Elsevier

Drug and Alcohol Dependence

Volume 96, Issue 3, 1 August 2008, Pages 233-248
Drug and Alcohol Dependence

The interaction of conduct problems and depressed mood in relation to adolescent substance involvement and peer substance use

https://doi.org/10.1016/j.drugalcdep.2008.03.012Get rights and content

Abstract

Conduct problems are strong positive predictors of substance use and problem substance use among teens, whereas predictive associations of depressed mood with these outcomes are mixed. Conduct problems and depressed mood often co-occur, and such co-occurrence may heighten risk for negative outcomes. Thus, this study examined the interaction of conduct problems and depressed mood at age 11 in relation to substance use and problem use at age 18, and possible mediation through peer substance use at age 16. Analyses of multirater longitudinal data collected from 429 rural youths (222 girls) and their families were conducted using a methodology for testing latent variable interactions. The link between the conduct problems × depressed mood interaction and adolescent substance use was negative and statistically significant. Unexpectedly, positive associations of conduct problems with substance use were stronger at lower levels of depressed mood. A significant negative interaction in relation to peer substance use also was observed, and the estimated indirect effect of the interaction on adolescent use through peer use as a mediator was statistically significant. Findings illustrate the complexity of multiproblem youth.

Introduction

This study examined the extent to which conduct problems and depressed mood interact to influence substance use and problem substance use among adolescents, and tested the degree to which peer substance use potentially mediates these links. Although rates of use for certain substances have been declining in recent years among teens in many developed countries, overall levels of substance use remain unacceptably high (Hibell et al., 2004). To illustrate, 77% of high school seniors in the United States had used alcohol at some point in their lifetimes in 2004, 53% had used cigarettes, and 46% had used marijuana/hashish (Johnston et al., 2005). Alcohol and tobacco currently are among the top contributors to global disease burden as measured by disability-adjusted life years (World Health Organization, 2002). Many substance users do not progress to problem substance use, which refers to the experience of adverse consequences, such as relationship difficulties or school troubles, that result from substance consumption. However, those who do experience problem use are at risk for continued difficulties, including the development of substance-related disorders (Lewinsohn et al., 1996) as defined in the International Statistical Classification of Diseases and Related Health Problems (ICD-10, World Health Organization, 2004) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, American Psychiatric Association, 2000).

Research has identified risk and protective factors across individual, peer, school, family, and community domains that are associated with teen substance use (Hawkins et al., 1992). Less is known about risk and protective factors for problem substance use (Stice et al., 1998). Identifying predictors of problem use may be useful for the development of interventions that target key factors to reduce the harms that can result from substance use (Toumbourou et al., 2007). For example, Newcomb and Bentler (1989) suggested from their review of the literature at the time that internal psychological processes (e.g., self-medication of depressed mood) may play an important role in problem substance use. Recently, investigators have begun to elucidate psychological and behavioral conditions, such as conduct problems and depressed mood, that increase risk for the full range of substance involvement, including use, problem use, and substance-related disorders (Glantz and Leshner, 2000).

Conduct problems, whether they are measured categorically or dimensionally, are common among teens. Conduct problems typically precede the initiation of substance involvement (Huba and Bentler, 1983, Kuperman et al., 2001), and manifestations of conduct problems, such as delinquency, positively predict substance use (Mason and Windle, 2002, Ellickson and Hays, 1991, King et al., 2004, Shedler and Block, 1990), problem use (Stice et al., 1998, White, 1992, Windle, 1990), and substance-related disorders (Harford and Muthén, 2000). For example, prior analyses of data from the current longitudinal project have shown that self-reported delinquency as early as age 11 was an indirect positive predictor of problem substance use at age 18 through elevated alcohol use at age 16 for boys and girls in this rural adolescent sample (Mason et al., 2007b). These findings are consistent with developmental theories suggesting that early antisocial behavior provides an important pathway leading to the development of substance-related disorders (Tarter and Vanyukov, 1994, Zucker, 1994).

Adolescent major depression is another prevalent DSM disorder that has been shown to be associated with substance use (Boys et al., 2003), as well as with substance-related disorders (Armstrong and Costello, 2002, Marmorstein and Iacono, 2001). Some research suggests that when substance abuse co-occurs with depression, the onset of depression tends to precede the onset of substance abuse (Clark and Mokros, 1993, Deykin et al., 1986). Likewise, subclinical depressed mood is relatively common among teens, and there is some evidence that elevated levels of depressed mood increase risk for substance use (King et al., 2004, Wills et al., 1999, Windle and Windle, 2001), problem use (Stice et al., 1998), and substance-related disorders (Lewinsohn et al., 2000, Costello et al., 1999). In our own research on the current sample (Mason et al., 2007b), depressed mood as early as age 11 positively predicted problem substance use at age 18 among females, controlling for delinquency.

These findings may be consistent with the self-medication hypothesis (Khantzian, 1985), which states that some depressed individuals turn to substance use as a way to alleviate the symptoms of their depression. Similarly, it has been suggested that indicators of negative affect, in addition to antisociality, may provide another important developmental pathway leading toward substance-related disorders (Tarter and Vanyukov, 1994, Zucker, 1994). However, findings regarding the predictive associations of depressed mood with adolescent substance use and problem use are much less consistent than those for conduct problems. For example, some investigators have failed to find links between depressed mood and adolescent substance use and problem use (Brook et al., 1998, Clark et al., 1999, Hansell and White, 1991), especially when controlling for conduct problems and related confounding factors (Capaldi and Stoolmiller, 1999, Fergusson and Woodward, 2002, Stice et al., 1998). Findings from these latter studies are noteworthy because they illustrate the importance of considering both conduct problems and depressed mood together in relation to adolescent substance involvement. Most studies have focused on one of these predictors in isolation from the other.

As stated by Sroufe (1997), comorbidity of disorders is the rule, not the exception for youth. In this regard, studies have found that conduct disorder and major depression often co-occur among adolescents (Kovacs et al., 1988, Loeber and Keenan, 1994). Similarly, teens often display elevated levels of severity in conduct problems and depressed mood, and the co-occurrence of conduct problems and depressed mood is particularly common, possibly placing individuals at heightened risk for adverse outcomes (Capaldi, 1991). In our own project work (Mason et al., 2007b), we have only examined estimated additive effects of delinquency, as one indicator of conduct problems, and depressed mood on adolescent substance involvement. A few studies have examined the interaction of conduct problems and depressed mood in relation to specific adjustment outcomes (Capaldi, 1991, Capaldi, 1992, Marmorstein and Iacono, 2001, Marmorstein and Iacono, 2003, Miller-Johnson et al., 1998, Capaldi and Stoolmiller, 1999, Pardini et al., 2007), but findings are mixed, especially for substance use.

Pardini et al. (2007) found that early adolescent depressive symptoms positively predicted young adult alcohol use disorder symptoms and diagnoses only among those who also displayed high levels of early adolescent conduct disorder symptoms in a sample of high-risk boys. Similarly, Marmorstein and Iacono, 2001, Marmorstein and Iacono, 2003 found that, compared with either disorder in isolation, comorbid conduct disorder and major depression predicted greater maladjustment in several domains, including substance dependence, among a community sample of adolescent twins. These studies are consistent with the hypothesis that the co-occurrence of multiple problems heightens risk for negative outcomes (Lewinsohn et al., 1995, Riggs et al., 1995). However, Capaldi and Stoolmiller (1999) failed to find statistically significant estimated interactive effects of adolescent conduct problems and depressive symptoms on later substance use (see also, Capaldi, 1992). Miller-Johnson et al. (1998) examined tobacco, alcohol, and marijuana use across Grades 6, 8, and 10 among a sample of African American teens categorized into groups according to their levels of conduct problems and depressive symptoms. Although they reported some instances in which risk for substance use was greatest in the comorbid conduct problems and depression group, the authors also noted instances in which risk was no greater in the comorbid group compared to the conduct-problems-only group.

Mixed findings regarding the interaction of conduct problems and depressed mood might be due to several factors, including variation in sample characteristics across studies; previous studies have recruited, for example, clinical (e.g., Riggs et al., 1995) and high-risk (e.g., Capaldi, 1991) youth. Less focus has been placed on longitudinal studies of general community samples of youth. Differences in the definition and measurement of key constructs across studies also might explain mixed findings in this literature, with some research focusing on the categorical assessment of ICD and DSM disorders (e.g., Marmorstein and Iacono, 2001) and other research focusing on the dimensional assessment of subclinical problems (Capaldi and Stoolmiller, 1999). Finally, mixed findings might be due to certain methodological limitations of prior studies. In particular, the difficulty of finding significant interactions within field research is well known (e.g., McClelland and Judd, 1993). This difficulty is due, in part, to the presence of measurement error in the constructs used to assess interactions (Jaccard and Wan, 1995). Thus, latent variable analyses that correct for measurement error are needed.

Although some studies have reported statistically significant estimated interactive effects of conduct problems and depressed mood on substance involvement, the potential mediating mechanisms involved in these associations have not yet been examined. Co-occurring conduct problems and depressed mood may be associated with increased risk for problems in several domains of life (Capaldi, 1992, Marmorstein and Iacono, 2003), especially within the peer domain during adolescence due to the increased salience of peer influences during this developmental period (Steinberg and Morris, 2001). For instance, teens who are elevated on both conduct problems and depressed mood may have difficulty forming and maintaining prosocial relationships with conventional peers; instead, such teens may gravitate toward deviant peer networks (Kaplan, 1975, Kaplan, 1980, Patterson et al., 2000). Association with substance-using peers, in particular, is a strong risk factor for substance use (Brook et al., 1989, Farrell and White, 1998) and problem use (Mason et al., 2007a).

Adopting a dimensional approach, with problem areas measured on a continuum of severity, the first objective of this study was to examine, using latent variable modeling techniques, the interaction of early adolescent (age 11) conduct problems and depressed mood and consequences for late adolescent (age 18) substance use and problem substance use among a community sample of rural adolescents. Identifying early adolescent predictors of late adolescent substance use and problem use may provide information useful for designing efficacious, developmentally timed interventions to prevent substance involvement. Notwithstanding the importance of early adolescence, the consequences of co-occurring problems for substance involvement may be particularly salient when the overall levels of conduct problems and depressed mood are elevated during the teen years (Windle and Windle, 2001). Thus, a series of supplemental analyses was conducted under objective 1 to examine the interaction of trait-like conduct problems and depressed mood, measured as averages across four time points extending from age 11 to age 16.

Note that the purpose of this investigation was to examine the consequences of conduct problems and depressed mood for the development of a general orientation to substance use and the experience of problems associated with such use among teens. Thus, substance use was defined as a latent variable indexing use versus nonuse of alcohol, tobacco, and marijuana. These are the three most prevalent forms of adolescent substance use (Johnston et al., 2005), and research shows that multiple substance use among teens is common (Newcomb, 1992).

Although findings have been mixed, we expected that the interaction of conduct problems and depressed mood would heighten risk for later substance use and problem use. Because problem use requires some level of substance intake (Stice et al., 1998), analyses tested for possible indirect associations of the predictors, especially the interaction of conduct problems and depressed mood, with problem use through substance use.

The second objective of this study was to begin exploring peer substance use as a possible mechanism linking co-occurring conduct problems and depressed mood in early adolescence (age 11) with substance involvement in late adolescence (age 18). Biddle et al. (1980) found that, whereas parental influence on alcohol use was strong in early adolescence at an average age of 12.9 years, peer influence was most important in middle adolescence at an average age of 15.2 years. Thus, peer substance use in mid-adolescence (measured at age 16 in the current study) may be one mediating link in the association of the conduct problems × depressed mood interaction with adolescent substance involvement. Identifying the mechanisms linking earlier risks with later outcomes may provide information useful for the development of preventive interventions designed to interrupt the progression from conduct problems and depressed mood to substance involvement. We expected that if conduct problems and depressed mood have a statistically significant estimated interactive effect on either substance use or problem use, regardless of the pattern of the interaction, then that effect might be mediated through peer substance use.

Analyses included early-onset substance use, parental problem drinking, gender, and parent education as covariates to capture early adolescent propensity for experiencing adverse consequences related to substance use. Early-onset substance use is a risk factor for the development of problem use (Nelson and Wittchen, 1998, Hawkins et al., 1997), and inclusion of this variable in the analyses helped control for the stability of substance use over the time frame of the study. Most likely through a combination of heritable and environmental mechanisms (Hopfer et al., 2003), parental problem drinking increases risk for substance use and problem use among teens (Chassin et al., 1999). Although similarities in rates of substance use initiation for boys and girls have been documented (Barnes et al., 1993), boys tend to have higher rates of problem use relative to girls (Regier et al., 1990); therefore, gender was included as a covariate. Finally, analyses controlled for parent educational attainment, which has been shown to be associated with missingness in the current study.

Section snippets

Participants

Data were drawn from a larger longitudinal study of rural adolescents and their families, some of whom participated in a universal substance use prevention program.1

Model specification

The hypothesized model to address study objective 1 was guided by the research of Klein and his colleagues (Klein and Moosbrugger, 2000, Klein and Stoolmiller, 2003), and is illustrated in Fig. 1.4

Discussion

Findings from latent variable analyses revealed an interaction of conduct problems and depressed mood at age 11 in relation to substance use at age 18, illustrating the importance of considering these behavioral and psychological problems together rather than in isolation (Capaldi, 1991, Kovacs et al., 1988, Loeber and Keenan, 1994). Contrary to the expectation that conduct problems and depressed mood would synergistically increase the likelihood of later problems as evidenced by a positive

Conflict of interest

None.

Acknowledgements

This research was supported by a grant from the National Institute on Drug Abuse (5R01DA018158-02). The authors would like to thank Jennifer A. Bailey, Eric C. Brown, Charles B. Fleming, and Rick Kosterman for their comments on earlier drafts of this paper.

Role of funding sources: The NIDA had no further role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the paper for publication.

Contributions: W. Alex

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