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A longitudinal study by Brooks and co-workers noted a significant relationship between adolescent drug use and disruptive disorders in young adulthood; except for earlier psychopathology, such as childhood conduct disorder, the drug use preceded the psychiatric disorders.18 In contrast with use of other illicit drugs and tobacco, moderate (less than once a week and more than once a month) to heavy marijuana use did not predict anxiety or depressive disorders; but it was similar to those other drugs in predicting antisocial personality disorder. The rates of disruptive disorders increased with increased drug use. Thus, heavy drug use among adolescents can be a warning sign for later psychiatric disorders; whether it is an early manifestation of or a cause of those disorders remains to be determined.

Psychiatric disorders are more prevalent among adolescents who use drugs—including alcohol and nicotine—than among those who do not.79 Table 3.5 indicates that adolescent boys who smoke cigarettes daily are about 10 times as likely to have a psychiatric disorder diagnosis as those who do not smoke. However, the table does not compare intensity of use among the different drug classes. Thus, although daily cigarette smoking among adolescent boys is more strongly associated with psychiatric disorders than is any use of illicit substances, it does not follow that this comparison is true for every amount of cigarette smoking.79

Few marijuana users become dependent on it (Table 3.4), but those who do encounter problems similar to those associated with dependence on other drugs. 19,143 Dependence appears to be less severe among people

TABLE 3.5  Relative Prevalence of Diagnoses of Psychiatric Disorders Associated with Drug Use Among Childrena


Relative Prevalence Estimatesb

Drug Use



Weekly alcohol use


1.6 (n.s.)

Daily cigarette smoking


2.1 (n.s.)

Any illicit substance use



aSubjects were from 9 to 18 years old (average, 13 years old).

bAn estimate of 1 means that the relative prevalence of the disorder is equal in those who do and those who do not use the particular type of drug; that is, there is no measurable association. An estimate greater than I indicates that the factor is associated. Substance abuse was excluded because the subjects were already grouped by high drug use. Except where noted (n.s.), all values are statistically significant.

SOURCE: Data from Table 4 in Kandel and co-workers (1997).79

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