Developmental sequence from disruptive behavior diagnosis to adolescent alcohol dependence

Objective: The authors sought to clinically describe the relationship of di sruptive behavior disorders with both alcohol dependence and the use of a v ariety of substances. Method: The Child Semi-Structured Assessment for the Genetics of Alcoholism was used to collect data on 54 adolescents with a diagnosis of alcohol dep endence. The frequency and age at onset of the disruptive behavior disorder diagnoses were examined as well as age at first use of alcohol, tobacco, m arijuana, and other street drugs. Results: Nearly three-quarters of the alcohol-dependent adolescents had at least one disruptive behavior disorder diagnosis. Attention deficit hyperac tivity disorder (ADHD) typically occurred first, followed by conduct disord er. Substance use began with alcohol or tobacco, followed by marijuana and then other street drugs. Alcohol dependence began significantly later than the onset of either ADHD or conduct disorder and significantly later than t he first use of tobacco. Conclusions: Disruptive behavior diagnoses, particularly conduct disorder, typically precede the initiation of use of a variety of substances that, in turn, precede the diagnosis of alcohol dependence in adolescents.