European Child & Adolescent Psychiatry

, Volume 20, Issue 6, pp 279–289 | Cite as

Patterns of substance use in adolescents attending a mental health department

  • Rosa DíazEmail author
  • Javier Goti
  • Montse García
  • Antoni Gual
  • Lourdes Serrano
  • Laura González
  • Rosa Calvo
  • Josefina Castro-Fornieles
Original Contribution


This study aimed to describe patterns of substance use in adolescents initiating mental health treatment and analyse factors associated with a high-risk pattern of substance use differentially by gender. Two hundred and thirty-seven 12- to 17-year-old new patients in an urban public mental health service were prospectively recruited and evaluated using semi-structured interviews and standardized questionnaires to obtain socio-demographic, psychopathological, family, school and substance use data. The most prevalent primary diagnoses among males were attention deficit disorder and conduct disorder, while among females they were eating disorders, affective and conduct disorders. Substance use disorder was diagnosed as follows: cannabis in 10.1% of the sample, alcohol in 3.4% and other drugs in 0.4%. A pattern of substance use with high risk of developing problems (at least regular use of alcohol or occasional use of cannabis or other illegal drugs) was found in 48.9% of the sample. After adjusting for age in the multivariate logistic regression, this pattern of risky use of drugs was found to be associated with Youth Self-Report scales of thought problems, delinquent and aggressive behaviour, in both genders. Altered family structure, having had to repeat a school grade and Youth Self-Report attention problems were only significantly associated with risky drug consumption in females. The high prevalence of risky and problematic substance use in adolescents entering mental health treatment warrants early systematic screening and specific preventive and therapeutic interventions, addressing mental health psychoeducation and motivation to avoid drugs, as well as differential associated risk factors for males and females.


Substance abuse Dual disorders Risk factors Adolescents 



This study has been supported by a grant from the INIFD (National Drug Research and Training Institute) (Ref: INT/1525/2003) of the Spanish Governmental Delegation for the National Drug Plan.

Conflict of interest

The authors reported no biomedical financial interest or potential conflicts of interests.


  1. 1.
    Observatorio Español sobre Drogas. Encuestas sobre drogas a población escolar, 1996–2006 y Encuestas domiciliarias sobre consumo de drogas, 1995–2005. Madrid: Delegación del Gobierno para el Plan Nacional sobre Drogas (Spanish Drug Watch. Drug use among the school population survey, 1996–2006 and Home survey on drug use, 1995–2005. Madrid: National Drugs Plan)Google Scholar
  2. 2.
    European Monitoring Center for Drugs and Drug Addiction (2006) The state of the drugs problem in the acceding and candidate countries to the European Union and Norway. Annual Report. Luxembourg: Office of the Official Publications of the European CommunitiesGoogle Scholar
  3. 3.
    Johnston LD, O’Malley PM, Bachman JG, Schulenberg JE (2006) Monitoring the future national survey results on drug use, 1975–2005: vol I, Secondary School Students. NIH Publication No-06-5883. National Institute on Drug Abuse, BethesdaGoogle Scholar
  4. 4.
    Mason WA, Hitchings JE, Spoth RL (2008) The interaction of conduct problems and depressed mood in relation to adolescent substance involvement and peer substance use. Drug Alcohol Depend 96:233–248PubMedCrossRefGoogle Scholar
  5. 5.
    Roberts RE, Roberts CR, Xing Y (2007) Comorbidity of substance use disorders and other psychiatric disorders among adolescents: evidence from an epidemiologic survey. Drug Alcohol Depend 88:4–13CrossRefGoogle Scholar
  6. 6.
    Shrier LA, Harris SK, Kurland M, Knight JR (2003) Substance use problems and associated psychiatric symptoms among adolescents in primary care. Pediatrics 111:699–705CrossRefGoogle Scholar
  7. 7.
    Becker DF, Grilo CM (2006) Prediction of drug and alcohol abuse in hospitalized adolescents: comparisons by gender and substance type. Behav Res Ther 44:1431–1440PubMedCrossRefGoogle Scholar
  8. 8.
    Swadi H, Bobier C (2003) Substance use disorder comorbidity among inpatient youths with psychiatric disorder. Aust N Z J Psychiatry 37:294–298PubMedCrossRefGoogle Scholar
  9. 9.
    Niethammer O, Frank R (2007) Prevalence of use abuse and dependence on legal and illegal psychotropic substances in an adolescent inpatient psychiatric population. Eur Child Adolesc Psychiatry 16:254–259PubMedCrossRefGoogle Scholar
  10. 10.
    Martin CA, Milich R, Martin WR, Hartung CM, Haigler ED (1997) Gender differences in adolescent psychiatry outpatient substance use: associated behaviors and feelings. J Am Acad Child Adolesc Psychiatry 36:486–494PubMedCrossRefGoogle Scholar
  11. 11.
    Wilens TE, Biederman J, Abrantes AM, Spencer TJ (1997) Clinical characteristics of psychiatrically referred adolescent outpatients with substance use disorder. J Am Child Adolesc Psychiatry 36:941–947CrossRefGoogle Scholar
  12. 12.
    Kramer TL, Robbins JM, Phillips SD, Miller TL, Burns BJ (2003) Detection and outcomes of substance use disorders in adolescents seeking mental health treatment. J Am Acad Child Adolesc Psychiatry 42:1318–1326PubMedCrossRefGoogle Scholar
  13. 13.
    Deas D (2006) Adolescent substance abuse and psychiatric comorbidities. J Clin Psychiatry 67:18–23PubMedCrossRefGoogle Scholar
  14. 14.
    Von Sydow K, Lieb R, Pfister H, Höfler M, Wittchen HU (2002) What predicts incident use of cannabis and progression to abuse and dependence? A 4-year prospective examination of risk factors in a community sample of adolescents and young adults. Drug Alcohol Depend 68:49–64CrossRefGoogle Scholar
  15. 15.
    Kostelecky KL (2005) Parental attachment, academic achievement, life events and their relationships to alcohol and drug use during adolescence. J Adoles 28:665–669CrossRefGoogle Scholar
  16. 16.
    Tapert SF, Baratta MV, Abrantes AM, Brown SA (2002) Attention dysfunction predicts substance involvement in community youths. J Am Acad Child Adolesc Psychiatry 41:680–686PubMedCrossRefGoogle Scholar
  17. 17.
    Poulin C, Hand D, Boudreau B, Santor D (2005) Gender differences in the association between substance use and elevated depressive symptoms in a general adolescent population. Addiction 100:525–535PubMedCrossRefGoogle Scholar
  18. 18.
    Winters KC, Stinchfield RD, Latimer WW, Stone A (2008) Internalizing and externalizing behaviors and their association with the treatment of adolescents with substance use disorder. J Subst Abuse Treat 35:269–278PubMedCrossRefGoogle Scholar
  19. 19.
    Elkins IJ, McGue M, Iacono WG (2007) Prospective effects of attentional deficit hyperactivity disorder conduct disorder and gender on adolescent substance use and abuse. Arch Gen Psychiatry 64:1145–1152PubMedCrossRefGoogle Scholar
  20. 20.
    Volkow ND (2004) The reality of comorbidity: depression and drug abuse. Biol Psychiatry 56:714–717PubMedCrossRefGoogle Scholar
  21. 21.
    King SM, Iacono WG, McGue M (2004) Childhood externalizing and internalizing psychopathology in the prediction of early substance use. Addiction 99:1548–1559PubMedCrossRefGoogle Scholar
  22. 22.
    Díaz R, Gual A, García M et al (2008) Children of alcoholics in Spain: from risk to pathology results from the ALFIL program. Soc Psychiatry Psychiat Epidemiol 43:1–10CrossRefGoogle Scholar
  23. 23.
    Díaz R, Castro-Fornieles J, Serrano L et al (2008) Clinical and research utility of Spanish Teen-Addiction Severity Index (T-ASI). Addict Behav 33:188–195PubMedCrossRefGoogle Scholar
  24. 24.
    American Psychiatric Association (2000) Diagnostic and Statistical Manual of Mental Disorders-Text Revision, 4th edn. DSM-IV (Spanish version). Ed Masson, BarcelonaGoogle Scholar
  25. 25.
    Moss RH, Moss BS, Tricket EJ (1984) Las escalas de clima social: Familia, trabajo, instituciones penitenciarias y escuela. TEA Ediciones, Madrid (Adapted from “The Social Climate Scales: Family, Work, Correctional Institutions and Classroom Environmental Scales”, Palo Alto, CA: Consulting Psychologists Press Inc; 1974.)Google Scholar
  26. 26.
    Achenbach TM (1991) Integrative guide for the 1991 CBCL/4-18, YSR and TRF profiles. University of Vermont, BurlingtonGoogle Scholar
  27. 27.
    Wagner FA, Anthony JC (2007) Male-female differences in the risk of progression from first use to dependence upon cannabis, cocaine and alcohol. Drug Alcoh Depen 86:191–198CrossRefGoogle Scholar
  28. 28.
    Masten AS, Roisman GI, Long JD et al (2005) Developmental cascades: Linking academic achievement and externalizing and internalizing symptoms over 20 years. Dev Psychol 41:733–746PubMedCrossRefGoogle Scholar
  29. 29.
    Flory K, Lynam DR (2003) The relationship between attention deficit hyperactivity disorder and substance abuse: what roles does conduct disorder play? Clin Child Fam Psychol Rev 6:1–16PubMedCrossRefGoogle Scholar
  30. 30.
    Chambers RA, Taylor JR, Potenza MN (2003) Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability. Am J Psychiatry 160:1041–1052PubMedCrossRefGoogle Scholar
  31. 31.
    Brener ND, Billy JO, Grady WR (2003) Assessment of factors affecting the validity of self-reported health-risk behavior among adolescents: evidence from the scientific literature. J Adolesc Health 33:436–457PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Rosa Díaz
    • 1
    Email author
  • Javier Goti
    • 1
  • Montse García
    • 2
  • Antoni Gual
    • 3
  • Lourdes Serrano
    • 4
  • Laura González
    • 4
  • Rosa Calvo
    • 1
  • Josefina Castro-Fornieles
    • 1
    • 5
    • 6
  1. 1.Department of Child and Adolescent Psychiatry and Psychology, Institute of NeurosciencesHospital Clínic Universitari of Barcelona, Biomedical Research Center in Mental Health Network CIBERSAMBarcelonaSpain
  2. 2.Cancer Prevention and Control UnitCatalan Institute of OncologyBarcelonaSpain
  3. 3.Alcohol Unit, Department of Psychiatry, Institute of NeurosciencesHospital Clinic Universitari of BarcelonaBarcelonaSpain
  4. 4.Department of Child and Adolescent Psychiatry and Psychology, Institute of NeurosciencesHospital Clínic Universitari of BarcelonaBarcelonaSpain
  5. 5.IDIBAPS (Institut d’Investigacions Biomèdiques August Pi Sunyer)BarcelonaSpain
  6. 6.Health Sciences Division, Department of Psychiatry and Clinical PsychobiologyUniversity of BarcelonaBarcelonaSpain

Personalised recommendations