Am J Psychiatry 1996; 153:914-920
Copyright © 1996 by American Psychiatric Association
Conduct disorder, substance use disorders, and coexisting conduct and substance use disorders in adolescent inpatients
CM Grilo, DF Becker, DC Fehon, WS Edell and TH McGlashan
Yale Psychiarric Institute, New Haven, CT 06520-8038, USA.
OBJECTIVE: The authors examined the association between conduct disorder
and substance use disorders in adolescent inpatients. METHOD: Structured
diagnostic interviews were given to 165 adolescent inpatients to assess the
presence of DSM-III-R axis I disorders and personality disorders from axis
II. Patients with conduct disorder (N = 25), substance use disorders (N =
24), and coexisting conduct and substance use disorders (N = 54) were
compared to determine whether additional axis I and axis II disorders
presented at significantly different rates. RESULTS: The groups with
conduct disorder and coexisting conduct and substance use disorders had a
higher proportion of male subjects than the group with substance use
disorders alone. Patients with conduct disorder had an earlier age at first
psychiatric contact and were diagnosed significantly more often with
attention deficit hyperactivity disorder than the other two groups.
Borderline personality disorder was diagnosed more frequently in the
patients with substance use and coexisting conduct and substance use
disorders than in the patients with conduct disorder. These differential
co-occurrence patterns were observed for both male and female subjects.
CONCLUSIONS: Conduct disorder and substance use disorders have high
comorbidity rates with other psychiatric disorders in adolescent
inpatients. The additional psychiatric comparison group (patients with
coexisting conduct and substance use disorders) allowed for finer
distinctions regarding psychiatric comorbidity. The validity of subtyping
conduct disorder on the basis of the presence of a coexisting substance use
disorder is suggested; conduct disorder patients without a coexisting
substance use disorder are more likely to have attention deficit
hyperactivity disorder.
