Preadolescent children of substance-dependent fathers with antisocial personality disorder: psychiatric disorders and problem behaviors

We compared psychiatric disorders and problem behavior scores in pre-adolescent children of fathers with alcohol or other drug dependence and ASP (SD+/ASP+), children whose fathers had substance dependence without ASP (SD+/ASP-), and children whose fathers were without either disorder (SD-/ASP-). SD+/ASP+ children showed elevated rates of major depression, conduct disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, and separation anxiety disorder when compared to SD+/ASP- and SD-/ASP- children. SD+/ASP+ children had higher internalizing and externalizing problem behavior scores than the other two groups of children. The results suggest that SD+/ASP+ children are at significant risk for internalizing and externalizing psychopathology.

Comorbid disruptive behavior disorder symptoms and their relationship to adolescent alcohol use disorders

This investigation evaluated the relationship between comorbid Disruptive Behavior Disorder (DBD) and Alcohol Use Disorder (AUD) symptoms in adolescents. The factor structure of both DBD and AUD symptoms was evaluated and a structural model then examined the relationships between comorbid DBD symptoms and AUD symptoms. A full model and a sex differentiated model were evaluated. For the full model, only Conduct Disorder (CD) symptoms were associated with AUD symptoms. In the sex differentiated model, male adolescents demonstrated direct effects of CD and Attention Deficit Hyperactivity Disorder (ADHD) on AUD. For female adolescents we found only a robust direct effect of CD on AUD. We concluded that CD symptoms have the strongest concurrent association with AUD symptoms in adolescents. However, there is preliminary evidence of sex heterogeneity.

Serotonin, impulsivity, and alcohol use disorders in the older adolescent: a psychobiological study

BACKGROUND

Alcohol use disorders (AUDs) among adolescents are associated with a high prevalence of conduct disorder (CD), much as type II alcoholism in adults is associated with impulsive-aggressive behavior and antisocial personality traits. Adults with impulsive personality disorders and AUD demonstrate diminished central serotonergic responsiveness to serotonergic agonists. Dysregulation of central serotonergic function may contribute to a vulnerability to impulsive-aggressive behavior, CD, and AUD. We studied older adolescents, both male and female, to examine the relationships between sex, dispositional impulsivity, aggressivity, CD, and responsiveness to serotonergic challenge with d,l fenfluramine (FEN) early in the development of AUD.

METHODS

Thirty-six adolescents between the ages of 16 and 21 years were assessed for DSM-IV AUD and other Axis I disorders by using the Psychoactive Substance Use Disorders section of the Structured Clinical Interview for DSM III-R, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, and CD interviews. Impulsivity and aggressivity were assessed by the Barratt Impulsiveness Scale, Lifetime History of Aggression, Buss-Durkee Hostility Inventory, Eysenck Impulsiveness Questionnaire, Youth Self Report, and Multidimensional Personality Questionnaires. FEN was administered as 0.8 mg/kg to a maximum of 60 mg, and blood was sampled at fixed intervals for prolactin, cortisol, fenfluramine, and norfenfluramine levels.

RESULTS

Eighteen adolescents (12 male, 6 female) with AUD scored significantly higher on all measures of impulsivity and aggressivity compared with 18 healthy controls (12 male, 6 female). There were no significant differences between groups in peak prolactin or cortisol responses (minus baseline), or area-under-the-curve determinations (AUC); however, 9 subjects with AUD and comorbid CD had significantly elevated cortisol AUC levels compared with subjects with AUD and no CD or with normal controls. In the total sample, cortisol AUC was associated positively with measures of aggression.

CONCLUSIONS

Adolescents with early-onset AUD are characterized by impulsivity and aggressivity compared with healthy peers but do not demonstrate the diminished prolactin or cortisol responses to FEN characteristic of adult alcoholics with impulsive-aggression.

Antisociality, substance dependence, and the DRD5 gene: a preliminary study

A pilot population-based study of a microsatellite polymorphism at the DRD5 locus in adult European-Americans showed its association with childhood symptom counts for oppositional defiant disorder (ODD) in males and females and adult antisocial personality disorder (ASPD) in females. No association with childhood conduct disorder symptom count was observed. ODD mediated the genotype-ASPD relationship in females. Neither ODD nor ASPD significantly mediated the relationship between the genotype and the liability to substance dependence (SD). The data suggest involvement of the DRD5 locus in the variation and sexual dimorphism of SD liability and antisociality and in the developmental continuity of antisociality.

Platelet dense granule secretion and aggregation in adolescents with conduct disorder: effects of marijuana use

BACKGROUND

We had previously reported a decrease in agonist-induced platelet dense granule secretion in blood samples from male adolescents with and without Conduct Disorder (CD). In an augmented sample, we have now employed multivariate modeling to examine the simultaneous effects of CD and regular monthly alcohol and marijuana use on both the dense granule secretion and aggregation phases of agonist-induced platelet responses.

METHODS

Blood samples were obtained from adolescents with and without a CD diagnosis. Platelet dense granule secretion and aggregation responses to a variety of agonists were examined in the laboratory.

RESULTS

Significant multivariate interactions of CD status with regular marijuana use were found for responses to collagen, ADP alone, and ADP plus 0.2 microgram. of serotonin. Responses in platelets from youth with CD, but without regular marijuana use differed from other subjects. Multivariate main effects of marijuana use alone on platelet responses to arachidonic acid and ADP plus 1.0 microgram. of serotonin were found. No effects of alcohol use were found.

CONCLUSIONS

The results demonstrate an interaction between CD and the effects of chronic marijuana use for several agonists in this platelet model system, and further support the possibility of a variation in signal transduction mechanisms in CD.

Hormonal and behavioral homeostasis in boys at risk for substance abuse

This study modeled the influences of cortisol reactivity, androgens, age-corrected pubertal status, parental personality, family and peer dysfunction on behavioral self-regulation (BSR), in boys at high (HAR) and low average risk (LAR) for substance abuse. Differences between risk groups in cortisol and androgen concentrations, and cortisol reactivity were also examined. Subjects were 10- through 12-year-old sons of substance abusing fathers (HAR; n = 150) and normal controls (LAR; n = 147). A multidimensional construct of BSR was developed which utilized multiple measures and multiple informants. Boys reported on family dysfunction and deviant behavior among their peers. Parents reported on their propensity to physically abuse their sons, and their own number of DSM-III-R Antisocial Personality Disorder symptoms. Endocrine measures included plasma testosterone, dihydrotestosterone, and salivary cortisol. HAR boys, compared to LAR boys, had lower mean concentrations for testosterone, dihydrotestosterone, salivary cortisol prior to evoked related potential testing, and lower cortisol reactivity. The number of maternal Antisocial Personality Disorder symptoms, parental potential for physical abuse, degree of family dysfunction, and peer delinquency were significantly associated with BSR. Parental aggression antisocial personality symptoms and parental physical abuse potential are likely to influence sons' behavioral dysregulation and homeostatic stress reactivity. These key components of liability are posited to increase the likelihood of developing suprathreshold Psychoactive Substance Use Disorder (PSUD).

Salivary cortisol responses in prepubertal boys: the effects of parental substance abuse and association with drug use behavior during adolescence

BACKGROUND

The purpose of this investigation was three-fold. First, we extended our original observation of decreased cortisol reactivity to an anticipated stressor in sons of fathers with a substance use disorder (SUD). Second, we examined the hypothesis that salivary cortisol underresponsivity in these high-risk prepubertal boys is an adaptation to the stress associated with having a father with a current, rather than remitted, SUD. Third, we tested the hypothesis that prepubertal cortisol underreactivity might be associated with subsequent drug use behavior during adolescence.

METHODS

Preadolescent salivary cortisol responses were examined in the context of risk-group status, paternal substance abuse offsets, and subsequent adolescent drug use behavior.

RESULTS

The results confirmed a decreased salivary cortisol response to an anticipated stressor among sons of SUD fathers in our expanded sample. In addition, sons of fathers with a current SUD and boys whose fathers had a SUD offset from their 3rd to 6th birthdays had lower anticipatory stress cortisol levels compared with sons of control fathers. Finally, lower preadolescent anticipatory cortisol responses were associated with regular monthly cigarette smoking and regular monthly marijuana use during adolescence.

CONCLUSIONS

Hyporeactivity as an adaptation to chronic stress may be salient to the intergenerational transmission of substance abuse liability.

Segregation analysis of attention deficit hyperactivity disorder

We performed segregation analysis on 495 nuclear families, ascertained for the father's substance abuse diagnosis, in an attempt to determine the role of genetic and other influences in determining the variability of DSM-III-R-defined attention deficit hyperactivity disorder (ADHD). For our analyses, ADHD was treated as a quantitative variable, utilizing the semicontinuous scale provided by the 15-item symptom count within DSM-III-R. Analyses consisted of both class A and class D regressive models for which covariate effects (socioeconomic status) and sex dependence were estimated. Segregation analysis of the quantitative trait (ADHD symptom count) in the entire data set supported a transmissible non-Mendelian major effect. Models which were sex-dependent and included covariate effects provided the best fit to the data. In addition, similar analyses were performed on a 130-nuclear family subgroup of the data set in which at least one of the members of the nuclear family met DSM-III-R diagnostic criteria for ADHD. The sex-dependent Mendelian codominant model was best supported by the data, while other models could be rejected. Incorporating covariate effects did not provide a better fit for the data. Thus, this study is consistent with Mendelian transmission of ADHD symptom count in a clinically relevant population. Overall, our results support the presence of a heritable continuous trait of which ADHD represents an extreme.

Substance abuse and associated psychosocial problems among Argentina adolescents: sex heterogeneity and familial transmission

OBJECTIVE

The goal of this investigation was to clarify the effects of sex and familial transmission in the psychosocial concomitants of substance abuse problems among adolescents.

METHOD

Male (n = 956) and female (n = 303) adolescents in school, and male adolescents in a drug treatment program (n = 51) in Buenos Aires Province, Argentina were administered a translated version of the Drug Use Screening Inventory. Use of substances, familial substance abuse and associations between psychosocial problem domains and substance abuse problems were examined.

RESULTS

Sex heterogeneity was broadly observed in terms of both substance abuse and psychosocial problems. Female adolescents in the school-based sample were found to generally report higher levels of psychosocial problems and greater use of minor tranquillizers than school boys or boys in treatment for substance abuse. Conduct deviancy was associated with substance abuse problems only in males, while health problems were associated only in females. However, among all youth, substance abuse problems were found to be associated with older age, greater social competency, problems in school performance, and involvement with deviant peers. Familial substance abuse was associated with substance abuse problems among all adolescents, however, the pattern of associations with other psychosocial problems differed between males and females.

CONCLUSIONS

Sex heterogeneity was found in the associations between psychosocial problems, adolescent substance abuse, and familial substance abuse. Furthermore, the results are consistent with a syndrome of problem behaviors.

Executive cognitive functioning in alcohol use disorders

Executive cognitive functioning (ECF) has been identified as an important determinant in the etiology of alcoholism. ECF represents a "higher-order" cognitive construct involved in the self-regulation of goal-directed behavior. The prefrontal cortex and its subcortical connections represent the primary neurological substrate that subserves ECF. Both alcoholics and individuals at high risk for alcoholism exhibit a mild dysfunction in ECF. However, this deficit appears to be significantly stronger in alcoholics with a comorbid diagnosis of an antisocial personality disorder. Individuals with other disorders that are also highly comorbid with alcoholism, such as attention deficit hyperactivity disorder and conduct disorder, also demonstrate deficits in ECF. As such, compromised ECF may not be specific to alcoholism, but instead, might be a potential underlying etiologic substrate for a number of disorders of behavioral excess-disinhibition. Subsequent to reviewing the literature implicating ECF deficits in alcoholism and comorbid disorders, the authors present a heuristic cognitive-neurobehavioral model of alcoholism implicating the frontostriatal system. Finally, recommendations for the prevention and treatment of alcoholism, based on this model, are discussed.

Early adolescent gateway drug use in sons of fathers with substance use disorders

This study determined the relevance of preadolescent psychopathology and substance use for predicting early adolescent alcohol and cannabis involvement in boys of fathers with and without substance use disorders (SUD). Fathers of preadolescent boys (ages 10 through 12 years) were recruited to represent families of boys with paternal SUD (High Risk or HR: N = 102) and boys without paternal SUD (Low Average Risk or LAR: n = 166). These boys and a parental informant participated in semistructured diagnostic interviews at baseline and 2-year follow-up assessments (ages 12 through 14 years). Preadolescent tobacco experimentation and early adolescent regular alcohol use were more prevalent in HR than in LAR subjects. Logistic regression analyses were utilized to develop prediction equations. The presence of oppositional defiant disorder and the absence of anxiety disorders predicted preadolescent tobacco use. Preadolescent conduct disorder predicted early adolescent regular alcohol use. Preadolescent tobacco use and conduct disorder were highly predictive of early adolescent cannabis use, achieving 100% sensitivity with 76% specificity. Children with tobacco use prior to adolescence, as well as those with disruptive behavior disorders, may be important to target for interventions to prevent cannabis use.

Drug use problem awareness and treatment readiness in dual-diagnosis patients

Problem awareness and treatment readiness are factors that influence treatment-seeking behavior, and thus, morbidity and outcome. The authors elucidated patterns of problem awareness and treatment readiness among hospitalized dually diagnosed patients by administering the Problem Awareness and Readiness for Treatment subscales of the Alcohol Use Inventory to 67 psychiatric inpatients with comorbid substance-related disorders and using a multivariate model approach to data analysis. The results suggested differential and interactive effects of gender, ethnicity, voluntary admission status, and a diagnosis of major depression (MDD) on drug abuse problem awareness and treatment readiness. Female gender, voluntary admission status, and a comorbid diagnosis of MDD were associated with increased awareness and readiness for treatment.

An association between a microsatellite polymorphism at the DRD5 gene and the liability to substance abuse: pilot study

We have conducted a population-based association study of substance abuse and a microsatellite at the dopamine D5 receptor locus (DRD5) in a sample of European-American males and females with substance dependence (SA) or without any psychiatric disorder. Overrepresentation of the most frequent allele (148 bp) was found in males in the SA group (OR = 2.2, P = .02); this finding was reproduced in females (OR = 5.4, p < .001). The difference in the frequencies of this allele between SA males and SA females was statistically significant. The genotype coded in accordance with the dose of this allele correlated with substance abuse liability in males and females (stronger in females) and with novelty seeking in females. There was no evidence of correlation between the genotypes of spouses that could be induced by assortative mating for the liability to substance abuse. The data suggest that the DRD5 locus is involved in the variation and sex dimorphism of substance abuse liability.

Familial and nonfamilial factors in the prediction of disruptive behaviors in boys at risk for substance abuse

This study aims to identify (1) a core disruptive behavior disorder (DBD) postulated to presage a substance use disorder, and (2) the relative importance of parental DBD phenotypes, and familial and nonfamilial environmental factors in the determination of DBD in male children. DBD symptom counts and measures of familial and nonfamilial environmentals were collected from intact families ascertained through the presence (SA+) or absence (SA-) of substance dependence in fathers. Multivariate analyses revealed that both behavioral symptoms and environmental measures were significant discriminators of the families. In SA+ families, the child's score DBD was best predicted by magnitudes of parental dyssocial behaviors and by familial environmental factors. However, in SA- families only familial environmental factors were significant predictors of the child's DBD. These findings suggest that in addition to independent actions of familial transmissible and nonfamilial factors, strong genotype-environment interactions may determine DBD in children and that may contribute to the liability for a substance use disorder.

Phosphorus-31 magnetic resonance brain spectroscopy of children at risk for a substance use disorder: preliminary results

The purpose of this exploratory investigation was to evaluate the heuristic potential of 31P magnetic resonance spectroscopy (MRS) in elucidating a neurobiologic component of the liability for a substance use disorder (SUD). We investigated 31P MRS spectra employing chemical shift imaging (CSI) derived from four distinct anatomic brain locations (i.e. frontal, occipital, right parietal, left parietal) in three groups of peripubertal children who are hypothesized to be at increasing levels of familial SUD risk. Specifically, we studied children with a positive paternal family history of SUD and a disruptive behavior disorder (DBD) diagnosis (SUD+/DBD+; n = 10), in contrast, to those with a positive paternal SUD history in the absence of other psychopathology (SUD+/DBD-; n = 13) and matched control children from normal families (SUD-/DBD-; n = 13). In addition, we examined neurocognitive tests of our subjects to determine any associations between cognitive capacities with regional 31P MRS spectra. The highest-risk sample (SUD+/DBD+) demonstrated a diminished proportion of phosphodiesters confined to the right parietal voxel. This right parietal phosphodiester proportion correlated only with the Information Scale score on a standard intelligence test for children. This suggested a relationship between general learning ability and motivation for academic achievement and right parietal physiology in the highest-risk sample. Variations in synaptic pruning could account for this observation.

Basal plasma beta-endorphin in prepubertal sons of alcoholics and drug addicts: lack of association with problem behaviors

Several reports have speculated that variations in beta-endorphin functioning may actually proceed the development of alcoholism and other drug use disorders, and is consequently a genetic mechanism of some etiologic importance. The goal of this investigation was to determine whether differences in basal plasma beta-endorphin concentrations could be confirmed in prepubertal children naive to alcohol and drugs, yet at parental risk for alcoholism, or drug dependence. Consequently, we have examined fasting basal plasma beta-endorphin concentrations in a sample of prepubertal sons of alcoholic fathers and compared them to both our existing sample of sons of drug dependent fathers and normal control boys. In addition, we examined the relationship between plasma beta-endorphin concentrations and maternal reports of problem behaviors posited to be related to the liability for alcoholism or drug abuse. The results reveal no differences in fasting basal plasma beta-endorphin concentrations. Although the at-risk groups differ significantly from normal boys having elevated scale scores for internalizing and externalizing problem behaviors, no association between plasma beta-endorphin and these behavioral risk factors could be found. Overall, the results fail to support an inherited 'opioid deficiency hypothesis' for the development of alcoholism or drug dependence.

Event-related potential negative shift in sons of polysubstance- and alcohol-use disorder fathers

Previous research has considered event-related potentials (ERPs) in relation to liability for alcohol and other substance use. This study explored ERPs in preadolescent boys at elevated risk for substance use due to paternal history of substance abuse or dependence. Sons (age 10-12) of fathers with an alcohol-use disorder (ALC, n = 29) were matched by age, IQ, education and parental alcohol use with sons of fathers with a polysubstance abuse or dependence diagnosis (POLY, n = 37). These two groups were matched with a low-risk comparison group (LOW, n = 29) of boys whose fathers had no substance-use disorder diagnosis. No boy in the study met criteria for a substance-use disorder. ERPs were collected from midline (Fz, Cz, Pz) and parietal (P3, P4) electrode leads during an auditory oddball task. ERPs of boys from the ALC and POLY groups showed a slow negative shift prominent at Cz and Pz. This negative shift, evident by 100 ms post-stimulus and lasting for the duration of the 1000-ms recording period, overlapped temporally with N1, N2 and P3 amplitude differences distinguishing the ALC and POLY groups from the LOW group. The ALC and POLY groups differed from each other in N2 amplitude at Cz, which was larger for ALC subjects. These findings offer a possible alternative explanation for previously observed amplitude anomalies noted in children at risk for substance-use disorders and suggest new avenues of inquiry.

Psychopathology in preadolescent sons of fathers with substance use disorders

OBJECTIVE

While preadolescent children of parents with substance use disorders (SUDs) are known to have more behavior problems, depression, and anxiety than expected, psychiatric disorders in these children and their relationships with parental disorders have not been systematically investigated. This study compares the psychiatric disorders of preadolescent boys of fathers with and without SUDs and examines the relationships between offspring and parental psychopathology.

METHOD

Fathers (i.e., probands) of boys 10 through 12 years old were recruited to represent families of boys with paternal SUD (high risk or HR: n = 113) and boys without paternal SUD (low average risk or LAR: n = 170). These boys (i.e., index cases) and their biological parents participated in structured diagnostic interviews, and diagnoses were determined by the best-estimate method.

RESULTS

Disruptive behavior disorders and anxiety disorders were more prevalent in HR than in LAR index cases. Logistic regression analyses examining the relationships between parental and index case psychopathology indicated that parental childhood psychiatric disorders were more strongly predictive of index case psychiatric disorders than parental adulthood psychiatric disorders, including SUDs.

CONCLUSIONS

Inasmuch as HR boys had increased rates of disruptive behavior disorders and anxiety disorders, these disorders may be important targets for early intervention to prevent the development of SUD, as well as the morbidity associated with these disorders. Prevention efforts and studies of the transmission of liability for psychiatric disorders in children should carefully consider parental childhood characteristics.

Timing of paternal substance use disorder cessation and effects on problem behaviors in sons

The developmental timing of paternal substance use disorder (SUD) offset on internalizing and externalizing problem behaviors was examined in prepubertal sons. Analyses revealed a significant main effect of the developmental timing of SUD offset on both internalizing and externalizing problems. No differences were found between sons of control-subject fathers and SUD+ fathers whose offsets occurred before the son's sixth birthday. However, when paternal SUD extended beyond the boys' sixth year, significant increases in internalizing and externalizing problem behaviors were found. The results suggest the importance of early parental SUD intervention in prevention of the intergenerational transmission of behavioral problems.

Platelet dense granule secretion in adolescents with conduct disorder and substance abuse: preliminary evidence for variation in signal transduction

Platelet aggregation responses to agonists have been employed as peripheral indices of the physiological responsiveness and density of neurotransmitter receptors, and in investigations of membrane functioning in psychopathological conditions. In particular, there are mechanistic similarities between neuronal secretory and receptor dynamics, and those involved in platelet dense granule secretion. Consequently, we have explored the platelet dense granule secretory responses to various agonists in abstinent male adolescents who meet current psychiatric diagnostic criteria for Conduct Disorder and Psychoactive Substance. Use Disorder (CD+/PSUD+) in contrast to controls (CD-/PSUD-). The results showed a significant hyporesponsivity among experimental subjects to collagen, thrombin, adenosine diphosphate (ADP), ADP plus 0.2 microgram of serotonin, and ADP plus 1.0 microgram of serotonin. Only dense granule responses to arachidonic acid did not differentiate the groups. Taken together, the lack of agonist specificity suggests that a variation in signal transduction mechanisms could account for the observed reduction in dense granule secretion among CD+/PSUD+ adolescents. Association between dense granule secretory responses and substance use behavior, and comorbid psychiatric conditions are also examined.

Mating assortment and the liability to substance abuse

Assortative mating can exert a profound influence on the phenotypic composition of the population since it may result in an increase in the frequency of the genotypes associated with extreme phenotypes. Applied to the risk for a disorder such as substance abuse, this would mean a possibility for an increase in the risk and severity of the disorder in consecutive generations. This paper reviews the theoretical and empirical literature on mechanisms related to mate resemblance for the liability to substance abuse, sources and consequences of such resemblance, and suggests directions for further research.

Decreased serotonergic responsivity in platelets of drug-free patients with schizophrenia

We have recently developed a simplified and time-saving method to measure the magnitude of serotonin (5-hydroxytryptamine, 5HT)-amplified platelet aggregation and dense granule secretion (DGS) responses. To study the effects of neuroleptics on peripheral serotonergic function, we measured physiologic responsivity of the platelet 5HT2 receptor complex in schizophrenic patients (n = 27), both before and after haloperidol withdrawal, and also in normal volunteers (n = 18). In human platelets, 5HT amplifies the adenosine diphosphate (ADP)-induced platelet aggregation and DGS. Such an amplification was significantly enhanced in platelets from both normal volunteers and haloperidol-stabilized patients. Following haloperidol withdrawal, however, the magnitude of 5HT-amplified DGS response was no longer significant in drug-free patients, demonstrating a decreased serotonergic responsivity in schizophrenia. Moreover, in drug-free patients, the net changes of ADP-induced DGS, with and without the presence of 5HT, were correlated significantly and negatively with both Bunney-Hamburg psychosis ratings and Brief Psychiatric Rating Scale (total) scores, but not with scores on the Scale for the Assessment of Negative Symptoms. In the drug-free group, no significant difference of 5HT amplification was demonstrated between relapsed and nonrelapsed patients. The present finding thus suggests that drug-free schizophrenic patients may have a reduced physiologic responsivity mediated through the platelet 5HT2 receptor complex, which can be modified by haloperidol treatment. The pharmacologic action of haloperidol may derive in part from serotonergic mechanisms. The magnitude of 5HT-amplified DGS may be useful in the prediction of therapeutic outcome after haloperidol treatment.

Executive cognitive functioning and aggressive behavior in preadolescent boys at high risk for substance abuse/dependence

OBJECTIVE

This study had three purposes; (1) to assess the underlying factor structure of a battery of neuropsychological tests putatively measuring executive cognitive functioning (ECF) in a sample of boys at high and low risk for substance abuse/dependence; (2) to assess the relationship between ECF and aggressive behavior; and (3) to determine the interactive effects of ECF and a family history (FH) of substance dependence on aggressive behavior.

METHOD

Multiple measures of ECF and aggressive behavior were used to test these relationships in a sample of 291 10-12 year old boys with and without a FH of substance dependence.

RESULTS

Analyses indicated that the measures of ECF loaded on one factor. ECF was related to aggressive behavior even when accounting for IQ and SES. The interaction between ECF and a FH of substance dependence was also associated with aggressive behavior.

CONCLUSIONS

The central finding of this investigation indicates that ECF and its interaction with a FH of substance dependence are associated with aggressive behavior. These results suggest that violence prevention and treatment efforts in high risk groups should incorporate cognitive habilitation focusing on training in ECFs.

Executive cognitive functioning predicts reactive aggression in boys at high risk for substance abuse: a prospective study

This study assessed the ability of executive cognitive functioning (ECF) to predict reactive aggression in boys at high and low risk for substance abuse using a 2-year prospective design. ECF is defined as the self-regulation of goal-directed behavior. Reactive aggression involves impulsive hostile reactions committed with little forethought. ECF was measured using five neuropsychological tests in 198 10- to 12-year-old boys with (SA+) and without (SA-) a paternal history of substance abuse/dependence. Reactive aggression was measured, 2 years later, using a composite index of items derived from two self-report measures. It was hypothesized that ECF would predict reactive aggression, and that this relation would be stronger for the SA+ compared with the SA- boys. SA+ subjects demonstrated lower ECF scores and higher reactive aggression scores, compared with SA- controls. ECF predicted reactive aggression in the SA+ group (beta = 0.37, p = 0.001), but not in the SA- group (beta = 0.09, p = NS). This suggests that compromised ECF may be a risk factor for reactive aggression in SA+ youth. The hypothesis that the relation between ECF and reactive aggression is a manifestation of a mild dysfunction of the prefrontal cortex is discussed.

Associations of beta-endorphin with HVA and MHPG in the plasma of prepubertal boys: effects of familial drug abuse and antisocial personality disorder liability

It is well-established that the secretion of the opioid neuropeptide beta-endorphin is perturbed by the administration of various drugs of abuse. Several investigators have speculated that variations in beta-endorphin secretory regulation may precede the development of a substance use disorder, and thus be a component of the liability for substance abuse. In order to test this hypothesis, we examined fasting, morning plasma concentrations of beta-endorphin and two catecholamine metabolites in prepubertal boys naive to drugs of abuse and at elevated familial risk for a substance use disorder (SA+), and in controls (SA-). Specifically, the dopaminergic metabolite homovanillic acid (pHVA), and the noradrenergic metabolite, 3-methoxy-4-hydroxy-phenylglycol (pMHPG) were measured. Between-group differences were not found for beta-endorphin, pHVA, or pMHPG. Similarly, such differences did not differentiate sons of fathers with Antisocial Personality Disorder and controls. However, regression analysis revealed that although both pHVA and pMHPG predicted beta-endorphin concentrations to similar degrees, the directions of influence were the opposite. pHVA was found to be positively associated with beta-endorphin while pMHPG was found to be negatively associated with beta-endorphin. No between-group differences in these relationships were found. The results suggest an opponent process in catecholaminergic regulation of beta-endorphin in humans, and are consistent with observations in the central nervous system of animal models.

Psychometric evaluation of the Situational Confidence Questionnaire in adolescents: fitting a graded item response model

Self-efficacy theory has been extensively applied to alcoholism treatment, theories of relapse, and relapse prevention. Most empirical studies of perceived self-efficacy to resist heavy drinking have used the Situational Confidence Questionnaire (SCQ). Among adults, this instrument has been shown to be psychometrically sound. Little is known, however, about the psychometric properties of the SCQ in the adolescent population. We administered the SCQ to a sample of 662 adolescents to evaluate its psychometric properties. Each of the eight subscales was found to be unidimensional. Invariance of the item parameters across different groups was also examined. The reliability coefficients, based on item response theory (marginal reliability) and classical measurement theory (Cronbach alpha), were found to be high. These results demonstrate that the SCQ is appropriate for use among adolescents.

A dinucleotide repeat polymorphism at the gene for monoamine oxidase A and measures of aggressiveness

The relationship between measures of aggressiveness (personality questionnaire scales, conduct disorder diagnosis, and symptom count) and a recently discovered dinucleotide repeat length polymorphism at the monoamine oxidase type A (MAOA) gene (MAOCA-1) as a candidate locus was examined in adolescents using polymerase chain reaction. No significant correlation between aggression scales and repeat length at the MAOCA-1 marker was found, whereas the categorical diagnosis of conduct disorder showed a nonsignificant trend for an association with the marker. Alternative explanations of this trend are discussed. The data obtained suggest that the polymorphism studied is not associated with the variation in aggressiveness.

Patterns of DSM-IV alcohol abuse and dependence symptoms in adolescent drinkers

OBJECTIVE

Diagnostic criteria for alcohol use disorders have largely been developed from research and clinical experience with adults. This research was designed to describe patterns of DSM-IV alcohol use disorder symptoms, and other problem domains, in adolescents with alcohol problems.

METHOD

A modified version of the Structured Clinical Interview for the DSM (SCID) was used to assess DSM-IV alcohol abuse and alcohol dependence symptoms in 91 male and 90 female adolescent drinkers with various levels of alcohol consumption and alcohol-related problems. The SCID was expanded to assess other alcohol problem domains thought to be relevant for adolescents.

RESULTS

DSM-IV dependence symptoms showed moderate to high covariation, supporting the utility of the alcohol dependence construct in adolescence. Compared to previous reports from adult samples, some symptoms were relatively infrequent (e.g., withdrawal, medical problems). Tolerance had low specificity for the diagnosis of alcohol dependence. There was significant heterogeneity in the symptomatology of subjects with DSM-IV alcohol abuse. Although they are not in the DSM-IV criteria, alcohol-related blackouts, craving and risky sexual behavior were common in adolescents with DSM-IV alcohol dependence and abuse diagnoses.

CONCLUSIONS

The data generally support the utility of DSM-IV criteria for alcohol dependence among adolescents. However, tolerance, withdrawal and medical problems appear to present differently in adolescents than has been reported in adults. Those with DSM-IV alcohol abuse diagnoses had very heterogeneous patterns of symptomatology, suggesting limitations of the criteria for DSM-IV alcohol abuse in adolescence. Alcohol-related blackouts, craving and risky sexual behavior are common among adolescents with alcohol use disorders and are an important focus for assessment and treatment efforts.

Salivary cortisol responses and the risk for substance abuse in prepubertal boys

Investigations of adults with a psychoactive substance use disorder (PSUD) or antisocial behavior have reported diminished secretion of the adrenal "stress" hormone, cortisol. Consequently, we determined whether prepubertal sons of PSUD fathers, at high risk for later PSUD, differed from controls on salivary cortisol concentrations before, and after, an anticipated stressor. The roles of problematic behavioral disposition and state anxiety in the cortisol responses were also examined. A significant risk-group x time interaction for salivary cortisol concentrations was found, with high-risk boys secreting less salivary cortisol than controls when anticipating the task. High-risk boys also had significantly higher scores for aggressive delinquency and impulsivity that wholly accounted for the risk-group x time effect on salivary cortisol. Thus, cortisol hyporesponsivity was associated with the dysregulated behaviors prevalent among high-risk boys. The results suggest that cortisol hyporesponsivity could be a "marker" for later antisociality and PSUD.

Event-related potentials and alpha synchronization in preadolescent boys at risk for psychoactive substance use

Numerous studies have evaluated event-related potentials (ERPs) as biological indicators of the liability for alcoholism. This study extends that approach by investigating ERPs in boys at risk for other substance use disorders. Prepubertal (10-12 years) sons of fathers diagnosed with psychoactive substance dependence (n = 28) were compared to matched sons of nonaffected fathers (n = 26) on an auditory ERP oddball task. Multivariate analyses of variance applied to peak amplitude and latency measures indicated small to moderate between-groups differences at midline or parietal sites: N2 and P3 amplitude; P2, N2, P3, and Nc latency. This replicated P3 amplitude findings in alcoholism-risk studies, though the effect size was moderate. Analysis of event-related alpha power indicated significantly longer latency of alpha synchronization and oscillations of desynchronization in boys at risk. The alpha power findings were statistically the more robust of the measures applied. The role of neurocognitive factors in determining liability for substance use disorders is discussed.

Aggressivity in adolescent alcohol abusers: relationship with conduct disorder

Several longitudinal and retrospective studies have documented an association between premorbid aggression and an increased risk for an alcohol-use disorder in adulthood. However, few data are available examining the relationship between trait aggressivity, alcohol use behavior, and the presence of an early-onset alcohol use disorder diagnosis among the adolescent population. To address this deficiency, this study had three goals. First, the relationship between aggressivity and adolescent alcohol consuming behavior was examined. Second, the presence and magnitude of trait aggressivity were determined among adolescents who met psychiatric diagnostic criteria for alcohol abuse/dependence (ALC), while controlling for the presence of a conduct disorder (CD). Third, because CD is overrepresented among adolescent alcohol abuse cases and is a priori defined by the presence of certain aggressive behaviors, the simultaneous contributions of CD and ALC on trait aggressivity were also investigated through structural equation modeling. The results confirm the salience of heightened aggressivity as an essential feature of this early-onset alcohol-abusing population and indicate the importance of addressing this behavioral domain in prevention and treatment efforts.

Aggressivity among sons of substance-abusing fathers: association with psychiatric disorder in the father and son, paternal personality, pubertal development, and socioeconomic status

An association between childhood aggression and risk for subsequent development of a substance abuse disorder is now well-accepted. In order to better understand the relationship between the presence of paternal substance abuse and aggression among their offspring, 10-12 year old sons of fathers with (n = 34) and without (n = 39) a history of a substance abuse disorder were contrasted on demographics, aggressivity, biological indices of reproductive maturation, and the presence of psychiatric diagnoses. In addition, personality factors, the potential for physical abuse, and psychiatric diagnoses were also ascertained among their fathers. Sons of substance-abusing fathers were found to be significantly more aggressive than sons of nonsubstance abusers. However, they also differed from comparison boys on the basis of SES and school grade attained, as well as the proportion with specific psychiatric disorders. Substance-abusing fathers differed from nonsubstance-abusing men in terms of personality factors and the presence of specific psychiatric disorders, including antisocial personality. They also showed significantly higher child abuse potential scores. A multiple regression analysis of factors contributing to aggression in the boys revealed that a paternal personality factor characterized by stress reactivity, alienation, and aggression was the most robust contributor to aggression among the boys. The boys' diagnoses of attention deficit disorder, oppositional defiant disorder, and lower household socioeconomic status were also significant predictors of aggressivity. Contrary to expectations, paternal, psychiatric diagnoses, substance abuse status, and potential for physical abuse were noncontributory. The results suggest potential mechanisms by which both aggression and risk for substance abuse may be transmitted from father to son.

Prepubertal sons of substance abusers: influences of parental and familial substance abuse on behavioral disposition, IQ, and school achievement

In order to better understand the transgeneration liability for a substance abuse disorder, we investigated the impact of parental and familial substance abuse disorders on prepubertal boys. Specifically, the influence of each parent's substance abuse history and the effects of significant family aggregation of substance abuse disorders were tested as predictors of the child's behavioral disposition, IQ, and school achievement scores, while controlling for socioeconomic status (SES). Sons of substance abusing fathers were found to have higher externalizing and internalizing problem-behavior scores, lower IQ scores, and lower school achievement scores. Internalizing and externalizing problem-behavior scores were most strongly associated with bilineal parental substance abuse, whereas SES and paternal substance abuse were most strongly associated with IQ and school performance scores. The results are compatible with the hypothesis that although paternal substance abuse has an adverse impact on the son's functioning, bilineal parental substance abuse is associated with the greatest behavioral deviancy among prepubertal males and is associated with a greater liability for substance abuse.

Preliminary evidence for an association of a dinucleotide repeat polymorphism at the MAOA gene with early onset alcoholism/substance abuse

An association between the liability to early onset alcoholism/substance abuse and a recently discovered dinucleotide repeat length polymorphism at the MAOA gene (MAOCA-1) was examined using polymerase chain reaction (PCR). A significant correlation between the presence/absence of the disorder and the length of the MAOCA-1 repeat was found in males, but not females, with "long" alleles (repeat length above 115 bp) associated with both increased risk for the disorder and lower age of onset of substance abuse. These preliminary data suggest that further exploration of the relationship between the MAOA gene and behavioral traits in an expanded sample is warranted.

Temperament-induced father-son family dysfunction: etiological implications for child behavior problems and substance abuse

The impact on family dysfunction and child behavior problems of difficult affective temperament in fathers and sons was investigated. In preadolescent sons of both substance-abusing and non-substance-abusing fathers, temperament was found to mediate the relationship between family history of substance abuse and family dysfunction.

Aggressivity, inattention, hyperactivity, and impulsivity in boys at high and low risk for substance abuse

Aggressivity, inattention, hyperactivity, and impulsivity are cardinal dimensions of externalizing behavior problems of childhood. They are diagnostic and clinical features of childhood disorders, and are thought to be linked to the subsequent development of adult disorders such as substance abuse (SA). Little is known, however, about the convergent and discriminant validity of these four constructs. We used multiple measures to develop indices of aggressivity, inattention, hyperactivity, and impulsivity in a sample of 10- to 12-year-old boys (N = 183) with and without a family history of SA. Data were taken from mother reports, child reports, teacher reports, and laboratory tasks. The study aims were (1) to test the convergent and discriminant validity of aggressivity, inattention, hyperactivity, and impulsivity; (2) to examine whether the data were consistent with a model specifying the four constructs as indicators of one superordinate factor; and (3) to differentiate boys with and without a family history of SA in construct scores. The results supported the convergent and discriminant validity of the four constructs. Although discriminable, the constructs covaried strongly and were consistent with a model specifying them as indicators of a single superordinate factor. Boys with a family history of substance abuse scored higher than control boys on aggressivity, inattention, and impulsivity scores, but the groups did not differ on hyperactivity scores. The results are discussed in terms of the role of childhood behavior problems in vulnerability to SA.

Familial resemblance for psychoactive substance use disorders: behavioral profile of high risk boys

Familial transmission plays an etiologically important role in psychoactive substance use disorders (PSUD). The delineation of the risk status of families is central to implementation of the "high risk paradigm" in studying liability characteristics for PSUD. We have utilized a latent variable approach to characterizing familial resemblance for PSUD which incorporates elements of both the affected parent design, as well as a genetic epidemiologic indicator of familial aggregation of disease. Family resemblance scores were computed for 175 families in which fathers either met diagnostic criteria for PSUD or did not. We then compared the problem behavior profiles of 10-12 year-old boys grouped by familial resemblance for PSUD, and by paternal PSUD only. Boys grouped by paternal PSUD only had higher problem behavior scores than controls across all scales except for somatic complaints. Boys from families that have significant PSUD familial resemblance were characterized by higher scores on measures of externalizing conduct and socialization problems. Thus, the familial resemblance approach was more specific for the externalizing problem behaviors that have been described in longitudinal studies of childhood risk factors for later substance abuse.

A neuropsychologic profile of adolescent alcoholics

Male and female adolescents who qualified for a DSM-III-R diagnosis of Alcohol Abuse or Dependence and a control sample of nonalcohol-abusing male and female adolescents were administered a battery of intellectual, achievement, and neuropsychologic tests. Alcohol-abusing adolescents were found to have significantly lower verbal and full-scale IQ scores than controls. Furthermore, alcohol-abusing adolescents were found to have a trend toward lower age-standardized scores on achievement tests of reading ability and spelling. Surprisingly, alcohol-abusing adolescents made less perseverative errors and commission errors on a learning and memory task than controls. Control males performed worse on the Wisconsin Card Sort than alcoholic males, whereas alcohol-abusing females performed worse than control females. In addition, alcoholic subjects scored better than controls on a measure of visual memory sensitivity. The results indicate that adolescent alcohol abusers in general have poorer language skills than adolescents who do not abuse alcohol. However, in contrast to results obtained from studies of adult alcoholics, there is little evidence of significant brain damage as revealed by using neuropsychologic test performance.

Effects of a history of heavy alcohol consumption on Alzheimer's disease

Neuropsychological and psychiatric evaluations were made of 39 subjects with possible Alzheimer's disease and a history of excessive alcohol consumption (AD + ETOH), who had been abstinent or had drunk minimally for at least three months before evaluation, and 225 patients with probable Alzheimer's disease (PAD) of comparable age, years of education, and baseline global impairment. At baseline, there were no significant differences between the groups in terms of age of onset of dementia, neuropsychological test scores, or current behavioural or psychiatric symptoms. One year later, no differences in rates of decline between 20 abstinent AD + ETOH patients and 88 PAD subjects could be shown. Thus, past heavy alcohol consumption does not appear to modify the presentation of dementia of the Alzheimer's type, nor does it modify progression over a one-year interval.

Measurement of acute tolerance to alcohol in human subjects

Acute tolerance can be defined as a decrease in response to alcohol within a single exposure to the drug, which occurs independently of changes in blood alcohol concentrations (BACs). BACs change over time in most human alcohol administration studies, and computational techniques that account for these changes must be used to measure the rate of acute tolerance development. The most widely used acute tolerance measure in human research is often called the Mellanby effect, and involves the comparison of responses at the same BAC on the ascending and descending limbs of the blood alcohol curve. We compared the Mellanby measure with two other measures of acute tolerance: a conceptually similar area under the curve measure, and a slope function approach that used data only from the descending limb of the blood alcohol curve. The measures were intercorrelated and discussed with regard to empirical and conceptual issues. Exploratory comparisons of those with and without a family history of alcoholism are reported. Methodological recommendations for the computation of acute tolerance are made. The results suggest new methods for measuring the rate of acquisition of acute tolerance, and suggest areas for future research on tolerance-proneness and risk for alcoholism.

Sexual functioning of male anabolic steroid abusers

The effects of anabolic steroid use on male sexual behavior were assessed using a structured clinical interview administered to male body builders currently using steroids, and to two comparison groups (body builders with a past but not current history of steroid use, and a group of "natural" body builders who had never used steroids). Current anabolic steroid users had a significantly higher coital and orgasmic frequency than did comparison athletes. They also reported a significantly higher incidence of erectile difficulties during the past month. Beliefs concerning the sexually stimulating effects of steroids did not correlate with the frequencies of specific sexual behaviors. The data support the contention that anabolic steroids, as androgenic compounds, enhance sexual desire.

Antisocial symptoms in preadolescent boys and in their parents: associations with cortisol

Conduct disorder (CD) symptom counts in preadolescent boys, and antisocial personality disorder (ASP) and childhood conduct disorder symptom counts in their parents, were used as dimensional measures of behavioral deviation. A significant correlation was found for CD and ASP symptom counts between the two parents and between CD symptom counts of the children and parental CD and ASP symptom counts. Although socioeconomic level correlated negatively with parental symptom counts, no association was observed between parental socioeconomic status and children's CD symptom counts. Saliva cortisol level in the children was negatively associated with their CD symptom count and with their fathers' ASP count. Cortisol level was also lower among sons whose fathers had CD as children and subsequently developed ASP compared with the cortisol level in sons whose fathers either did not have any Axis I psychiatric disorder or did not develop ASP.

Heightened motor activity level in male offspring of substance abusing fathers

Heightened activity level has been implicated in the liability for substance abuse, but no prior research has directly examined motor activity in a sample of prepubertal boys at high-risk for substance abuse. The magnitude of behavioral activity of 10-12 year-old sons of substance abusing fathers (SA +) (n = 42) and controls (SA -) (n = 60) was assessed using a microprocessor-based activity monitor during tasks that demanded significant concentration, effort, and constraint on motor activity, and when no such demands were present. Psychiatric status, measures of temperament traits, and measures of internalizing and externalizing behaviors were also obtained on the boys. Although the groups did not differ during the lower demand task, SA + boys showed significantly greater motor activity than SA - boys during the tasks that required concerted effort, attention, and behavioral suppression. Multiple regression analysis indicated that under the low-demand condition, the presence of an anxiety disorder in the boy was the only significant predictor of activity level. However, under the conditions that demanded effort, concerted attention and behavioral suppression, SA + group membership, and having low rhythmicity (as a temperament trait) predicted heightened activity. Statistically controlling for rhythmicity, the SA + boys were estimated to have about 24% higher activity than control boys. The results suggest that heightened motor activity may be associated with susceptibility to substance abuse.

Subclinical hepatic encephalopathy: relationship between neuropsychological deficits and standard laboratory tests assessing hepatic status

A multivariate analysis of the relationship between biochemical measures of hepatic function and neuropsychological assessments of specific cognitive domains was performed on data obtained from 74 patients with chronic liver disease and subclinical hepatic encephalopathy. Biochemical tests of hepatic protein synthesis correlated significantly with measures of impaired language efficiency, perceptual speed, and psychomotor efficiency. Biochemical indices of impaired processing of nitrogenous compounds correlated with visuopractic deficits. Hepatic blood flow indices correlated with language inefficiency. Interestingly, biochemical measures of hepatic injury did not demonstrate a significant association with any neuropsychological parameter assessed. These results suggest that subclinical hepatic encephalopathy is the consequence of a multifactorial hepatic dysfunction, and that acute hepatic injury, as assessed by elevation of aminotransferases, does not appear to be involved in the pathogenesis of subclinical hepatic encephalopathy.

The psychiatric diagnosis of alcoholism: critique and proposed reformulation

A taxonomy of alcohol problem involvement is proposed which encompasses categorical and dimensional approaches to classification. It is argued that contemporary nosology such as that described in DSM or ICD cannot, in principle, yield discrete categories containing homogeneous membership. Nor does current classification and diagnosis yield sufficient specific information necessary for effective treatment. These limitations are not resolvable by additional empirical research; rather, as discussed herein, a new conceptual framework and focus are required. The proposed new taxonomy comprises the first step in developing a comprehensive and clinically useful method for characterizing the alcohol consuming population.