relation and influence of psychopathology on outcome after treatment for ado- lescent alcohol and drug abuse. The current study examines the relation between CD, as assessedby the extent of preadolescentCD behaviors occurring before the initiation of drug use, and outcome for 131 adolescents over 2 years after inpatienttreatment for alcohol and drug abuse. Drawing on recent conceptualizations of the pro- cess of relapse and progressionof addictive behavior, CD is hypoth- esized to influence the process of relapse by altering coping efforts and intentions and increasing exposure to potential relapse situa- tions. Resultsrevealthat the extent of preadolescentCD behaviorsis positively related to alcohol involvement in the 2 years after treat- ment, and that much of this relation is accounted for by posttreat- ment cognitive coping, motivation for alcohol abstinence, interper- sonal problems, and exposure to alcohol use. Contraty to expectations, preadolescentCD behaviors did not predict posttreat- ment drug use. These findings provide evidencefor the influence of psychopathology on the process of relapse and progression of ad- diction after treatment for adolescent alcohol and drug abuse, and suggest that teens with early life CD behaviors may be at greater risk for continued alcohol abuse. Key Words: Adolescent Alcohol and Drug Abuse, Comorbidity, Conduct Disorder, Relapse. ECOGNITION OF the heterogeneity among alcohol zyxwv R and drug abusers has directed increased attention to the presence and influence of concomitant psychopathol- zyxwvu ogy on the course of addiction. Research consistently re- veals a high co-occurrence between psychiatric disorders From the Department of Psychiatry (M.G.M., S.A.B.), University of Cal- ifornia San Diego School of Medicine; and the Department of Psychology (S.A.B.), Veterans Affairs Medical Center, San Diego, California; and the Treatment Foster Family Services Division (M.A.M.), Father Flanagan’s Boys Town, Omaha, Nebraska. Received for publication March 20, 1995; accepted June 7, 1995 This study was supported by the National Institute on Alcohol Abuse and Alcoholism (Grant AA07033-06), the National Institute on Drug Abuse (Grant DA 09181-01), and the Research Service of the Department of VeteransAffairs. Reprint requests: Mark G. Myers, Ph.D., Department of Psychology (116B), Veterans Affairs Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161. Copyright zyxwvutsrqp 0 1995 by The Research Society on Alcoholism. and substance abuse,’ high levels of psychopathology among clinical samples of adult alcoholics,2 as well as a significant relation between such symptomatology and treatment outcome for alcohol and other drug a b ~ s e . ~ ” For example, adult Antisocial Personality Disorder (ASPD) is found related to poorer outcome after treatment for alcoholism.6However, little information currently exists regarding comorbid psychopathology in relation to treat- ment outcome for adolescent alcohol and drug abusers. Investigations examining psychopathology among ado- lescent alcohol and drug abusers find that conduct disorder (CD) is the most common comorbid psychiatric diagnosis. For example, a recent study of 226 adolescents on an inpatient alcohol and drug abuse unit found that 54% of the teens met criteria for CD, a greater prevalence than for any other di~order.~ In an examination of affective comor- bidity among 156 teens hospitalized on a dual diagnosis unit for teen alcohol and drug abusers, Bukstein et a1.8 reported that 70% of these teens met criteria for CD, 51% for affective disorders, and 14% were diagnosed with both CD and major depression. An investigation of 57 adoles- cents consecutively admitted for treatment of alcohol and drug abuse found that 42% of the patients met diagnostic criteria for CD.9 A chart review of adolescents admitted to an outpatient alcohol and drug abuse treatment program found that 60% had a nonalcohol and drug use psychiatric diagnosis, with 40% meeting criteria for CD.1° In examin- ing 43 inpatient adolescent alcohol abusers, Tarter et a1.l’ categorized the majority as demonstrating externalizing symptoms and behavioral dyscontrol. In the same sample, those teens with externalizing problems were found to demonstrate greater severity for both substance involve- ment and psychiatric disturbance than those with internal- izing symptomatology.12Thus, investigations to date con- sistently find that CD is a prevalent comorbid diagnosis in clinical samples of alcohol and drug-abusing teens, and also suggest that this subgroup may evidence the greatest sever- ity of substance involvement and psychopathology. Yet, little is currently known regarding the influence of CD on outcome after teen alcohol and drug abuse treatment. Little information is available exploring the relationship between CD and adolescent alcohol and drug abuse treat- ment outcome. We have previously reported findings that both a diagnosis of CD based on behaviors independent of 1528 zyxwvutsrqponmlk Alcohol CIin Exp Res, Vol19, No 6, 1995: pp 1528-1536