Which juvenile delinquents given drug treatment for chemical dependency still go on to develop antisocial personality disorder? In an ambitious four year longitudinal study, researchers explored the Progression from Conduct Disorder to Antisocial Personality Disorder Following Treatment for Adolescent Substance Abuse (American Journal of Psychiatry, April 1998).

One hundred and sixty-six adolescents were recruited from two inpatient substance disorder programs, and evaluated in terms of interpersonal functioning. Four years later, those remaining in the study, now at an average age of 20,were re-diagnosed and evaluated in terms of interpersonal and work functioning. Based on existing research and clinical practice, it was predicted that drug abusers who in their teens had been diagnosed with "conduct disorder" would now be likely diagnosed as adults with "anti-social personality disorder" Best predictors of progression to antisocial personality disorder were the onset of deviant behavior at or before age 1 0, male gender, a greater diversity of deviant behavior and more extensive pretreatment drug use.

Further, young adults with anti-social personality disorder were more likely to self-report significant difficulties in work or school (relating to drug abuse), four times more likely to seek professional help for emotional problems, five times more likely to report marital problems, and six times more likely to be arrested.

This study group may not be representative of the population of teens at large, since the vast majority of teens who abuse alcohol, tobacco, and other drugs do not present themselves for inpatient treatment. Nor do all conduct-disordered adolescents wind up as substance abusers. Still, the study does confirm the continuity of alienation from the social mainstream, often beginning in adolescence, and corroborates the findings of earlier research into conduct disorder, adolescence, and substance abuse among adults. When working with the futures of adolescent offenders, these findings can be considered in plea negotiations and sentencing matters.