Published online July 1, 2008
PEDIATRICS Vol. 122 No. 1 July 2008, pp. 209 (doi:10.1542/10.1542/peds.2008-0777)

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LETTER TO THE EDITOR

The Conduct Disorder–Alcohol Link: Implications for Prevention Strategies

Vania Modesto-Lowe, MD, MPH
Department of Psychiatry
University of Connecticut School of Medicine
Farmington, CT 06030
STAR Program
Connecticut Valley Hospital
Middletown, CT 06457

To the Editor.—

According to recent articles in Pediatrics, underage drinking poses enormous challenges to health care systems.^1,2 Alcohol use in youth also contributes to school truancy, getting into fights, carrying weapons, using illicit drugs, and engaging in suicidal and risky sexual behaviors.^1,2 Most tragically, underage drinking leads to nearly 5000 deaths per year. Alcohol-related mortality in this population is primarily attributable to motor vehicle crashes, homicides, suicides, falls, burns, and drowning.¹

The adverse consequences of underage drinking underlie the importance of preventing early alcohol use. In the United States, initial efforts to curtail this problem have focused on school-based programs. Drug Abuse Resistance Education (DARE) was intended to increase the awareness of alcohol's harmful effects and teach children strategies for resisting peer pressure.³ Although school-based programs have been widely implemented, their effectiveness has been called into question.³

Additional strategies for limiting underage drinking include population-based measures that limit youth access to alcohol, such as enforcing minimum legal drinking age laws and restricting alcohol advertising.³ Overall, these preventive measures have been universal in scope and targeted the general adolescent population. However, this "one-size-fits-all" approach is yet to exert a demonstrable impact on youth alcohol consumption. Hence, the question of whether a primary prevention model by which interventions that target modifiable risk factors in high-risk populations can be applied to alcohol prevention is of interest.

Among adolescents, a history of conduct disorder (CD) (lying, aggression, serious violation of rules) is one of the strongest risk factors for early drinking.⁴ Efforts to understand this relationship indicate that symptoms of CD significantly correlate with early onset of first drink as well as a rapid progression from first drink to the development of alcohol use disorders.⁴ Although the prognostic implications of this comorbidity have received considerable attention, the potential utility of averting CD as an alcohol-prevention strategy has been largely overlooked. The lack of emphasis on this key risk factor may reflect underlying views of CD as intractable. However, evidence that early-stage CD is responsive to parent training⁵ challenges the wisdom of this clinical lore and offers opportunities for novel interventions in the alcohol-prevention field.

FOOTNOTES

Statements appearing here are those of the writers and do not represent the offcial position of the American Academy of Pediatrics or its Committees. Comments on any topic, including the contents of PEDIATRICS, are invited from all members of the profession; those accepted for publication will not be subject to major editorial revision but generally must be no more than 400 words in length. The editors reserve the right to publish replies and may solicit responses from authors and others.

Please see www.pediatrics.org for instructions on submitting letters.

REFERENCES

1. Swahn MH, Bossarte RM, Sullivent EE 3rd. Age of alcohol use initiation, suicidal behavior, and peer and dating violence victimization and perpetration among high-risk, seventh-grade adolescents. Pediatrics.2008; 121 (2):297 –305[Abstract/Free Full Text]
2. Miller JW, Naimi TS, Brewer RD, Jones SE. Binge drinking and associated health risk behaviors among high school students. Pediatrics.2007; 119 (1):76 –85[Abstract/Free Full Text]
3. Komro KA, Toomey TL. Strategies to prevent underage drinking. Alcohol Res Health.2002; 26 (1):5 –14[Web of Science][Medline]
4. Moss HB, Lynch KG. Comorbid disruptive behavior disorder symptoms and their relationship to alcohol use disorders. Drug Alcohol Depend.2001; 64 (1):75 –83[CrossRef][Web of Science][Medline]
5. Hutchings J, Gardner F, Bywater T, et al. Parenting intervention in Sure Start services for children at risk for developing conduct disorder: pragmatic randomized controlled trial. BMJ.2007; 334 (7595):678[Abstract/Free Full Text]

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PEDIATRICS (ISSN 1098-4275). ©2008 by the American Academy of Pediatrics

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This Article Extract Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Request Permissions Citing Articles Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Modesto-Lowe, V. Search for Related Content PubMed PubMed Citation Articles by Modesto-Lowe, V. Related Collections Adolescent Medicine Social Bookmarking                         What's this?