Youth Substance Abuse and Co occurring Disorders
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CONTENTS
Contributors - - - - - - - - - - - - - - - - - - - - - - - - - - ix
Preface- - - - - - - - - - - - - - - - - - - - - - - - - - - - - xv
Yifrah Kaminer, M.D., M.B.A.
1 Developmental Pathways to Substance Use Disorder and
Co-occurring Psychiatric Disorders in Adolescents- - - - - - 1
Ralph E. Tarter, Ph.D.
Michelle S. Horner, D.O.
2 Relationship Between Substance Use Disorders and
Psychiatric Comorbidity
Implications for Integrated Health Services - - - - - - - - - 21
Marc Fishman, M.D.
3 Screening, Assessment, and Treatment Options for
Youths With a Substance Use Disorder - - - - - - - - - - - - 49
Yifrah Kaminer, M.D., M.B.A.
Ken C. Winters, Ph.D.
John Kelly, Ph.D.
4 Conduct Disorder and Delinquency and
Substance Use Disorders - - - - - - - - - - - - - - - - - - - - - 81
Oscar G. Bukstein, M.D., M.P.H.
5 Attention-Deficit/Hyperactivity Disorder and
Substance Use Disorders - - - - - - - - - - - - - - - - - - - - 103
Timothy E. Wilens, M.D.
Courtney A. Zulauf, B.A.
6 Depressive Disorders and Substance Use Disorders - - - 131
John F. Curry, Ph.D., ABPP
Jacqueline Hersh, Ph.D.
7 Bipolar Disorders and Substance Use Disorders - - - - - 157
Anne Duffy, M.D., M.Sc., FRCPC
Maryam Nemati, M.A., CCC
8 Anxiety Disorders and Substance Use Disorders - - - - - 169
Jessica J. Black, Ph.D.
Tammy Chung, Ph.D.
Duncan B. Clark, M.D., Ph.D.
9 Posttraumatic Stress Disorder and
Substance Use Disorders - - - - - - - - - - - - - - - - - - - - 197
Julian D. Ford, Ph.D.
Josephine M. Hawke, Ph.D.
10 Suicidal and Nonsuicidal Self-Harm Behaviors and
Substance Use Disorders - - - - - - - - - - - - - - - - - - - - 227
Christianne Esposito-Smythers, Ph.D.
Alexandra Perloe, M.A.
Kyla Machell, M.A.
Bethany Rallis, Ed.M.
11 Schizophrenia and Substance Use Disorders - - - - - - - 253
Kara S. Bagot, M.D.
Robert Milin, M.D., FRCPC
12 Eating Disorders and Substance Use Disorders - - - - - - 279
Jessica H. Baker, Ph.D.
Lauren M. Metzger, LCSWA
Cynthia M. Bulik, Ph.D.
13 Youth Gambling Problems - - - - - - - - - - - - - - - - - - - - 307
Jeffrey L. Derevensky, Ph.D.
14 Pathological Preoccupation With the Internet - - - - - - - 337
Yvonne H.C. Yau, M.Sc.
Jeffrey L. Derevensky, Ph.D.
Marc N. Potenza, M.D., Ph.D.
Index - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 351
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CONTRIBUTORS
Kara S. Bagot, M.D.
Fellow, Albert J. Solnit Integrated Training Program in Adult, Child,
and Adolescent Psychiatry, Yale University School of Medicine Child
Study Center, New Haven, Connecticut
Jessica H. Baker, Ph.D.
Assistant Professor, Department of Psychiatry, University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina
Jessica J. Black, Ph.D.
Postdoctoral Research Scholar, Department of Psychiatry and Gradu-
ate School of Public Health, University of Pittsburgh, Pittsburgh,
Pennsylvania
Oscar G. Bukstein, M.D., M.P.H.
Medical Director, DePelchin Children’s Center; Clinical Professor of
Psychiatry, University of Texas Health Science Center–Houston,
Baylor College of Medicine, Houston, Texas
Cynthia M. Bulik, Ph.D.
Distinguished Professor of Eating Disorders, Department of Psychiatry,
University of North Carolina at Chapel Hill, Chapel Hill, North
Carolina; Professor, Department of Medical Epidemiology and
Biostatistics, Karolinska Institutet, Stockholm, Sweden
Tammy Chung, Ph.D.
Associate Professor, Departments of Psychiatry and Epidemiology,
University of Pittsburgh, Pittsburgh, Pennsylvania
Duncan B. Clark, M.D., Ph.D.
Associate Professor, Department of Psychiatry, University of
Pittsburgh, Pittsburgh, Pennsylvania
ix
x Youth Substance Abuse and Co-occurring Disorders
John F. Curry, Ph.D., ABPP
Professor, Department of Psychiatry and Behavioral Sciences and
Department of Psychology and Neuroscience, Duke University,
Durham, North Carolina
Jeffrey L. Derevensky, Ph.D.
Professor, Department of Psychiatry and Department of Educational
and Counselling Psychology, and Director, International Centre for
Youth Gambling Problems and High-Risk Behaviors, McGill Univer-
sity, Montreal, Quebec, Canada
Anne Duffy, M.D., M.Sc., FRCPC
Campus Alberta Innovates Program (CAIP), Research Chair in Youth
Mental Health, and Professor, Department of Psychiatry, University of
Calgary, Mathison Centre for Mental Health Research and Education,
Calgary, Alberta, Canada
Christianne Esposito-Smythers, Ph.D.
Associate Professor, Department of Psychology, George Mason
University, Fairfax, Virginia
Marc Fishman, M.D.
Assistant Professor, Department of Psychiatry, Johns Hopkins Univer-
sity School of Medicine; Medical Director, Maryland Treatment Centers,
Baltimore, Maryland
Julian D. Ford, Ph.D.
Professor, Department of Psychiatry, University of Connecticut Health
Center, Farmington, Connecticut
Josephine M. Hawke, Ph.D.
Assistant Professor, Department of Psychiatry, University of Connecti-
cut Health Center, Farmington, Connecticut
Jacqueline Hersh, Ph.D.
Postdoctoral Fellow, Department of Psychology, Harvard University,
Cambridge, Massachusetts
Michelle S. Horner, D.O.
Assistant Professor, Department of Psychiatry and Behavioral Sciences,
Johns Hopkins School of Medicine, Baltimore, Maryland
Contributors xi
Yifrah Kaminer, M.D., M.B.A.
Professor of Psychiatry and Pediatrics, University of Connecticut
Health Center, Farmington, Connecticut
John Kelly, Ph.D.
Elizabeth R. Spalin Associate Professor of Psychiatry, Harvard Medical
School; Director, Recovery Research Institute, Massachusetts
General Hospital, Boston, Massachusetts
Kyla Machell, M.A.
Graduate Student in Clinical Psychology, Department of Psychology,
George Mason University, Fairfax, Virginia
Lauren M. Metzger, LCSWA
Clinical Instructor, Department of Psychiatry, University of North
Carolina at Chapel Hill, Chapel Hill, North Carolina
Robert Milin, M.D., FRCPC
Head, Division of Addiction and Mental Health, and Associate Profes-
sor, Department of Psychiatry, University of Ottawa; Clinical Scientist,
Institute of Mental Health Research; Director, Adolescent Day Treat-
ment Unit, Youth Psychiatry Program, Royal Ottawa Mental Health
Centre, Ottawa, Ontario, Canada
Maryam Nemati, M.A., CCC
Research Associate, Mood Disorders Centre of Ottawa, Ottawa,
Ontario, Canada
Alexandra Perloe, M.A.
Graduate Student in Clinical Psychology, Department of Psychology,
George Mason University, Fairfax, Virginia
Marc N. Potenza, M.D., Ph.D.
Professor, Departments of Psychiatry, Child Study, and Neurobiology,
Yale University, New Haven, Connecticut
Bethany Rallis, Ed.M.
Graduate Student in Clinical Psychology, Department of Psychology,
George Mason University, Fairfax, Virginia
xii Youth Substance Abuse and Co-occurring Disorders
Ralph E. Tarter, Ph.D.
Professor, Center for Education and Drug Abuse Research, School of
Pharmacy, University of Pittsburgh, Pittsburgh, Pennsylvania
Timothy E. Wilens, M.D.
Chief of Child and Adolescent Psychiatry, Director, Center for Addic-
tion Medicine, and Director, Substance Abuse Services in Pediatric
Psychopharmacology, Massachusetts General Hospital; Associate Pro-
fessor of Psychiatry, Harvard Medical School, Boston, Massachusetts
Ken C. Winters, Ph.D.
Professor of Psychiatry, University of Minnesota Medical School,
Minneapolis, Minnesota
Yvonne H.C. Yau, M.Sc.
Ph.D. Candidate, Department of Neurology and Neurosurgery,
McGill University, Montreal, Quebec, Canada
Courtney A. Zulauf, B.A.
Doctoral Student, Department of Psychology, University of Illinois
at Chicago, Chicago, Illinois
Contributors xiii
Disclosure of Competing Interests
The following contributors to this book have indicated a financial interest in or
other affiliation with a commercial supporter, a manufacturer of a commercial
product, a provider of a commercial service, a nongovernmental organization,
and/or a government agency, as listed below:
Cynthia M. Bulik, Ph.D.—Consultant: Shire Pharmaceuticals; Royalties:
Pearson.
John F. Curry, Ph.D., ABPP—Research support: Pfizer for a naturalistic
follow-up study on the safety of sertraline in youth, Forest Research In-
stitute for a clinical trial of vilazodone for adolescent major depressive
disorder; Member: Integrated Psychotherapy Consortium, which pro-
vides training in cognitive behavior therapy through the REACH Insti-
tute.
Marc Fishman, M.D.—Research support: US WorldMeds.
Julian D. Ford, Ph.D.—Co-owner: Advanced Trauma Solutions, Inc.
Robert Milin, M.D., FRCPC—Speaker’s honorarium: Bristol-Myers
Squibb Canada
Marc N. Potenza, M.D., Ph.D.—Consultation and advisement: Boehringer
Ingelheim, Lundbeck, Ironwood, Shire, INSYS; Consultation and financial
interests: Somaxon; Research support: National Institutes of Health, Vet-
eran’s Administration, Mohegan Sun Casino, National Center for Re-
sponsible Gaming and its affiliated Institute for Research on Gambling
Disorders, Forest Laboratories, Ortho-McNeil, Oy-Control/Biotie,
Glaxo-SmithKline, Pfizer, Psyadon Pharmaceuticals. The author has
participated in surveys, mailings, or telephone consultations related to
drug addiction, impulse control disorders, or other health topics; has
consulted for law offices and the federal public defender’s office on is-
sues related to impulse control disorders; provides clinical care in the
Connecticut Department of Mental Health and Addiction Services
Problem Gambling Services Program; has performed grant reviews for
the National Institutes of Health and other agencies; has guest-edited
journal sections; has given academic lectures in grand rounds, CME
events, and other clinical or scientific venues; and has generated books
or book chapters for publishers of mental health texts.
xiv Youth Substance Abuse and Co-occurring Disorders
Timothy E. Wilens, M.D.—Grant support: NIH (NIDA), Pfizer, Shire;
Consultant: Bay Cover Human Services, Euthymics/Neurovance, Ma-
jor/Minor League Baseball, US National Football League/ERM Associ-
ates, NIH (NIDA), Shire, Theravance, TRIS; Author: Straight Talk About
Psychiatric Medications for Kids; Co-editor: ADHD in Children and Adults
and Comprehensive Clinical Psychiatry.
The following contributors to this book have indicated no competing interests
to disclose during the year preceding manuscript submission:
Kara S. Bagot, M.D.
Jessica H. Baker, Ph.D.
Jessica J. Black, Ph.D.
Oscar G. Bukstein, M.D., M.P.H.
Tammy Chung, Ph.D.
Duncan B. Clark, M.D., Ph.D.
Jeffrey L. Derevensky, Ph.D.
Anne Duffy, M.D., M.Sc., FRCPC
Christianne Esposito-Smythers, Ph.D.
Jacqueline Hersh, Ph.D.
Michelle S. Horner, D.O.
Yifrah Kaminer, M.D., M.B.A.
John Kelly, Ph.D
Kyla Machell, M.A
Alexandra Perloe, M.A.
Ralph E. Tarter, Ph.D.
Ken C. Winters, Ph.D.
Yvonne H. C. Yau, M.Sc.
Courtney A. Zulauf, B.A.
PREFACE
There is a continuing worldwide public health challenge: adoles-
cents with substance use disorders (SUDs). Heterogeneity with respect
to severity of substance use and the association of comorbid psychiat-
ric disorders is characteristic of this population according to clinical
consensus. Indeed, it is the rule rather than the exception that the ma-
jority (70%–80%) of adolescents with the diagnosis of SUD manifest co-
morbid psychopathology, known also as co-occurring disorders or dual
diagnosis—that is, the presence of one or more comorbid psychiatric
disorders in addition to SUD (Bukstein et al. 1989). Psychiatric disor-
ders in childhood, including disruptive behavior and mood and anxi-
ety disorders, increase risk for the development of SUD in adolescence.
Etiological mechanisms have not been methodically researched; how-
ever, a number of possible relationships exist between SUD and psy-
chopathology. Psychopathology may precede SUD in the majority of
cases. It may also develop as a consequence of a preexisting SUD or
may influence the severity of SUD. Psychopathology may be unrelated
or may arise from a common vulnerability.
The objective of this book is to address theory and practice pertain-
ing to understanding and treating psychiatric comorbidity in adoles-
cents with SUDs. Some of the most prominent investigators in the field
have contributed scholarly chapters to this volume. Given the growing
interest in clinical research and the advancement of treatment, it is im-
portant to note that future directions in clinical research are empha-
sized in each and every chapter. The authors are hoping that this book
will enhance and inspire continued clinical and research investment in
the dual-diagnosis domain. For instance, although comorbidity is a
key correlate of treatment outcome among adolescents in treatment for
SUDs, most studies examine comorbidity as a static patient character-
istic that affects drug use severity and outcomes. The stability or labil-
ity of psychiatric diagnostic status among substance-using adolescents
has not been systematically investigated. Additional research on this
aspect of the diagnostic status of substance-using youths is warranted.
xv
xvi Youth Substance Abuse and Co-occurring Disorders
Improved understanding of the relationship between SUD and psychi-
atric comorbidity among youth, including how the respective courses
of SUD and psychiatric disorders are related, how changes occur
across different types of disorders, and how trajectories of change af-
fect the clinical course of recovery from SUD, is essential. Finally, clin-
ical trials for specific treatment modalities for SUDs should include
youths with psychiatric comorbidity, but they should also examine
specific interventions for specific comorbid conditions, for example,
attention-deficit/hyperactivity disorder, depression, and anxiety dis-
orders. This book should stimulate further discussion and advance-
ment of the field, with the ultimate result of better care and more
effective services and intervention modalities for these youth.
All but chapters 13 and 14 include in the titles the terms substance
use disorder or disorders. Chapters 13 and 14 are included in this edi-
tion because they represent important emerging non-substance-related
addictive disorders; both gambling disorder and Internet gaming dis-
order are represented in DSM-5 (American Psychiatric Association
2013). In both chapters, there is a limited review of co-occurring disor-
ders because the literature is still lagging behind in publications on sub-
stance-related disorders.
Chapters 5–14 include DSM-5 criteria for the reviewed respective
disorders. This allows readers to compare these criteria with previous
editions of DSM. Finally, it remains to be seen whether the DSM-5 diag-
nostic criteria for substance-related and addictive disorders will meet
the needs of adolescents better than DSM-IV (American Psychiatric As-
sociation 1994) diagnostic criteria, which also included the abuse and
dependence categories. Some criticisms about the limitations of the new
diagnostic formulation for youth have already emerged (Kaminer and
Winters 2015). These include questioning the utility and justification for
the low two-symptom threshold for SUD (out of 11 potential symptoms)
and the inclusion and definition (or lack of) of symptoms such as toler-
ance, withdrawal, hazardous use, and craving.
The applied approach of this book will serve the needs of clinicians,
clinical researchers, and students in the fields of mental health, public
health, and medicine (particularly in pediatrics, family medicine, and
child and adolescent psychiatry).
As the editor of this volume, I wish to acknowledge current support
from the National Institute on Drug Abuse and the National Institute on
Alcohol Abuse and Alcoholism.
Yifrah Kaminer, M.D., M.B.A.
Preface xvii
References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, 4th Edition. Washington, DC, American Psychiatric Association,
1994
American Psychiatric Association: Diagnostic and Statistical Manual of Mental
Disorders, 5th Edition. Arlington, VA, American Psychiatric Association,
2013
Bukstein O, Brent DA, Kaminer Y: Comorbidity of substance abuse and other
psychiatric disorders in adolescents. Am J Psychiatry, 146:1131–1141,
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Kaminer Y, Winters K: DSM-5 adolescent substance use disorders: lost in trans-
lation? J Am Acad Child Adolesc Psych 54(5):350–351, 2015 25901770
