Neurobehavioral disinhibition in childhood predicts early age at onset of substance use disorder

OBJECTIVE

This longitudinal study had three aims: 1) determine the extent to which boys at high average risk and low average risk for substance use disorder differ on a construct of neurobehavioral disinhibition, 2) evaluate the capacity of neurobehavioral disinhibition to predict substance use frequency at age 16, and 3) demonstrate the utility of neurobehavioral disinhibition in predicting substance use disorder.

METHOD

The authors derived an index of neurobehavioral disinhibition from measures of affect, behavior, and cognition. The neurobehavioral disinhibition score was used to discriminate youth at high and low average risk for substance use disorder and to predict substance use frequency after 4-6 years and substance use disorder after 7-9 years.

RESULTS

The neurobehavioral disorder score significantly discriminated boys at high average risk from those at low average risk at ages 10-12. Neurobehavioral disinhibition at age 16, in conjunction with substance use frequency and risk status group, predicted substance use disorder at age 19 with 85% accuracy and accounted for 50% of the variance in Drug Use Screening Inventory overall problem density score. Neurobehavioral disinhibition was a stronger predictor of substance use disorder (odds ratio=6.83) than substance consumption frequency (odds ratio=3.19).

CONCLUSIONS

Cross-sectional and longitudinal analyses indicated that neurobehavioral disinhibition is a component of the liability to early age at onset of substance use disorder.

Transancestral GWAS of alcohol dependence reveals common genetic underpinnings with psychiatric disorders

Liability to alcohol dependence (AD) is heritable, but little is known about its complex polygenic architecture or its genetic relationship with other disorders. To discover loci associated with AD and characterize the relationship between AD and other psychiatric and behavioral outcomes, we carried out the largest genome-wide association study to date of DSM-IV-diagnosed AD. Genome-wide data on 14,904 individuals with AD and 37,944 controls from 28 case-control and family-based studies were meta-analyzed, stratified by genetic ancestry (European, n = 46,568; African, n = 6,280). Independent, genome-wide significant effects of different ADH1B variants were identified in European (rs1229984; P = 9.8 × 10-13) and African ancestries (rs2066702; P = 2.2 × 10-9). Significant genetic correlations were observed with 17 phenotypes, including schizophrenia, attention deficit-hyperactivity disorder, depression, and use of cigarettes and cannabis. The genetic underpinnings of AD only partially overlap with those for alcohol consumption, underscoring the genetic distinction between pathological and nonpathological drinking behaviors.

Common liability to addiction and "gateway hypothesis": theoretical, empirical and evolutionary perspective

BACKGROUND

Two competing concepts address the development of involvement with psychoactive substances: the "gateway hypothesis" (GH) and common liability to addiction (CLA).

METHOD

The literature on theoretical foundations and empirical findings related to both concepts is reviewed.

RESULTS

The data suggest that drug use initiation sequencing, the core GH element, is variable and opportunistic rather than uniform and developmentally deterministic. The association between risks for use of different substances, if any, can be more readily explained by common underpinnings than by specific staging. In contrast, the CLA concept is grounded in genetic theory and supported by data identifying common sources of variation in the risk for specific addictions. This commonality has identifiable neurobiological substrate and plausible evolutionary explanations.

CONCLUSIONS

Whereas the "gateway" hypothesis does not specify mechanistic connections between "stages", and does not extend to the risks for addictions, the concept of common liability to addictions incorporates sequencing of drug use initiation as well as extends to related addictions and their severity, provides a parsimonious explanation of substance use and addiction co-occurrence, and establishes a theoretical and empirical foundation to research in etiology, quantitative risk and severity measurement, as well as targeted non-drug-specific prevention and early intervention.

Differentiation of alcoholics. Childhood history of minimal brain dysfunction, family history, and drinking pattern

Alcoholics were differentiated into two subgroups on the basis of drinking patterns and subjective response to alcohol. Severe drinkers (primary alcoholics) retrospectively reported more symptoms of childhood minimal brain dysfunction than less severe drinkers (secondary alcoholics), psychiatric patients, and normals. The alcoholics as a group reported a greater incidence of familial alcohol abuse than the psychiatric subjects, but a difference on this factor was not observed between the primary and secondary subgroups. In terms of clinical status, the primary alcoholics presented Minnesota Multiphasic Personality Inventory profile more indicative of normality than the other groups, but scored significantly higher on the MacAndrew Alcoholism Scale. These findings are discussed in light of further delineating a specific subtype of alcoholism that may have a genetic-constitutional relationship with other pathological disorders.

Evaluation and treatment of adolescent substance abuse: a decision tree method

A procedure for systematically evaluating and treating adolescents with known or suspected substance abuse is described. Integrating assessment with intervention affords the opportunity to comprehensively characterize the adolescent's problems and to quantitatively monitor treatment progress and outcome.

A large-scale genome-wide association study meta-analysis of cannabis use disorder

BACKGROUND

Variation in liability to cannabis use disorder has a strong genetic component (estimated twin and family heritability about 50-70%) and is associated with negative outcomes, including increased risk of psychopathology. The aim of the study was to conduct a large genome-wide association study (GWAS) to identify novel genetic variants associated with cannabis use disorder.

METHODS

To conduct this GWAS meta-analysis of cannabis use disorder and identify associations with genetic loci, we used samples from the Psychiatric Genomics Consortium Substance Use Disorders working group, iPSYCH, and deCODE (20 916 case samples, 363 116 control samples in total), contrasting cannabis use disorder cases with controls. To examine the genetic overlap between cannabis use disorder and 22 traits of interest (chosen because of previously published phenotypic correlations [eg, psychiatric disorders] or hypothesised associations [eg, chronotype] with cannabis use disorder), we used linkage disequilibrium score regression to calculate genetic correlations.

FINDINGS

We identified two genome-wide significant loci: a novel chromosome 7 locus (FOXP2, lead single-nucleotide polymorphism [SNP] rs7783012; odds ratio [OR] 1·11, 95% CI 1·07-1·15, p=1·84 × 10-9) and the previously identified chromosome 8 locus (near CHRNA2 and EPHX2, lead SNP rs4732724; OR 0·89, 95% CI 0·86-0·93, p=6·46 × 10-9). Cannabis use disorder and cannabis use were genetically correlated (rg 0·50, p=1·50 × 10-21), but they showed significantly different genetic correlations with 12 of the 22 traits we tested, suggesting at least partially different genetic underpinnings of cannabis use and cannabis use disorder. Cannabis use disorder was positively genetically correlated with other psychopathology, including ADHD, major depression, and schizophrenia.

INTERPRETATION

These findings support the theory that cannabis use disorder has shared genetic liability with other psychopathology, and there is a distinction between genetic liability to cannabis use and cannabis use disorder.

FUNDING

National Institute of Mental Health; National Institute on Alcohol Abuse and Alcoholism; National Institute on Drug Abuse; Center for Genomics and Personalized Medicine and the Centre for Integrative Sequencing; The European Commission, Horizon 2020; National Institute of Child Health and Human Development; Health Research Council of New Zealand; National Institute on Aging; Wellcome Trust Case Control Consortium; UK Research and Innovation Medical Research Council (UKRI MRC); The Brain & Behavior Research Foundation; National Institute on Deafness and Other Communication Disorders; Substance Abuse and Mental Health Services Administration (SAMHSA); National Institute of Biomedical Imaging and Bioengineering; National Health and Medical Research Council (NHMRC) Australia; Tobacco-Related Disease Research Program of the University of California; Families for Borderline Personality Disorder Research (Beth and Rob Elliott) 2018 NARSAD Young Investigator Grant; The National Child Health Research Foundation (Cure Kids); The Canterbury Medical Research Foundation; The New Zealand Lottery Grants Board; The University of Otago; The Carney Centre for Pharmacogenomics; The James Hume Bequest Fund; National Institutes of Health: Genes, Environment and Health Initiative; National Institutes of Health; National Cancer Institute; The William T Grant Foundation; Australian Research Council; The Virginia Tobacco Settlement Foundation; The VISN 1 and VISN 4 Mental Illness Research, Education, and Clinical Centers of the US Department of Veterans Affairs; The 5th Framework Programme (FP-5) GenomEUtwin Project; The Lundbeck Foundation; NIH-funded Shared Instrumentation Grant S10RR025141; Clinical Translational Sciences Award grants; National Institute of Neurological Disorders and Stroke; National Heart, Lung, and Blood Institute; National Institute of General Medical Sciences.

Vulnerability to alcoholism in men: a behavior-genetic perspective

The psychological and biological characteristics associated with the vulnerability to alcoholism are reviewed. The predisposing features can be accounted for on the basis of deviations in empirically established temperament traits, thereby supporting the viability of a behavior-genetic perspective for elucidating the susceptibility to alcoholism. The temperament perspective also has heuristic value for improving our understanding of the neurobiological mechanisms that link the genetic predisposition to overt behavior. In addition, the temperament approach has ramifications for the prevention and treatment of alcoholism, as well as for clarifying the etiology and classification of certain other psychiatric disorders. The questions of what may be inherited in alcoholism and how this information can be usefully applied to enhance our knowledge of alcoholism etiology, prevention and clinical management are addressed.

Adolescent versus adult onset and the development of substance use disorders in males

This study examines the influence of adolescent age of onset on the development of substance use disorders (SUD) by comparing adult males (n = 181) with SUD categorized into adolescent-onset, early-adult onset and late-adult onset groups on patterns of substance use and related disorders, time course of the development of substance dependence and rates of comorbid mental disorders. A sample of male adolescents (n = 81) with SUD was also included as a comparison group. The subjects were recruited from intervention programs in the community and participated in semistructured interviews with diagnoses determined by the best estimate method. Adolescent-onset adults, compared with other adult-onset groups, had higher lifetime rates of cannabis and hallucinogen use disorders, shorter times from first exposure to dependence, shorter times between the development of their first and second dependence diagnoses and higher rates of disruptive behavior disorders and major depression. Adolescents were similar to adolescent-onset adults. While the findings must be interpreted in light of methodological limitations, these results suggest that adolescent-onset SUD is a distinct subtype involving different substances and more rapid development than adult-onset SUD.

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.

Neurobehavior disinhibition in childhood predisposes boys to substance use disorder by young adulthood: direct and mediated etiologic pathways

OBJECTIVE

The development of substance use disorder (SUD) was prospectively investigated in 66 boys having fathers with SUD and 104 boys having fathers with no adult Axis I or II psychiatric disorder. Evaluations were conducted to determine the context in which neurobehavior disinhibition in relation to parental SUD, parental neglect of the child and child's social maladjustment culminated in a DSM-III-R diagnosis of SUD.

METHODS

A neurobehavior disinhibition latent trait was derived using indicators of behavior undercontrol, affect dysregulation and executive cognitive functioning in the boys when they were 10-12 and again at 16 years of age. These latter characteristics have been frequently observed in individuals who have a prefrontal cortex disturbance. The data were analyzed to determine whether the score on the neurobehavior disinhibition construct mediates the association between father's and mother's SUD and son's SUD.

RESULTS

SUD in the mother and father predicted neurobehavior disinhibition in the son. The neurobehavior disinhibition score in the sons predicted SUD between ages 10-12 and 19. Neurobehavior disinhibition, in conjunction with social maladjustment and drug use frequency, mediated the association between paternal and maternal SUD and son's SUD. Neurobehavior disinhibition was unrelated to neglect of the child by either the father or mother; however, paternal but not maternal neglect at age 10-12 predicted SUD at age 19.

CONCLUSIONS

The association of neurobehavior disinhibition in childhood and SUD by young adulthood suggests that a prefrontal cortex dysfunction contributes to SUD liability. The results extend previous findings demonstrating that neurobehavior disinhibition is an important component of the liability to SUD.

Orthotopic liver transplantation for alcoholic liver disease

Alcohol abuse is the most common cause of end-stage liver disease in the United States, but many transplant centers are unwilling to accept alcoholic patients because of their supposed potential for recidivism, poor compliance with the required immunosuppression regimen and resulting failure of the allograft. There is also concern that alcohol-induced injury in other organs will preclude a good result. From July 1, 1982, to April 30, 1988, 73 patients received orthotopic liver transplants at the University of Pittsburgh for end-stage alcoholic liver disease. Fifty-two (71%) of these were alive at 25 +/- 9 mo (mean +/- S.D.) after transplantation, when a phone survey of these patients, their wives/husbands, and their physicians was performed to evaluate their subsequent use of alcohol, current medical condition and employment. Data obtained were compared with those for nonalcoholic patients selected as transplant controls. The recidivism rate has been 11.5%, with most patients drinking only socially. Fifty-four percent of the survivors are employed, 21% classify themselves as homemakers and only 11 (21%) are unable to work. Twenty-one patients died after transplantation; the most frequent cause of death was sepsis (43%), and intraoperative death was the next most common cause (28.6%). These data demonstrate that alcoholic patients can be transplanted successfully and achieve good health not significantly different from that of individuals transplanted for other causes. Thus orthotopic liver transplantation is a therapeutic option that should be considered for individuals with end-stage alcoholic liver disease who desire such therapy.

Adolescent sons of alcoholics: neuropsychological and personality characteristics

Adolescent sons of alcoholics and nonalcoholics were compared on a battery of intellectual, neuropsychological, personality, and behavioral measures. The former group demonstrated certain neuropsychological deficits in perceptual-motor ability, memory, and language processing. They also had auditory and visual attentional impairments and a lower level of achievement in reading comprehension. In addition, the sons of alcoholics presented a more neurotic personality profile than sons of nonalcoholics. They were, however, less impulsive than the comparison group. More development and familial problems were noted in the alcoholics' offspring as well. The implications of these findings for understanding the causes and consequences of alcoholism are discussed.

Childhood risk categories for adolescent substance involvement: a general liability typology

Childhood risks for adolescent substance involvement include parental substance use disorders (SUDs), psychological dysregulation and early tobacco and alcohol experimentation. This study was designed to identify childhood risk categories predicting accelerated adolescent substance involvement across drug types and stages. The index subjects were 560 children recruited from high risk (n = 266) or low risk (n = 294) families based on fathers' SUDs. Assessments were conducted at approximately ages 11 (baseline), 13, 16, and 19 years. Childhood predictors included parent SUDs, early tobacco or alcohol use (i.e., substance use), and neurobehavior disinhibition (ND) as determined by indicators of cognitive, affective and behavioral disinhibition. A cluster analysis defined five risk categories based on baseline characteristics as follows: (1) High (n = 31; 100% had both parents with SUDs, 100% had early substance use, and the mean ND score = 58.9); (2) Intermediate-High (n = 76; 45% had one parent with SUD, 100% early substance use and ND = 51.9); (3) Intermediate (n = 76; 100% both parents with SUDs, 0% early substance use and ND = 51.4); (4) Intermediate-Low (n = 161; 100% with one SUD parent; 0% early substance use and ND = 49.9) and; (5) Low (n = 216; no parental SUD, no early substance use and ND = 47.5). Compared with all other groups, children in the High risk group had significantly accelerated substance involvement across all substance types and stages. The ordering of risk categories from low to high was also consistent for all substance involvement outcomes. The findings indicate that these five risk categories constitute general liability classes for adolescent substance involvement, and may identify homogeneous groups of children requiring distinct preventive interventions.

Liability to substance use disorders: 1. Common mechanisms and manifestations

Variation in the risk for and severity of substance use disorders (SUD) in the population is caused by multiple organismic (genetic, biochemical, psychological) and environmental factors. Whereas drug- or drug-class-specific liability mechanisms exist, a substantial proportion of variance in the risk is shared between specific liabilities, reflecting mechanisms that determine common liability to SUD. Data from epidemiologic, clinical, psychological, physiological, biochemical, and family and genetic studies reviewed in this paper indicate the existence of mechanisms and characteristics shared in common by liabilities to SUD related to different drugs. These mechanisms can be conceptualized as common liability to SUD, a latent trait accounting for a substantial portion of variation in SUD risk and severity and determined by all factors influencing the probability of SUD development. An accompanying paper describes an approach to the quantitative estimation of this trait.

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.

Substance use and risky sexual behavior in female adolescents

The purpose of this study was to elucidate the etiological pathways towards substance use and risky sexual behavior in female adolescent substance abusers. The study had three aims: (1) to determine the relations between behavioral dysregulation, negative affectivity, and childhood victimization with substance use and risky sexual behavior, (2) to determine whether these relations are mediated by internalizing symptomatology, antisocial behavior, and affiliating with an adult boyfriend; and (3) to determine whether age of menarche moderates the relation between the mediating variables and substance use and risky sexual behavior. Multiple behavioral, psychiatric interview, and self-report measures were used to index behavioral dysregulation, negative affectivity, childhood victimization, internalizing symptomatology, antisocial behavior, affiliation with adult boyfriends, substance use, and risky sexual behavior in 125 substance abusing female adolescents and 78 controls between the ages of 14-18 years. Structural equation modeling was used to determine the etiological pathways. Results indicated that behavioral dysregulation, negative affectivity, and childhood victimization were related to substance use and risky sexual behavior. Age of menarche was significantly correlated with affiliation with an older boyfriend and risky sexual behavior. Antisocial behavior mediated the associations between behavioral dysregulation, negative affectivity and childhood victimization with substance use and risky sexual behavior. Affiliation with an adult boyfriend was directly associated with substance use involvement and accounted for the relationship between chronological age and risky sexual behavior. Finally, late menarche enhanced the association between internalizing symptomatology and substance use involvement. The results highlight the importance of behavioral dysregulation, negative affectivity, and childhood victimization in predicting substance use and risky sexual behavior, as well as the finding that antisocial behavior and affiliation with an adult boyfriend may be etiologically important in predicting these outcomes. Therefore, from a prevention and treatment standpoint, behavioral and affective dysregulation, childhood victimization as well as antisocial behavior may serve as clinical 'gateways' for altering the developmental trajectory toward substance use and risky sexual behavior in high risk and substance abusing youth. For example, reducing dysregulation through behavior modification procedures that have been developed for conduct disordered children would appear to be a heuristic avenue of investigation emanating from the results obtained in this study.

Executive cognitive functioning, temperament, and antisocial behavior in conduct-disordered adolescent females

The authors assessed whether low executive cognitive functioning (ECF) and a difficult temperament are related to aggressive and nonaggressive forms of antisocial behavior (ASB) in 249, 14-18-year-old, conduct-disordered females and controls. ECF was measured using neuropsychological tests; temperament was measured using the Dimensions of Temperament Survey-revised; and ASB was assessed using psychiatric symptom counts for conduct disorder. The conduct-disordered females exhibited lower ECF capacity and a greater difficult temperament compared with the controls. The combined influence of low ECF and difficult temperament was significantly related to both forms of ASB. In comparison with low ECF, difficult temperament was more strongly related to nonaggressive ASB, whereas in comparison with difficult temperament, low ECF was more strongly related to aggressive ASB. Last, ECF mediated the relation between difficult temperament and aggressive ASB.

Etiology of adolescent substance abuse: a developmental perspective

Approximately 5% of adolescents in the U.S. qualify for a diagnosis of substance use disorder (SUD). Low affect and behavior self-regulation during child development interacting with family, peer and other ecological factors predisposes to substance use in adolescence. Maturational processes during adolescence, particularly involving the brain and reproductive system, exacerbate the low psychological self-regulation evidenced during childhood to promote initiation of alcohol, tobacco, and other drug (ATOD) consumption. This discussion examines the etiology of ATOD abuse and SUD from a developmental perspective. The ramifications of a developmental perspective for clinical practice and social policy are also considered.

Alcoholism: a developmental disorder

Alcoholism etiology is discussed from a developmental behavior genetic perspective. At the outset point, temperament characteristics, by means of ongoing and reciprocal interaction with the social environment, shape the course of behavioral development. The behavioral characteristics successively acquired during development are vectors that determine the ontogenetic trajectory that culminates ultimately in the clinical disorder of alcoholism. The temperament features that appear to be associated with a heightened risk for alcoholism are examined. Their interactions with the environment during the course of development are considered within an epigenetic framework and, as discussed, have important ramification for improving the prevention and treatment of alcoholism.

Association between hyperactivity and executive cognitive functioning in childhood and substance use in early adolescence

OBJECTIVE

To determine whether deficient executive cognitive functioning (ECF) in association with high behavioral activity level comprise components of the liability to substance abuse.

METHOD

A high-risk (HR) group having fathers with a lifetime DSM-III-R diagnosis of a psychoactive substance use disorder was compared with a low-average-risk (LAR) group whose fathers had neither psychoactive substance use disorder nor another adult Axis I psychiatric disorder. ECF and behavioral activity were measured using neuropsychological tests, activity monitor, diagnostic interview, and informant ratings when the subjects were 10 to 12 years of age. Alcohol, tobacco, and cannabis use were measured at 2-year follow-up.

RESULTS

At baseline, the HR group had a significantly higher behavioral activity level and exhibited poorer performance on ECF tests than the LAR group. By early adolescence, HR subjects had a higher lifetime rate of tobacco and cannabis use and earlier age at onset of cannabis use. ECF capacity, but not behavioral activity level, predicted tobacco and cannabis use, total number of drugs ever tried, and severity of drug involvement. ECF accounted for additional variance beyond the effects of conduct problems on these outcomes.

CONCLUSION

Whereas behavioral activity and ECF capacity in late childhood distinguishes HR from LAR youth, childhood ECF capacity is the more salient predictor of drug use in early adolescence.

Executive Cognitive Functioning and Risk for Substance Abuse

Individuals with a substance use disorder (SUD) exhibit deficits in executive cognitive functioning (ECF). ECF is involved in the regulation of goal-directed behavior and includes abilities such as attentional control, strategic goal planning, organization, and cognitive flexibility. The prefrontal cortex is believed to be the primary cortical substrate that subserves ECF. Children deemed at high risk for drug abuse because they have parents with SUD similarly demonstrate cognitive limitations suggesting an ECF deficit. High-risk children, as a group, also exhibit deviations in temperament, an attenuated amplitude of the P300 event-related potential, and heightened aggressivity compared with control groups. These latter characteristics are associated with low ECF capacity and are believed to reflect dysfunction within the prefrontal cortex. It is hypothesized that deviations on these traits form a core disorder of affective, cognitive, and behavioral dysregulation that serves as a general vulnerability factor for SUD.

Reactive aggression in boys with disruptive behavior disorders: behavior, physiology, and affect

This study examined responses to peer provocation in boys ages 9-13 years who met symptomatic criteria for ADHD-only, ODD/CD-only, comorbid ADHD/ODD/CD, or no diagnosis. Boys participated in a reaction-time game that included standardized verbal and behavioral provocation. Their behavioral, physiological, and affective responses to this task were measured. Results showed that groups did not differ following high levels of provocation because all boys behaved aggressively. However, following low provocation boys with comorbid ADHD/ODD/CD had higher levels of behavioral aggression, had greater heart rate acceleration, and were rated as angrier than all other boys. In addition, boys with comorbid ADHD/ODD/CD held a grudge longer than other children. Results suggest that boys with comorbid ADHD/ODD/CD are especially reactive to provocation from their peers.

Origins and consequences of child neglect in substance abuse families

The empirical literature pertaining to the prevalence, origins, and consequences of neglectful parenting as it relates to substance abuse is critically reviewed. Available evidence indicates that children who experience parental neglect, with or without parental alcohol or drug abuse, are at high risk for substance use disorder (SUD). The effects of parental substance abuse on substance abuse outcome of their children appear to be partly mediated by their neglectful parenting. The discussion concludes with presentation of a developmental multifactorial model in which neglect, in conjunction with other individual and environmental factors, can be integratively investigated to quantify the child's overall liability across successive stages of development as well as to map the trajectory toward good and poor outcomes.