Association of Lifetime Mental Disorders and Subsequent Alcohol and Illicit Drug Use: Results From the National Comorbidity Survey–Adolescent Supplement

doi:10.1016/j.jaac.2016.01.006

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 55, Issue 4, April 2016, Pages 280-288

https://doi.org/10.1016/j.jaac.2016.01.006 Get rights and content

Objective

To estimate the association of prior lifetime mental disorders with transitions across stages of substance use in a cross-sectional, nationally representative sample of US adolescents.

Method

The sample includes 10,123 adolescents aged 13 to 18 years who participated in the National Comorbidity Survey–Adolescent Supplement (NCS-A), and who were directly interviewed with the Composite International Diagnostic Interview (CIDI) Version 3.0 that generates criteria for DSM-IV disorders.

Results

Adolescents with prior lifetime mental disorders had high rates of both alcohol (10.3%) and illicit drug (14.9%) abuse, with or without dependence. Alcohol and drug abuse were highest among adolescents with prior anxiety disorders (17.3% and 20%, respectively) and behavior disorders (15.6% and 24%, respectively). Any prior disorder significantly increased the risk of transition from nonuse to first use, and from use to problematic use of either alcohol or illicit drugs. Multivariate models attenuated the magnitude of the risk of transition associated with each disorder, although prior weekly smoking and illicit drug use demonstrated significant risks of transitions across the 3 stages of alcohol or drug use, as did behavior disorders.

Conclusion

The findings provide the first evidence from a nationally representative sample that prior mental disorders represent risk factors for the transition from nonuse to use, and the progression to drug- and alcohol-related problems. Treatment of primary mental disorders is likely to be an important target for the prevention of secondary substance use disorders in youth.

Section snippets

Sample and Procedure

The NCS-A is a cross-sectional, nationally representative, face-to-face survey of 10,123 adolescents aged 13 to 18 years in the continental United States.³⁷ The survey was administered by trained lay interviewers from the Institute for Social Research at the University of Michigan. The NCS-A was carried out in a dual-frame sample that included a household subsample and a school subsample.38, 39, 40 The overall NCS-A adolescent response rate combining the 2 subsamples was 75.6%.³⁸ The

Prevalence of Alcohol and Drug Use Stages Among Adolescents With Prior Mental Disorders

In all, 37.7% of adolescents experienced at least 1 mental disorder before the first use of alcohol, 47.6% before regular alcohol use, and 66.6% before alcohol abuse with or without dependence. The percentage of adolescents for whom the prior disorder persisted into the year of onset for each of these stages was respectively 11.3%, 9.4%, and 7.8%. For drug use categories, 41.2% of adolescents met criteria for at least 1 mental disorder before having the opportunity to use drugs, 53.8% before

Discussion

Despite converging evidence that most lifetime cases of substance use disorders are likely to begin in adolescence1, 5, 7, 45 and that prior mental disorders constitute a major risk factor for these conditions,22, 23, 24, 25, 30, 31, 32, 33, 34, 35 the majority of information for these forms of lifetime comorbidity in nationally representative samples has been acquired from adult respondents. Moreover, information on patterns of substance use in representative samples of adolescents has

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: This article is discussed in an editorial by Dr. Karen M. Abram on page 265.

: This article can be used to obtain continuing medical education (CME) at www.jaacap.org.

: An interview with the author is available by podcast at www.jaacap.org or by scanning the QR code to the right.

: This work was supported by the Intramural Research Program of the National Institute of Mental Health (Z01MH002808-08). The National Comorbidity Survey Adolescent Supplement (NCS-A) and the larger program of related NCS surveys are supported by the National Institute of Mental Health (U01-MH60220). The views and opinions expressed in this article are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or US government.

: Ms. He served as the statistical expert for this research.

: Disclosure: Drs. Conway, Swendsen, Husky, Merikangas, and Ms. He report no biomedical financial interests or potential conflicts of interest.

View full text

New researchAssociation of Lifetime Mental Disorders and Subsequent Alcohol and Illicit Drug Use: Results From the National Comorbidity Survey–Adolescent Supplement

Objective

Method

Results

Conclusion

Section snippets

Sample and Procedure

Prevalence of Alcohol and Drug Use Stages Among Adolescents With Prior Mental Disorders

Discussion

Comp Psychiatry

Prev Med

Gend Med

J Am Acad Child Adolesc Psychiatry

Drug Alcohol Depend

Drug Alcohol Depend

J Am Acad Child Adolesc Psychiatry

Drug Alcohol Depend

Drug Alcohol Depend

Use and abuse of alcohol and illicit drugs in U.S. adolescents: results of the National Comorbidity Survey–Adolescent Supplement

Arch Gen Psychiatry

Smoking, alcohol use, and illicit drug use reported by adolescents aged 12-17 years: United States, 1999-2004

Natl Health Stat Report

Monitoring the Future National Survey Results on Drug Use, 1975-2008: Volume I. Secondary School Students

Results from the 2010 National Survey on Drug Use and Health (NSDUH): Summary of National Findings

Racial/ethnic differences in the relationship between parental education and substance use among U.S. 8th-, 10th-, and 12th-grade students: findings from the Monitoring the Future project

J Stud Alcohol Drugs

SAMHSA releases Behavioral Health, United States, 2012

Psychiatr Serv

Lifetime co-morbidity of DSM-IV disorders in the US National Comorbidity Survey Replication Adolescent Supplement (NCS-A)

Psychol Med

Gender and ethnic differences in smoking, drinking and illicit drug use among American 8th, 10th and 12th grade students, 1976-2000

Addiction

Results from the 2013 National Survey on Drug Use and Health: Summary of National Findings

Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Arch Gen Psychiatry

Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions

J Clin Psychiatry

Prevalence, correlates, disability, and comorbidity of DSM-IV alcohol abuse and dependence in the United States: results from the National Epidemiologic Survey on Alcohol and Related Conditions

Arch Gen Psychiatry

Familial transmission of substance use disorders

Arch Gen Psychiatry

Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study

JAMA

Lifetime prevalence and age-of-onset distributions of mental disorders in the World Health Organization's World Mental Health Survey Initiative

World Psychiatry

New research
Association of Lifetime Mental Disorders and Subsequent Alcohol and Illicit Drug Use: Results From the National Comorbidity Survey–Adolescent Supplement