Conduct Disorder as a Substance Abuse Risk Factor

In this series of research reviews on conduct disorder several important findings are evident.

1. Conduct disorder (CD) commonly evolves into adult antisocial personality disorder
2. Conduct disorder in children often presents along with attention deficit hyperactivity disorder and learning problems
3. CD in childhood and adolescence raises risk for alcohol, drug and nicotine dependence.

Margaret Sibley and colleagues recently published a study of CD and ADHD and later initiation and escalation of the use of alcohol, cigarettes and cannabis.

In her study, 113 children with ADHD were assessed between the ages of 5 and 18 years of age. A control group of 65 children without ADHD were similarly assessed during this developmental period.

Twelve percent of the childhood ADHD later met criteria for a diagnosis of CD. This contrasts with only 1.5% of the control group. Also noteworthy was the high rate of oppositional defiant disorder in the ADHD group (59%) compared to only 5% of the control group.

Significant differences emerged in substance use. These key findings included the following:

• ADHD adolescents were more likely to have ever smoked a cigarette (47% v 28%) and were much more likely to be daily smokers (27% v 6%).
• ADHD adolescents were not more likely not more likely to have ever tried marijuana (53% v 51%) but were more likely to use on at least a weekly frequency (23% v 8%).
• There were no differences in the ADHD group compared to controls in ever use of alcohol or frequent drinking
• Maternal drinking in early childhood was the strongest predictor of adolescent alcohol use

The authors also found another important finding:

"escalating CD symptoms in childhood were viewed as a mediator of the relationship between ADHD and cigarette and marijuana use."

The authors noted in the longitudinal data analysis that increasing ADHD symptom endorsement predicted more CD symptoms. More CD symptoms was the strongest predictor of later substance use.

The take home message for clinicians is early identification and treatment of ADHD in children is important. Early identification and treatment of ADHD holds the promise for modifying later CD and substance use morbidity.

This is an important study teasing out some of the issues in ADHD/CD overlap and later substance use risk. Readers with more interest in this topic can access the free full-text manuscript by clicking on the PMID link in the citation below.

Graphic figure is an original created by the author using Canva.

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Sibley MH, Pelham WE, Molina BS, Coxe S, Kipp H, Gnagy EM, Meinzer M, Ross JM, & Lahey BB (2014). The role of early childhood ADHD and subsequent CD in the initiation and escalation of adolescent cigarette, alcohol, and marijuana use. Journal of abnormal psychology, 123 (2), 362-74 PMID: 24886010