SUBSTANCE-DEPENDENT, CONDUCT-DISORDERED ADOLESCENT MALES - SEVERITY OF DIAGNOSIS PREDICTS 2-YEAR OUTCOME

Most delinquent youths have conduct disorder (CD), often with comorbid substance use disorder (SUD), attention-deficit/hyperactivity disorde r (ADHD) and depression. Some youths' conduct problems later abate, wh ile those of others persist into adult antisocial personality disorder . Earlier CD onset and ADHD reportedly predict persisting antisocial p roblems, but predictors of persisting SUD are poorly understood. Males aged 13-19 years (n = 89), most referred by criminal justice and soci al service agencies, received residential treatment for comorbid CD an d SUD. They had diagnostic assessments for SUD at intake and for CD, A DHD, and depression (as well as drug-use assessments) at intake and 6, 12 and 24 months later. At intake nearly all had DSM-III-R substance dependence (usually on alcohol and marijuana) and CD with considerable violence and criminality. The 2-year follow-ups revealed improvements in criminality, CD, depression and ADHD, but substance use remained l argely unchanged. Various aspects of conduct, crime and substance outc omes at 2 years were predicted by intake measures of intensity of subs tance involvement, and by CD severity and onset age, but not by severi ty of either ADHD or depression, nor by treatment duration. Earlier CD onset, more severe CD and more drug dependence predicted worse outcom es, supporting the validity of these diagnoses in adolescents. (C) 199 8 Elsevier Science Ireland Ltd. All rights reserved.