HOMEResourcesArchive of Brown Newsletter
| Psychiatric comorbidity high among minorities |
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African-American and Hispanic adolescents with substance abuse problems also have a high rate of psychiatric comorbidity, according to new research. Hispanic adolescents, in particular, appear to be at even greater risk of externalizing disorders, such as ADHD and conduct disorder, when compared with their African-American peers. Researchers conducted a study that examined differences in psychiatric comorbidity between African-American and Hispanic adolescents referred for outpatient treatment for substance abuse between October 1997 and March 2000. One hundred sixty-seven Hispanic (N=90) and African-American (N=77) adolescents 12 to 17 years old and their families participated in the study, which randomly assigned adolescents to three treatment conditions and followed them over 18 months. All adolescent participants met the DSM-IV criteria for substance abuse and/or dependence. Psychiatric comorbidity was assessed with the Diagnostic Interview Schedule for Children-Predictive Scales, an instrument that screens for simple phobia, social phobia, agora-phobia, panic, overanxious, separation anxiety, major depression, attention-deficit/ hyperactivity, oppositional defiant and conduct disorders. To minimize burden, parents were only interviewed about the externalizing disorders (i.e., attention-deficit/hyperactivity, conduct, oppositional defiant). The Adolescent Drug Abuse Diagnosis measured adolescents' substance use in the 30 days preceding assessment. Substance use Slightly more than 80 percent of adolescents used marijuana, with over 30 percent reporting using daily, every other day or weekly. More than 20 percent reported using the drug on a monthly basis. Alcohol use was reported by about 35 percent of the sample, with 59 percent of those using reporting use daily or every other day, 29 percent reporting weekly use and 12 percent reporting monthly use. Of the adolescents reporting cocaine use (16.9%), 75 percent reported frequent use (every three days). The remaining 25 percent of cocaine users reported use that ranged from once every eight days to 30 days. No significant differences in the drugs used or in the frequency of drug use was found between African American and Hispanic youth; however, Hispanic adolescents reported more frequent past use of alcohol than their African-American peers (p<0.001). Psychiatric comorbidity Both groups of adolescents presented with above-threshold symptoms of co-occurring disorders, with 18.9 percent reporting above-threshold symptoms for one disorder, 14 percent for two disorders, 19.5 percent for three disorders and 34 percent for four or more disorders. Hispanic adolescents had significantly greater rates of externalizing psychiatric symptoms, reporting higher rates of attention-deficit/hyperactivity (41.4%) and oppositional defiant disorders (60.5%) than African-American adolescents (20.8% and 41.6%, respectively). Likewise, Hispanic parents reported significantly greater rates of attention deficit/ hyperactivity (58.6%) and conduct disorder (67.8%) in their children compared with African-American parents (40.3% and 42.9% respectively). In addition, analyses revealed that African-American adolescents reported greater above-threshold rates of agoraphobia (40.3%) than Hispanic adolescents (19.5%). The authors say that research has shown that adolescents with comorbid externalizing disorders have poorer treatment outcomes. "Among Hispanics in particular, therapists must attend to the youths' entrenchment in a deviant subculture that may profoundly impact their functioning in their home, school and community," say the authors. "Interventions that fail to address constellations of symptoms are less likely to lead to lasting and significant improvements in adolescent substance abuse." Robbins MS, Kumar S, Walker-Barnes C, et al.: Ethnic differences in comorbidity among substance-abusing adolescents referred to outpatient therapy. Journal of the American Academy of Child & Adolescent Psychiatry 2002; 41(4):394-401. Correspondence to: Dr. Robbins, University of Miami School of Medicine, Center for Family Studies, 1425 N.W. 10 th Avenue, 3 rd Floor, Miami, FL 33136; e-mail: mrobbins@med.miami.edu. |