Psychiatric comorbidity in hospitalized adolescent substance abusers

Co-occurrence of psychiatric disorders was investigated among 52 adolescent substance abusers and 23 non-substance-abusing adolescents with conduct and/or oppositional defiant disorders, admitted to the same inpatient facility.

During independent face-to-face interviews with parent(s) or caretaker(s) and subjects, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version was administered to collect data on substance abuse, psychopathology, and sociodemographic characteristics, such as age, gender, home situation, and psychosocial stressors. A semistructured interview was used to identify the presence of substance abuse and other psychopathology among first-degree family members. Substance abuse was diagnosed according to both DSM-III-R and Halikas criteria.

Excluding conduct and oppositional defiant disorders, 85% of the substance abusers versus 65% of the non-substance abusers demonstrated psychiatric comorbidity. Substance abusers had a higher incidence of dysthymia, major depression, social phobia, and "other" diagnoses than did the comparison group (p < .05), in which oppositional defiant disorder, conduct disorder, and attention-deficit hyperactivity disorder prevailed. Overanxious disorder was predominant among female (p = .022) and conduct disorder among male substance abusers (p < or = .002). Psychopathology preceded or coincided with substance abuse, except for major depression. No correlation between the severity and type of substance abuse and the number and degree of various coexisting psychopathologies was found. Psychopathology in parents and siblings of substance abusers was similar to that of non-substance abusers.

These data indicate that adolescent substance abusers are at high risk for comorbid psychopathology and need to be carefully evaluated for psychiatric comorbidity to provide them with a comprehensive treatment plan.