Externalizing disorders and substance use: empirically derived subtypes in a population-based sample of adults

  • Stephanie RodgersEmail author
  • Mario Müller
  • Wulf Rössler
  • Enrique Castelao
  • Martin Preisig
  • Vladeta Ajdacic-Gross
Original Paper



Attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD) are common externalizing disorders of childhood. The common effects of these disorders on substance abuse need further investigation. The current study investigated the joint clusters of childhood/adolescence ADHD, CD, and ODD, and their influence on substance abuse/dependence in a population-based sample of adults.


The data were drawn from the PsyCoLaus study (n = 3,720) conducted in Lausanne, Switzerland. The population-based sample included 238 subjects meeting criteria for ADHD/ODD/CD diagnoses before the age of 15. Latent class analyses (LCA) were performed to derive comorbidity subtypes, which were subsequently characterized with respect to psychosocial correlates and substance use.


The best fit in LCAs was achieved with three latent classes: an ADHD subtype (35.7 %); an externalizing multimorbid subtype (33.6 %) involving ODD, ADHD, and CD; and a third subtype with CD (30.7 %). The CD subtype showed the highest association with substance use. Apart from this, the externalizing multimorbid subtype was also significantly linked to substance use. The ADHD subtype had only elevated frequencies for alcohol dependence in comparison with subjects that had no history of ADHD, ODD, and CD during childhood or adolescence. Finally, important interactions between subtypes and sex were observed with regard to substance use.


This study provides evidence showing that subtyping the externalizing disorders, ADHD, ODD and CD, along their comorbidity patterns leads to important differences regarding substance use. This could have implications for the etiology, prevention, and treatment of substance use disorders.


Attention-deficit/hyperactivity disorder Conduct disorder Oppositional defiant disorder Latent class analysis Epidemiology 



The CoLaus/PsyCoLaus study was supported by grants from the Swiss National Science Foundation (105993, 118308, 122661 and 139468) and two grants from GlaxoSmithKline Clinical Genetics.

Conflict of interest

All authors declare that they have no conflicts of interest.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Stephanie Rodgers
    • 1
    Email author
  • Mario Müller
    • 1
  • Wulf Rössler
    • 1
    • 2
    • 4
  • Enrique Castelao
    • 3
  • Martin Preisig
    • 3
  • Vladeta Ajdacic-Gross
    • 1
  1. 1.Department of Psychiatry, Psychotherapy and PsychosomaticsZurich University Hospital of PsychiatryZurichSwitzerland
  2. 2.Collegium HelveticumUniversity of Zurich and Swiss Federal Institute of TechnologyZurichSwitzerland
  3. 3.Department of PsychiatryCHUVLausanneSwitzerland
  4. 4.University of Sao Paulo, Institute of Psychiatry, Laboratory of Neuroscience (LIM27)São PauloBrazil

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