PROGRESSION FROM CONDUCT DISORDER TO ANTISOCIAL PERSONALITY-DISORDER FOLLOWING TREATMENT FOR ADOLESCENT SUBSTANCE-ABUSE

Objective: This study investigated the progression from conduct disord er to antisocial personality disorder among individuals treated for ad olescent substance abuse. This issue is important because of the poor outcomes observed among individuals with antisocial pathology after tr eatment for alcohol and drug problems. The utility of factors assessed at the rime of treatment in predicting progression to adult antisocia l personality disorder was evaluated in the context of developmental m odels of antisocial behavior. Method: This was a prospective longitudi nal study of 137 substance-abusing adolescents (53 female and 84 male) , whose average age was 15.9 years and who met the DSM-III-R criteria for conduct disorder. Consecutively admitted patients were recruited f rom two adolescent inpatient alcohol and drug treatment facilities. Pa rticipants were interviewed again 4 years after treatment. Results: Fo ul years after treatment, 61 % of the study group met the DSM-III-R cr iteria for antisocial personality disorder. Results of a logistic regr ession analysis indicated that onset of deviant behavior at or before age 10, a greater diversity of deviant behavior, and more extensive pr etreatment drug use best predicted progression to antisocial personali ty disorder. At 4-year follow-tip, the subjects with an antisocial per sonality disorder diagnosis exhibited more involvement with alcohol an d drugs and poorer functioning across important life domains than the subjects without antisocial personality disorder. Conclusions: This st udy, found a high rate of progression to antisocial personality disord er among substance-abusing adolescents and identified factors predicti ve of this progression. Careful assessment of conduct disorder history at the time of treatment may be valuable for treatment planning and i ntervention.