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Think substance dependency disorder in preteen drug users.

CHICAGO--Substance abuse before the age of 13 is a powerful predictor of legal problems and substance dependency disorders in adolescence that may warrant a differential approach to treatment, results of a study of 78 adolescents suggest.

"[They] have significantly more psychiatric impairment and protracted involvement in the juvenile correctional system at the start of residential [chemical dependency] treatment," noted Felipe Amunategui, Ph.D., in a poster at the annual meeting of the American Academy of Child and Adolescent Psychiatry.

The findings support the view of pre-puberty as a critical period during which the initiation of substance abuse and the presence of psychiatric disorders signal a heightened risk for future chemical dependency and significant legal problems, said Dr. Amunategui of Case Western Reserve University, Cleveland.

Children who began using with drugs and alcohol before puberty and later developed substance dependency disorders (SDDs) were significantly more likely to have DSM-IV diagnoses of attention-deficit/hyperactivity disorder (ADHD), posttraumatic stress disorder (PTSD), or personality disorder, and to have been in jail, with a trend toward more burglary, arrests, and charges.

"These findings speak to the need for ongoing treatment of these disorders to mitigate against the early onset of substance use and subsequent development of SDD," Dr. Amunategui said.

"The scant evidence indicates that sustaining treatment for adequate periods is essential to good outcomes," he said in an interview. "So for ADHD, this means adhering to psychostimulant treatment. [These] youths ... are likely to be more refractory to treatment [and] require longer treatment engagement. Treatment is likely to require higher levels of care" than those with later on set of substance use and delinquency.

The children who did and did not begin using drugs before age 13 did not differ in demographic factors, including age, sex, race, education, living situation, or presence of a learning disability. No clear pattern was seen for conduct disorder or major depressive disorder. A reverse pattern was found for bulimia.

"Pediatricians and family practitioners should be able to screen for these disorders during well care visits," he said. "Children identified as needing treatment for ADHD should be monitored at least annually for treatment optimization, and those who have endured a traumatic event should be monitored for symptoms related to [such] events."

Patients admitted for residential treatment who began using drugs during adolescence had significantly less psychiatric morbidity, suggesting "the causes underlying substance abuse for this group may be more transitory and developmentally related."

Researchers determined current and past DSM-IV diagnoses based on results of the Mini-International Neuropsychiatric Interview, confirmed diagnoses with medical chart reviews, and assessed legal problems using court records and treatment services reviews. Most in the sample met DSM-IV criteria for at least one SDD. The drugs were marijuana (88%), hallucinogen (32%), cocaine (19%), stimulant (19%), opioid (19%), sedative (12%), and inhalant (4%); 56% also met the criteria for alcohol dependence. Dr. Amunategui said he had no financial conflicts of interest related to the study.


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Author:Birk, Susan
Publication:Clinical Psychiatry News
Date:Jan 1, 2009
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