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Book Forum: Child and Adolescent Psychiatry   |    
Etiology of Substance Use Disorder in Children and Adolescents: Emerging Findings From the Center for Education and Drug Abuse Research
BARRY LISKOW, M.D.
Am J Psychiatry 2003;160:805-a-806. doi:10.1176/appi.ajp.160.4.805-a
View Author and Article Information
Kansas City, Kan.

Edited by Ralph E. Tarter and Michael M. Vanyukov. Binghamton, N.Y., Haworth Press, 2002, 165 pp., $39.95.

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Substance abuse among our nation’s youth is a seemingly intractable crisis. Theories and action plans abound, but there is no clear consensus as to the cause or control of the crisis. This book describes the 20-year research project of the Center for Education and Drug Abuse Research, led by Dr. Tarter, which has the ambitious goal of determining the etiology and consequent prevention of substance use disorder in the young. Seven hundred families with a 10–12-year-old child were identified in 1989. Half of the children were identified as high risk for substance abuse (because of fathers with substance use disorder) and half were identified as low risk (fathers without substance abuse). The children initially underwent extensive multimodal assessments, had repeat intensive follow-ups at ages 12–14, 16, and 19, and will continue to be followed yearly until age 30. This brief volume is an interim report of the methods, assessment instruments, and initial findings of this major undertaking.

The first section, Measurement of Substance Use Disorder Liability, contains five chapters describing the purpose and design of the study with emphasis on the assessment tools developed and their validity, reliability, and potential use as predictors of adolescent substance abuse. I would have liked a clearer description of some of basic details of the study, such as its location, the number of families screened, the length of time each assessment took, the dropout rate between evaluations, whether subjects were paid, etc. The description of the scales used and developed is too abbreviated; most of the emphasis is on the statistical manipulations necessary to derive usable measures. Although the chapter authors acknowledge that some of the measures developed are unwieldy to use, others appear to show promise as practical clinical predictors of substance use disorders.

The second section of the book, Etiological Mechanisms, has seven chapters that describe the project’s preliminary findings. These range widely and begin with the suggestion that D5 dopamine receptor gene polymorphisms are associated with the development of substance use disorder. The chapter authors are aware that the study suffers from a lack of replication by other investigators and the small variance in the risk of substance abuse accounted for by the genetic findings. As with much genetic research of this type, the language and methods used are not easily grasped by most clinicians. Potential biological factors in the development of substance abuse continue into the next chapter, which reports a correlation between cortisol levels in females (but not males) and behavioral dysregulation measured by a questionnaire developed by project researchers. Because behavioral dysregulation correlates with the development of substance abuse in both males and females, the authors hypothesize that males and females may progress to substance abuse by different neuroendocrine-driven pathways.

The authors of the next chapter report that sexual maturation in males (measured by pubic hair development at ages 10, 12, and 15) correlates with parental substance use disorder. They hypothesize that accelerated sexual maturity leads to deficient behavioral self-regulation, increased sensation seeking, and hence greater likelihood of involvement with substances. As the authors note, multiple alternative hypotheses could be constructed, and not enough time has elapsed (or enough subjects or variables analyzed) to test their hypothesis that accelerated sexual maturation is involved in the mechanisms of familial transmission of substance abuse liability.

The next four chapters relate a variety of findings, including that behavioral dysregulation at age 12 correlates with cigarette smoking at age 16 and suicidality at age 19, that high negative affect and low executive cognitive functioning at age 16 is found in boys at high risk for substance abuse, and that neglect and substance abuse in mothers’ histories (but not fathers’) are associated with severity of neglect of their children.

The above are only a few of the findings and hypotheses generated by the Center for Education and Drug Abuse Research project with its ambitious goal of "delineating the mechanisms underlying the development of a diagnosed substance use disorder." The research team is halfway through its 20-year phase of longitudinal data collection, and these initial findings and speculations are promising if not immediately convincing or useful for treatment. Future reports are eagerly awaited because the project has the potential of revealing the antecedents of adolescent substance abuse, knowledge of which may lead to effective initiatives to ameliorate the crisis persisting among America’s youth.

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