Advertisement

Drug Abuse Heterogeneity and the Search for Subtypes

  • Meyer D. Glantz
  • Kevin P. Conway
  • James D. Colliver

4. Conclusions

In addition to the research on the association between substance use disorders and antisociality, there is a large body of literature reporting connections with behavior disinhibition and affect dysregulation. It is not possible in this short chapter to review these and other findings on risk factors for substance use disorders. However, the above discussion illustrates the convergences in the research findings on risk factors that point to possible clusters having implications for further understanding the heterogeneity of substance abuse and the identification of drug abuse subtypes.

It is also not possible in this chapter to discuss important related issues, such as the relationship of heterogeneity to substance use disorder phenotypes and endophenotypes, the role of protective factors in the divergence of subtypes, the relationship of co-morbid psychiatric conditions and developmental psychopathology to heterogeneity, developmental influences, and individual and group diversity, and the implications of heterogeneity and subtypes for prevention and treatment. Despite the unanswered questions, however, it is clear that investigation of the heterogeneity of substance use disorders and their underlying processes can advance our ability to effectively understand, prevent and treat substance abuse.

It is clearly important to go beyond the recognition of the heterogeneity of drug abuse and to look for systematic variations in the etiology and manifest patterns of substance abuse. There may be critical variations in the underlying processes of substance abuse as well as significant systematic differences in the observable behavior patterns. Distinguishing major divergences in the differing patterns may lead to the identification of clinically significant subtypes, help determine the underlying processes of substance abuse, and facilitate the study of the ways in which environmental factors interact with individuals’ characteristics (and the underlying processes of substance abuse) to result in different subtypes. While the available research does not answer the question of whether there are drug abuse subtypes, it does provide encouragement to continue the search.

Keywords

Substance Abuse Personality Disorder Conduct Disorder Drug Abuse Heterogeneity Antisocial Personality Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. American Psychiatric Association, Washington, D.C.Google Scholar
  2. Armstrong, T.D. and Costello, E.J. (2002). Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity. Journal of Consulting and Clinical Psychology 70, pp. 1224–1239.PubMedCrossRefGoogle Scholar
  3. Anthony, J.C., Warner, L.A., and Kessler, R.C. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey, Experimental and Clinical Psychopharmacology 2, pp. 224–268.CrossRefGoogle Scholar
  4. Anthony, J.C. and Petronis, K.R. (1995). Early-onset drug use and risk of later drug problems. Drug and Alcohol Dependence 40, pp. 9–15.PubMedCrossRefGoogle Scholar
  5. Babor, T.F., Hofmann, M., DelBoca, F.K., Hesselbrock, V., Meyer, R.E., Dolinsky, Z.S. and Rounsaville, B. (1992). Types of alcoholics, I. Evidence for an empirically derived typology based on indicators of vulnerability and severity. Archives of General Psychiatry 49, pp. 599–608.PubMedGoogle Scholar
  6. Bierut, L.J., Dinwiddie, S.H., Begleiter, H., Crowe, R.R., Hesselbrock, V., Nurnberger, J.I. Jr., Porjesz, B., Schuckit, M.A., and Reich, T. (1998). Familial transmission of substance dependence: Alcohol, marijuana, cocaine, and habitual smoking: A report from the Collaborative Study on the Genetics of Alcoholism. Archives of General Psychiatry 55, pp. 982–988.PubMedCrossRefGoogle Scholar
  7. Burke J.D., Loeber R. and Lahey, B.B. (2001). Which aspects of ADHD are associated with tobacco use in early adolescence? Journal of Child Psychology and Psychiatry 42, pp. 493–502.PubMedCrossRefGoogle Scholar
  8. Cadoret, R.J. (1992). Genetic and environmental factors in initiation of drug use and the transition to abuse. In M. Glantz and R. Pickens (Eds.), Vulnerability to Drug Abuse. American Psychological Association, Washington, D.C., pp. 99–113.Google Scholar
  9. Cadoret, R.J., Yates, W.R., Troughton, E, Woodworth G. and Stewart MA. (1996). An adoption study of drug abuse/dependency in females. Comprehensive Psychiatry 37, pp. 88–94.PubMedCrossRefGoogle Scholar
  10. Cadoret, R.J., Troughton, E., O’Gorman, T., and Heywood, E. (1986). An adoption study of genetic and environmental factors in drug abuse. Archives of General Psychiatry 43, pp. 1131–1136.PubMedGoogle Scholar
  11. Chassin L, Pitts S.C., and Prost, J. (2002). Binge drinking trajectories from adolescence to emerging adulthood in a high-risk sample: predictors and substance abuse outcomes. Journal of Consulting and Clinical Psychology 70, pp. 67–78.PubMedCrossRefGoogle Scholar
  12. Chilcoat, H.D. and Breslau, N. (1998). Posttraumatic stress disorder and drug disorders: Testing causal pathways. Archives of General Psychiatry 55(10), pp. 913–917.PubMedCrossRefGoogle Scholar
  13. Cuijpers, P. and Smit, F. (2004). Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatrica Scandinavia 109, pp. 325–331.CrossRefGoogle Scholar
  14. Glantz, M.D. and Colliver, J.D. (2002). Drug use, drug abuse, and heterogeneity. Bulletin on Narcotics, United Nations 54(1), pp. 45–59.Google Scholar
  15. Glantz, M.D., and Pickens, R.W. (1992). Vulnerability to drug abuse: Introduction and overview. In M. Glantz and R. Pickens (Eds.), Vulnerability to drug abuse. American Psychological Association, Washington, D.C., pp. 1–14.Google Scholar
  16. Grant, B.F. and Dawson, D.A. (1998). Age of onset of drug use and its association with DSM-IV drug abuse and dependence. Journal of Substance Abuse 10, pp. 163–173.PubMedCrossRefGoogle Scholar
  17. Grant, B.F. and Pickering, R. (1998). The relationship between cannabis use and DSM-IV cannabis abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse 10(3), pp. 225–264.CrossRefGoogle Scholar
  18. Grant, B.F. Stinson F.S., Dawson, D.A., Chou, S.P., Ruan, W.J., and Pickering, R.P. (2004). Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, pp. 361–368.PubMedCrossRefGoogle Scholar
  19. Grilo, C.M., Masheb, R.M., and Wilson, G.T. (2001). Subtyping binge eating disorder. Journal of Consulting and Clinical Psychology 69(6), pp. 1066–1072.PubMedCrossRefGoogle Scholar
  20. Grove, W., Eckert, E., Heston, L., Bouchard, T., Segal, N., and Lykken, D. (1990). Heritability of substance abuse and antisocial behaviour: A study of monozygotic twins reared apart. Biological Psychiatry 27, pp. 1293–1304.PubMedCrossRefGoogle Scholar
  21. Haertzen, C.A., Kocher, T.R., and Miyasato, K. (1983). Reinforcements from the first drug experience can predict later drug habits and/or addiction: results with coffee, cigarettes, alcohol, barbiturates, minor and major tranquilizers, stimulants, marijuana, hallucinogens, heroin, opiates and cocaine. Drug and Alcohol Dependence 11, pp. 147–165.PubMedCrossRefGoogle Scholar
  22. Hawkins, J.D., Catalano, R.F., and Miller, J.Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin 112(1), pp. 64–105.PubMedCrossRefGoogle Scholar
  23. Hyman, S.E. and Nestler, E.J. (1996). Initiation and adaptation: a paradigm for understanding psychotropic drug action. American Journal of Psychiatry 153, pp. 151–162.PubMedGoogle Scholar
  24. Jang, K.L., Livesley, W.J., and Vernon, P.A. (1995). Alcohol and drug problems: a multivariate behavioural genetic analysis of co-morbidity. Addiction 90, pp. 1213–1221.PubMedCrossRefGoogle Scholar
  25. Kandel, D.B. and Yamaguchi, K. (1993). From beer to crack: Developmental patterns of drug involvement. American Journal of Public Health 83(6), pp. 851–855.PubMedCrossRefGoogle Scholar
  26. Kellam, S.G. and Anthony, J.C. (1998). Targeting early antecedents to prevent tobacco smoking: Findings from an epidemiologically based randomized field trial. American Journal of Public Health 88, pp. 193–197.Google Scholar
  27. Kendler K.S., Jacobson K.C., Prescott C.A., and Neale M.C. (2003). Specificity of genetic and environmental risk factors for use and abuse/dependence of cannabis, cocaine, hallucinogens, sedatives, stimulants, and opiates in male twins. American Journal of Psychiatry 160(4), pp. 687–695.PubMedCrossRefGoogle Scholar
  28. Kendler, K.S., Karkowski, L.M., and Prescott, C.A. (1999). Hallucinogen, opiate, sedative and stimulant use and abuse in a population-based sample of female twins. Acta Psychiatrica Scandinavia 99, pp. 368–376.Google Scholar
  29. Kendler, K.S., Karkowski, L.M., Neale, M.C., and Prescott, C.A. (2000). Illicit psychoactive substance use, heavy use, abuse and dependence in a US population-based sample of male twins. Archives of General Psychiatry 57, pp. 261–269.PubMedCrossRefGoogle Scholar
  30. Kessler, R.C., Aguilar-Gaxiola, S., Andrade, L., Bijl, R., Borges, G., Caraveo-Anduaga, J.J., DeWit, D.J., Kolody, B., Merikangas, K.R., Molnar, B.E., Vega, W.A., Walters, E.E., Wittchen, H.U., and Ustun, T.B. (2001). Mental-substance comorbidities in the ICPE surveys. Psychiatria Fennica 32(suppl 2), pp. 62–79.Google Scholar
  31. Kessler, R.C., Nelson, C.B., McGonagle, K.A., Edlund, M.J., Frank, R.G., and Leaf, P.J. (1996). The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization. American Journal of Orthopsychiatry 66, pp. 17–31.PubMedGoogle Scholar
  32. Koob, G.F. and Le Moal, M. (1997). Drug abuse: hedonic homeostatic dysregulation. Science 278(5335), pp. 52–58.PubMedCrossRefGoogle Scholar
  33. Langbehn, D.R. and Cadoret, R.J. (2001). The adult antisocial syndrome with and without antecedent conduct disorder: Comparisons from an adoption study. Comprehensive Psychiatry 42, pp. 272–282.PubMedCrossRefGoogle Scholar
  34. Lewinsohn, P.M., Brown, R.A., Seeley, J.R., and Ramsey, S.E. (2000). Psychosocial correlates of cigarette smoking abstinence, experimentation, persistence and frequency during adolescence. Nicotine and Tobacco Research 2, pp. 121–131.PubMedGoogle Scholar
  35. Lewinsohn, P.M., Gotlib I.H., and Seeley, J.R. (1995). Adolescent psychopathology: IV. Specificity of psychosocial risk factors for depression and substance abuse in older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 34, pp. 1221–1229.PubMedCrossRefGoogle Scholar
  36. Lynskey, M.T., Health, A.C., Bucholz, K.K., Slutskey, W.S., Madden, P.A., Nelson, E.C., Stratham, D.J., and Martin, N.G. (2003). Escalation of drug use in early onset cannabis users vs. co-twin controls. Journal of the American Medical Association 289, pp. 427–433.PubMedCrossRefGoogle Scholar
  37. McKay, D., Abramowitz, J.S., Calamari, J.E., Kyrios, M., Radomsky, A., Sookman, D., Taylor S. and S. Wilhelm. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms, Clinical Psychology Review 24(3), pp. 283–313.PubMedCrossRefGoogle Scholar
  38. Merikangas, K.R., Mehta, R.L., Molnar, B.E., Walters, E.E., Swendsen, J.D., Aguilar-Gaziola, S., Bijl, R.V., Borges, G., Caraveo-Anduaga, J.J., DeWit, D.J., Kolody, B., Vega, W.A., Wittchen, H.U., and Kessler, R.C. (1998). Comorbidity of substance use disorders with mood and anxiety disorders: Results of the international consortium in psychiatric epidemiology. Addictive Behaviors 23, pp. 893–907.PubMedCrossRefGoogle Scholar
  39. Merikangas, K.R., Stolar, M., Stevens, D.E., Goulet, J., Priesig, M., Fenton, B., and Rounsaville, B.J. (1998). Familial transmission of substance use disorders. Archives of General Psychiatry 55, pp. 973–979.PubMedCrossRefGoogle Scholar
  40. Moss, H.B., Lynch, K.G., Hardie, T.L., and Baron, D.A. (2002). Family functioning and peer affiliation in children of fathers with antisocial personality disorder and substance dependence: associations with problem behaviors. American Journal of Psychiatry 159, pp. 607–614.PubMedCrossRefGoogle Scholar
  41. Neumark, Y.D. and Anthony, J.C. (1997). Childhood misbehavior and the risk of injection drug use. Drug and Alcohol Dependence 48, pp. 193–197.PubMedCrossRefGoogle Scholar
  42. Pomerleau, C.S., Pomerleau, O.F., Namenek, R.J., and Marks, J.L. (1999). Initial exposure to nicotine in college-age women smokers and never-smokers: a replication and extension. Journal of Addictive Disorders 18, pp. 13–19.CrossRefGoogle Scholar
  43. Regier, D.A., Farmer, M.E., Rae, D.S., Locke, B.Z., Keith, S.J., and Judd, L.L. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. Journal of the American Medical Association 262, pp. 2511–2518.CrossRefGoogle Scholar
  44. Reinherz, H.Z., Giaconia, R.M., Hauf, A.M., Wasserman, M.S., and Paradis, A.D. (2000). General and specific childhood risk factors for depression and drug disorders by early adulthood. American Academy of Child and Adolescent Psychiatry 39, pp. 223–231.CrossRefGoogle Scholar
  45. Robins, L.N. and McEvoy, L. (1990). Conduct problems as predictors of substance abuse. In L. Robins and M. Rutter (Eds.), Straight and Deviant Pathways from Childhood to Adulthood. New York: Cambridge University Press, pp. 182–204.Google Scholar
  46. Robins, L.N. and Przybeck, T.R. (1985). Age of onset of drug use as a factor in drug and other disorders. In C.L. Jones and R.L. Battjes, (Eds.). Etiology of Drug Abuse: Implications for Prevention. NIDA Research Monograph 56, National Institute on Drug Abuse, Rockville, MD., pp. 178–193.Google Scholar
  47. Schuckit, M.A., Tipp, J.E., Smith, T.L., Shapiro, E., Hesselbrock, V.M., Bucholz, K.K., Reich, T., Nurnberger Jr., J.I. (1995). An evaluation of Type A and B alcoholics. Addiction 90(9), pp. 1189–1204.PubMedCrossRefGoogle Scholar
  48. Spence, S.H. (1997). Structure of anxiety symptoms among children: A confirmatory factor-analytic study. Journal of Abnormal Psychology 106(2), pp. 280–297.PubMedCrossRefGoogle Scholar
  49. Storr, C.L., Reboussin, B.A., and Anthony, J.C. (2004). Early childhood misbehavior and the estimated risk of becoming tobacco-dependent. American Journal of Epidemiology 160, pp. 126–130.PubMedCrossRefGoogle Scholar
  50. Substance Abuse and Mental Health Services Administration. (2003). Results from the 2002 National Survey on Drug Use and Health: National Findings. (Office of Applied Studies, NHSDA Series H-22, DHHS Publication No. SMA 03-3836). Rockville, MD.Google Scholar
  51. Swendsen, J.D. and Merikangas, K.R. (2000). The comorbidity of depression and substance use disorders. Clinical Psychology Review 20, pp. 173–189.PubMedCrossRefGoogle Scholar
  52. Toomey, R. and Eaves, L. (1998). Co-occurrence of abuse of different drugs in men: the role of drug-specific and shared vulnerabilities. Archives of General Psychiatry 55, pp. 967–972.PubMedCrossRefGoogle Scholar
  53. Tsuang, M.T., Lyons, M.J., Meyer, J.M., Doyle, T., Eisen, S.A., Goldberg, J., True, W., Lin, N., Toomey, R., and Eaves, L. (1998). Co-occurrence of Abuse of Different Drugs in Men: The Role of Drug-Specific and Shared Vulnerabilities. Archives of General Psychiatry 55, pp. 967–972.PubMedCrossRefGoogle Scholar
  54. Tsuang, M.T., Lyons, M.J., Meyer, J.M., Doyle, T., Eisen, S.A., Goldberg, J., True, W., Lin, N., Warner, L.A., Kessler, R.C., Hughes, M., Anthony, J.C., and Nelson, C.B. (1995). Prevalence and correlates of drug use and dependence in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry 52, 219–229.Google Scholar
  55. Wagner, F.A. and Anthony, J.C. (2002). From first drug use to drug dependence: Developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Neuropsychopharmacology 26(4), pp. 479–488.PubMedCrossRefGoogle Scholar
  56. White, H.R., Xie, M., Thompson, W., Loeber, R., and Stouthamer-Loeber, M. (2001). Psychopathology as a predictor of adolescent drug use trajectories. Psychology of Addictive Behaviors 15, pp. 210–218.PubMedCrossRefGoogle Scholar
  57. World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. WHO, Geneva.Google Scholar

Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Meyer D. Glantz
    • 1
  • Kevin P. Conway
    • 1
  • James D. Colliver
    • 1
  1. 1.Division of Epidemiology, Services, and Prevention ResearchNational Institute on Drug AbuseBethesda

Personalised recommendations