National Institute on Drug Abuse
National Institutes of Health

"Child Psychopathology Risk Factors For Drug Abuse: Features and Mechanisms"

Gaithersburg Hilton
July 9-10, 1997
SUMMARY

Naimah Weinberg, M.D.
Meyer Glantz, Ph.D.
Division of Epidemiology and Prevention Research
September 11, 1997

Meeting Goals:

1. Review current state of knowledge on the relationships between child psychopathology entities and drug abuse/dependence;
2. explore possible mechanisms for those relationships that have been established in the scientific literature, and hear presentations of new and emerging data;
3. bring together researchers from the psychopathology, developmental, and drug abuse fields, to think creatively about these issues and inform NIDA's agenda;
4. develop consensus regarding those features underlying the diagnostic labels that may increase an individual's liability to drug abuse;
5. inform NIDA staff about this cutting edge area.

Meeting Process:

The agenda included a mix of overview, data-based, speculative, and synthesizing discussions, followed by a session to achieve consensus among the invited speakers on common features and mechanisms relating child psychopathologic disorders to later drug abuse and dependence.

Content:

The following key points emerged from the meeting:

1. Several psychopathologic conditions of childhood are associated with later development of drug abuse and dependence, particularly conduct disorder, bipolar disorder, and anxiety disorders; subtypes of attention deficit hyperactivity disorder may also present increased risk. Depression in the presence of another disorder constitutes a risk factor. Learning disabilities and language disorders strongly merit further study.

2. The co-occurrence of more than one childhood psychiatric disorder greatly enhances the risk for later drug abuse. In particular, the co-occurrence of externalizing (behavioral) and internalizing (emotional) disorders constitutes a high risk.

3. Multiple pathways characterize the etiologic course to drug abuse and dependence, a phenomenon labelled equifinality. Moreover, a particular characteristic can contribute to a variety of outcomes, some adverse and some beneficial; this is labelled multifinality.

4. Different disorders demonstrate different patterns in relationship to later substance abuse; there is specificity between specific disorders and drug abuse outcomes. Therefore it is not simply the condition of having a childhood disorder that puts children at risk, nor do disorders constitute non-specific markers of risk. For example, many children follow a path of externalizing behavior, and their drug use problems are part of a picture of deviant behavior; others may be attempting to self-medicate an internalizing condition.

5. Drug abuse etiology must be considered within the framework of transactional developmental processes, wherein individual child features interact with parental and other environmental factors over time.

6. Many key parent and parenting factors interact with the child's features to enhance, mediate, or moderate risk, particularly:
   • family history of drug abuse
   • parental psychopathology
   • quality of parenting and timing of parental problems
   • physical and sexual abuse

7. Neurobiological factors include:

   • The likely role of executive cognitive function deficits in the risk for drug abuse. Other brain mechanisms may also prove useful as markers or mediators in the development of drug abuse.

   • Psychophysiologic responses to anger and anxiety differentiate some high-risk children, and may serve explanatory (e.g. stress-dampening effects of some drugs) and marker functions in future research.

   • The possible role of prescribed stimulant use in childhood as a risk or protective factor in high risk children is of considerable interest and importance, and merits future exploration.

8. If we choose the right features to study, we can predict risk. For example, some features of difficult temperament can now be used with good discrimination to identify children at high risk for drug abuse, and some components of attention deficit hyperactivity disorder may prove predictive.

9. Future studies are needed on all of the above, with additional attention to:

   • Gender differences. For the externalizing disorders, girls have been understudied. Of note, the presence of a disorder which is less common in oneÕs gender portends a worse course. For example, girls with conduct problems or boys with depression are at greater risk for drug use problems and demonstrate a poorer outcome.

   • Social disabilities and peer rejection in the developmental course of high risk children

10. Methodologic issues must be addressed to reduce the confusion and contradiction in the field. These include: sampling issues, instrumentation, diagnostic schema, limitations of DSM diagnoses for some childhood conditions, data analytic techniques that control for variables that may actually be covariates of interest.

Conclusion:

The panel unanimously endorsed the conclusion that a wide range of diagnosable psychiatric disorders premorbid to substance abuse are strongly associated with subsequent substance abuse. The group then elucidated features that underlie the diagnoses discussed, and the mechanisms, mediating and moderating influences which interact protectively or disadvantageously with these characteristics. They strongly stressed 1) that individual characteristics are not inherently harmful, nor are any necessary or sufficient to produce drug abuse and dependence, and 2) the importance of transactional developmental processes and individual pathways.

Products and Follow up:

1. This meeting summary, to be posted on the NIDA website and distributed on request, with a write-up in NIDA NOTES.
2. An expanded meeting report on child psychopathology risk factors for drug abuse, written by program staff and reviewed and approved by the meeting panel.
3. Proposal for a workshop or meeting, organized by the Risk and Resilience Workgroup, on the impact of mental health interventions in childhood on the risk and resilience for later substance use disorders, to follow up on several issues raised by the Child Psychopathology Meeting panel.
4. Under consideration: A review article, for publication, summarizing the current literature and findings compiled at the meeting.
5. Under exploration: A special section in a journal, including an introductory paper and several original papers coming from the meeting.

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