ASPEN, COLO. — Surveys consistently show that 90% of all youths have experimented with drugs and alcohol by the time they finish high school. Yet only a minority develop substance abuse problems, Paula D. Riggs, M.D., said at a psychiatry conference sponsored by the University of Colorado.
Convergent evidence from multiple genetic studies and longitudinal behavioral studies shows that children who develop adolescent substance use disorder can often be identified as early as preschool, he said.
The developmental trajectory that leads to adolescent substance use disorder begins in early childhood. Youngsters in substance abuse treatment programs are more likely than are their non-drug-abusing peers to have displayed a particular constellation of temperament traits as toddlers and preschoolers. This constellation consists of aggressiveness, impulsivity, poor attentiveness and persistence, and difficulty in regulating affect and behavior.
These aspects of temperament are quite heritable. In addition, the home life of affected children is often characterized by conflict and poor parental monitoring.
Without intervention, children with this pattern of difficult temperament often develop oppositional defiant disorder, learning disabilities, conduct disorder, and/or attention deficit-hyperactivity disorder by the time they enter school. They often are unsuccessful in school and may be placed in special education classes where they associate with a deviant peer group, becoming deficient in social skills and coping strategies. Eventually they turn to drugs and alcohol as their coping strategy.
If primary care physicians were to identify preschoolers with the red-flag characteristic temperament constellation and refer them for a comprehensive psychologic assessment and evaluation, it could have a huge impact on the problem of teen substance abuse down the road. “We have early interventions that help reduce the risk of later problems,” Dr. Riggs said at the conference, which was also sponsored by the Colorado Psychiatric Society and the Denver Institute for Psychoanalysis.