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Does Conduct Disorder Interfere With Treatment of Substance Abuse?

Conduct disorder is the name of a mental health condition in teens and younger children that leads to a serious decline in the ability to follow social norms or interact well with others. Researchers and doctors know that people diagnosed with this condition have an unusually high chance of developing substance use disorder (diagnosable substance abuse/substance addiction). In a study published in October 2014 in the journal Alcoholism Treatment Quarterly, researchers from Harvard Medical School sought to determine if teenagers affected by conduct disorder have a harder time recovering from substance use disorder than teens without any significant conduct-related problems.

Conduct Disorder

The American Psychiatric Association (APA) places conduct disorder in a larger category of mental illnesses known as disruptive, impulse-control and conduct disorders. This category also includes oppositional defiant disorder, another conduct-related condition that sometimes acts as a precursor for the onset of conduct disorder. A teenager or younger child may display a range of behaviors that indicate an ongoing inability to conform to social standards or rules. Examples of these behaviors include threats of violence or violent acts toward others, use of a weapon as part of a violent threat or violent act, perpetration of a sexual assault, perpetration of acts of human cruelty or animal cruelty, use of lies to avoid facing consequences for negative or damaging acts, property destruction, commission of a burglary, shoplifting, truancy and failure to come home regularly at night. In addition, children with conduct disorder often have a deep-seated distrust of adults. Apart from substance problems, co-occurring issues found in association with the disorder include attention-deficit hyperactivity disorder (ADHD), post-traumatic stress disorder (PTSD), major depression and bipolar disorder.

Substance Use Disorder

Substance use disorder is the American Psychiatric Association’s term for all forms of diagnosable substance addiction, as well as all forms of diagnosable, non-addiction-related substance abuse. The APA began using this term in 2013 in response to a clear consensus among practicing physicians and researchers that people affected by the symptoms of substance addiction often have symptoms normally linked to substance abuse, and vice versa. A person affected by substance use disorder has as few as two and as many as 11 specific problems that indicate the presence of abuse or addiction related to alcohol, a drug or a mind-altering medication. Doctors use the number of symptoms to designate the severity of the condition; they also note the substance acting as the source of problems in the individual.

Interference With Substance Treatment?

In the study published in Alcoholism Treatment Quarterly, the Harvard Medical School researchers used a project involving 129 teenagers to help determine the extent to which the presence of conduct disorder alters the normal course of treatment for substance use disorder. The average age of the study participants was between 16 and 17. All of the study participants were receiving outpatient care for a diagnosable case of substance use disorder; 52 of these individuals had a co-occurring case of conduct disorder. The researchers compared factors between the conduct disorder-affected group and the non-affected group that included the overall number of mental health-related symptoms, the severity of substance-related problems, the level of negative consequences associated with substance-related problems and the co-occurring existence of diagnosable mental health conditions known as internalizing disorders.

After completing their initial comparison, the researchers concluded that the teenagers dealing with conduct disorder and substance use disorder were more severely affected by all relevant factors than the teenagers only dealing with substance use disorder. However, both groups of teenagers made progress during treatment and, at the end of treatment, were equally as likely to successfully avoid substance use. In addition, while the group dealing with substance use disorder and conduct disorder continued to experience a greater overall number of mental health-related symptoms, they still had a reduced frequency of such symptoms and also had fewer arrest-related encounters with the police.

The study’s authors concluded that teenagers affected by conduct disorder and substance use disorder still benefit meaningfully from substance treatment. However, these individuals may need programs that more effectively integrate treatment of substance-related issues with treatment of non-substance-related mental health concerns. Such an integrated approach could potentially significantly reduce the need to hospitalize teens with conduct disorder and increase these teens’ general well-being.

Posted on December 4th, 2014

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