Association between psychiatric disorders and the progression of tobacco use behaviors

Objective. To examine the progression of tobacco use and the patterns of co morbidity of tobacco use and psychiatric disorders. Method: The authors con ducted analyses of prospective and retrospective reports, collected from 19 88 to 1998, of a sample of high- and low-risk youths identified on the basi s of the presence or absence of a parental history of substance abuse or de pendence. Results: A parental history of substance use disorders was associ ated with regular tobacco use and nicotine dependence, but not with experim entation for all youths. Individual and composite psychiatric diagnoses wer e strongly associated with nicotine dependence, but not with regular use or experimentation. While the presence of an affective disorder and drug abus e/dependence generally increased the risk for co-occurring nicotine depende nce, analyses based on the temporal onset of disorders showed that it was t he initiation of alcohol or drug use that predicted the progression to nico tine dependence. For low-risk youths, oppositional defiant disorder was the single psychiatric risk factor that predicted the transition to nicotine d ependence. Conclusions: This study adds to the accumulating evidence that h as Implicated comorbid psychiatric disorders in the etiology and subsequent course of nicotine dependence. In addition, family history may represent a n important indicator of an increased risk for nicotine dependence.