Myers M G, Brown S A, Mott M A
Department of Psychiatry, University of California San Diego School of Medicine, USA.
Alcohol Clin Exp Res. 1995 Dec;19(6):1528-36. doi: 10.1111/j.1530-0277.1995.tb01019.x.
Increased awareness of the heterogeneity among alcohol and drug abusers has led to examination of the influence of concomitant psychopathology on the course of addiction and addictive relapse. Research among adult alcohol and drug abusers has found a detrimental influence of comorbid psychopathology on treatment outcome. Evidence exists for prevalent comorbidity, in particular conduct disorder (CD), among clinical samples of teen alcohol and drug abusers. However, little information is currently available on the relation and influence of psychopathology on outcome after treatment for adolescent alcohol and drug abuse. The current study examines the relation between CD, as assessed by the extent of preadolescent CD behaviors occurring before the initiation of drug use, and outcome for 131 adolescents over 2 years after inpatient treatment for alcohol and drug abuse. Drawing on recent conceptualizations of the process of relapse and progression of addictive behavior, CD is hypothesized to influence the process of relapse by altering coping efforts and intentions and increasing exposure to potential relapse situations. Results reveal that the extent of preadolescent CD behaviors is positively related to alcohol involvement in the 2 years after treatment, and that much of this relation is accounted for by posttreatment cognitive coping, motivation for alcohol abstinence, interpersonal problems, and exposure to alcohol use. Contrary to expectations, preadolescent CD behaviors did not predict posttreatment drug use. These findings provide evidence for the influence of psychopathology on the process of relapse and progression of addiction after treatment for adolescent alcohol and drug abuse, and suggest that teens with early life CD behaviors may be at greater risk for continued alcohol abuse.
对酒精和药物滥用者之间异质性认识的提高，促使人们审视并发精神病理学对成瘾过程和成瘾复发的影响。针对成年酒精和药物滥用者的研究发现，共病精神病理学对治疗结果有不利影响。在青少年酒精和药物滥用的临床样本中，存在普遍共病的证据，尤其是品行障碍（CD）。然而，目前关于精神病理学与青少年酒精和药物滥用治疗后结果之间的关系及影响的信息很少。本研究考察了通过吸毒开始前青春期前CD行为的程度评估的CD与131名青少年酒精和药物滥用住院治疗后2年的结果之间的关系。借鉴最近关于成瘾行为复发和进展过程的概念，假设CD通过改变应对努力和意图以及增加接触潜在复发情况来影响复发过程。结果显示，青春期前CD行为的程度与治疗后2年的酒精使用情况呈正相关，并且这种关系很大程度上是由治疗后的认知应对、戒酒动机、人际问题以及接触酒精使用所解释的。与预期相反，青春期前CD行为并不能预测治疗后的药物使用情况。这些发现为精神病理学对青少年酒精和药物滥用治疗后成瘾复发和进展过程的影响提供了证据，并表明有早期生活CD行为的青少年可能面临持续酒精滥用的更大风险。
