Skip to main content
SpringerLink
Log in

Drug Abuse Heterogeneity and the Search for Subtypes

  • Chapter
Epidemiology of Drug Abuse

4. Conclusions

In addition to the research on the association between substance use disorders and antisociality, there is a large body of literature reporting connections with behavior disinhibition and affect dysregulation. It is not possible in this short chapter to review these and other findings on risk factors for substance use disorders. However, the above discussion illustrates the convergences in the research findings on risk factors that point to possible clusters having implications for further understanding the heterogeneity of substance abuse and the identification of drug abuse subtypes.

It is also not possible in this chapter to discuss important related issues, such as the relationship of heterogeneity to substance use disorder phenotypes and endophenotypes, the role of protective factors in the divergence of subtypes, the relationship of co-morbid psychiatric conditions and developmental psychopathology to heterogeneity, developmental influences, and individual and group diversity, and the implications of heterogeneity and subtypes for prevention and treatment. Despite the unanswered questions, however, it is clear that investigation of the heterogeneity of substance use disorders and their underlying processes can advance our ability to effectively understand, prevent and treat substance abuse.

It is clearly important to go beyond the recognition of the heterogeneity of drug abuse and to look for systematic variations in the etiology and manifest patterns of substance abuse. There may be critical variations in the underlying processes of substance abuse as well as significant systematic differences in the observable behavior patterns. Distinguishing major divergences in the differing patterns may lead to the identification of clinically significant subtypes, help determine the underlying processes of substance abuse, and facilitate the study of the ways in which environmental factors interact with individuals’ characteristics (and the underlying processes of substance abuse) to result in different subtypes. While the available research does not answer the question of whether there are drug abuse subtypes, it does provide encouragement to continue the search.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition. American Psychiatric Association, Washington, D.C.

    Google Scholar 

  • Armstrong, T.D. and Costello, E.J. (2002). Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity. Journal of Consulting and Clinical Psychology 70, pp. 1224–1239.

    Article  PubMed  Google Scholar 

  • Anthony, J.C., Warner, L.A., and Kessler, R.C. (1994). Comparative epidemiology of dependence on tobacco, alcohol, controlled substances, and inhalants: Basic findings from the National Comorbidity Survey, Experimental and Clinical Psychopharmacology 2, pp. 224–268.

    Article  Google Scholar 

  • Anthony, J.C. and Petronis, K.R. (1995). Early-onset drug use and risk of later drug problems. Drug and Alcohol Dependence 40, pp. 9–15.

    Article  PubMed  CAS  Google Scholar 

  • Babor, T.F., Hofmann, M., DelBoca, F.K., Hesselbrock, V., Meyer, R.E., Dolinsky, Z.S. and Rounsaville, B. (1992). Types of alcoholics, I. Evidence for an empirically derived typology based on indicators of vulnerability and severity. Archives of General Psychiatry 49, pp. 599–608.

    PubMed  CAS  Google Scholar 

  • Bierut, L.J., Dinwiddie, S.H., Begleiter, H., Crowe, R.R., Hesselbrock, V., Nurnberger, J.I. Jr., Porjesz, B., Schuckit, M.A., and Reich, T. (1998). Familial transmission of substance dependence: Alcohol, marijuana, cocaine, and habitual smoking: A report from the Collaborative Study on the Genetics of Alcoholism. Archives of General Psychiatry 55, pp. 982–988.

    Article  PubMed  CAS  Google Scholar 

  • Burke J.D., Loeber R. and Lahey, B.B. (2001). Which aspects of ADHD are associated with tobacco use in early adolescence? Journal of Child Psychology and Psychiatry 42, pp. 493–502.

    Article  PubMed  CAS  Google Scholar 

  • Cadoret, R.J. (1992). Genetic and environmental factors in initiation of drug use and the transition to abuse. In M. Glantz and R. Pickens (Eds.), Vulnerability to Drug Abuse. American Psychological Association, Washington, D.C., pp. 99–113.

    Google Scholar 

  • Cadoret, R.J., Yates, W.R., Troughton, E, Woodworth G. and Stewart MA. (1996). An adoption study of drug abuse/dependency in females. Comprehensive Psychiatry 37, pp. 88–94.

    Article  PubMed  CAS  Google Scholar 

  • Cadoret, R.J., Troughton, E., O’Gorman, T., and Heywood, E. (1986). An adoption study of genetic and environmental factors in drug abuse. Archives of General Psychiatry 43, pp. 1131–1136.

    PubMed  CAS  Google Scholar 

  • Chassin L, Pitts S.C., and Prost, J. (2002). Binge drinking trajectories from adolescence to emerging adulthood in a high-risk sample: predictors and substance abuse outcomes. Journal of Consulting and Clinical Psychology 70, pp. 67–78.

    Article  PubMed  Google Scholar 

  • Chilcoat, H.D. and Breslau, N. (1998). Posttraumatic stress disorder and drug disorders: Testing causal pathways. Archives of General Psychiatry 55(10), pp. 913–917.

    Article  PubMed  CAS  Google Scholar 

  • Cuijpers, P. and Smit, F. (2004). Subthreshold depression as a risk indicator for major depressive disorder: a systematic review of prospective studies. Acta Psychiatrica Scandinavia 109, pp. 325–331.

    Article  CAS  Google Scholar 

  • Glantz, M.D. and Colliver, J.D. (2002). Drug use, drug abuse, and heterogeneity. Bulletin on Narcotics, United Nations 54(1), pp. 45–59.

    Google Scholar 

  • Glantz, M.D., and Pickens, R.W. (1992). Vulnerability to drug abuse: Introduction and overview. In M. Glantz and R. Pickens (Eds.), Vulnerability to drug abuse. American Psychological Association, Washington, D.C., pp. 1–14.

    Google Scholar 

  • Grant, B.F. and Dawson, D.A. (1998). Age of onset of drug use and its association with DSM-IV drug abuse and dependence. Journal of Substance Abuse 10, pp. 163–173.

    Article  PubMed  CAS  Google Scholar 

  • Grant, B.F. and Pickering, R. (1998). The relationship between cannabis use and DSM-IV cannabis abuse and dependence: Results from the National Longitudinal Alcohol Epidemiologic Survey. Journal of Substance Abuse 10(3), pp. 225–264.

    Article  Google Scholar 

  • Grant, B.F. Stinson F.S., Dawson, D.A., Chou, S.P., Ruan, W.J., and Pickering, R.P. (2004). Co-occurrence of 12-month alcohol and drug use disorders and personality disorders in the United States: Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61, pp. 361–368.

    Article  PubMed  Google Scholar 

  • Grilo, C.M., Masheb, R.M., and Wilson, G.T. (2001). Subtyping binge eating disorder. Journal of Consulting and Clinical Psychology 69(6), pp. 1066–1072.

    Article  PubMed  CAS  Google Scholar 

  • Grove, W., Eckert, E., Heston, L., Bouchard, T., Segal, N., and Lykken, D. (1990). Heritability of substance abuse and antisocial behaviour: A study of monozygotic twins reared apart. Biological Psychiatry 27, pp. 1293–1304.

    Article  PubMed  CAS  Google Scholar 

  • Haertzen, C.A., Kocher, T.R., and Miyasato, K. (1983). Reinforcements from the first drug experience can predict later drug habits and/or addiction: results with coffee, cigarettes, alcohol, barbiturates, minor and major tranquilizers, stimulants, marijuana, hallucinogens, heroin, opiates and cocaine. Drug and Alcohol Dependence 11, pp. 147–165.

    Article  PubMed  CAS  Google Scholar 

  • Hawkins, J.D., Catalano, R.F., and Miller, J.Y. (1992). Risk and protective factors for alcohol and other drug problems in adolescence and early adulthood: Implications for substance abuse prevention. Psychological Bulletin 112(1), pp. 64–105.

    Article  PubMed  CAS  Google Scholar 

  • Hyman, S.E. and Nestler, E.J. (1996). Initiation and adaptation: a paradigm for understanding psychotropic drug action. American Journal of Psychiatry 153, pp. 151–162.

    PubMed  CAS  Google Scholar 

  • Jang, K.L., Livesley, W.J., and Vernon, P.A. (1995). Alcohol and drug problems: a multivariate behavioural genetic analysis of co-morbidity. Addiction 90, pp. 1213–1221.

    Article  PubMed  CAS  Google Scholar 

  • Kandel, D.B. and Yamaguchi, K. (1993). From beer to crack: Developmental patterns of drug involvement. American Journal of Public Health 83(6), pp. 851–855.

    Article  PubMed  CAS  Google Scholar 

  • Kellam, S.G. and Anthony, J.C. (1998). Targeting early antecedents to prevent tobacco smoking: Findings from an epidemiologically based randomized field trial. American Journal of Public Health 88, pp. 193–197.

    Google Scholar 

  • Kendler K.S., Jacobson K.C., Prescott C.A., and Neale M.C. (2003). Specificity of genetic and environmental risk factors for use and abuse/dependence of cannabis, cocaine, hallucinogens, sedatives, stimulants, and opiates in male twins. American Journal of Psychiatry 160(4), pp. 687–695.

    Article  PubMed  Google Scholar 

  • Kendler, K.S., Karkowski, L.M., and Prescott, C.A. (1999). Hallucinogen, opiate, sedative and stimulant use and abuse in a population-based sample of female twins. Acta Psychiatrica Scandinavia 99, pp. 368–376.

    CAS  Google Scholar 

  • Kendler, K.S., Karkowski, L.M., Neale, M.C., and Prescott, C.A. (2000). Illicit psychoactive substance use, heavy use, abuse and dependence in a US population-based sample of male twins. Archives of General Psychiatry 57, pp. 261–269.

    Article  PubMed  CAS  Google Scholar 

  • Kessler, R.C., Aguilar-Gaxiola, S., Andrade, L., Bijl, R., Borges, G., Caraveo-Anduaga, J.J., DeWit, D.J., Kolody, B., Merikangas, K.R., Molnar, B.E., Vega, W.A., Walters, E.E., Wittchen, H.U., and Ustun, T.B. (2001). Mental-substance comorbidities in the ICPE surveys. Psychiatria Fennica 32(suppl 2), pp. 62–79.

    Google Scholar 

  • Kessler, R.C., Nelson, C.B., McGonagle, K.A., Edlund, M.J., Frank, R.G., and Leaf, P.J. (1996). The epidemiology of co-occurring addictive and mental disorders: Implications for prevention and service utilization. American Journal of Orthopsychiatry 66, pp. 17–31.

    PubMed  CAS  Google Scholar 

  • Koob, G.F. and Le Moal, M. (1997). Drug abuse: hedonic homeostatic dysregulation. Science 278(5335), pp. 52–58.

    Article  PubMed  CAS  Google Scholar 

  • Langbehn, D.R. and Cadoret, R.J. (2001). The adult antisocial syndrome with and without antecedent conduct disorder: Comparisons from an adoption study. Comprehensive Psychiatry 42, pp. 272–282.

    Article  PubMed  CAS  Google Scholar 

  • Lewinsohn, P.M., Brown, R.A., Seeley, J.R., and Ramsey, S.E. (2000). Psychosocial correlates of cigarette smoking abstinence, experimentation, persistence and frequency during adolescence. Nicotine and Tobacco Research 2, pp. 121–131.

    PubMed  CAS  Google Scholar 

  • Lewinsohn, P.M., Gotlib I.H., and Seeley, J.R. (1995). Adolescent psychopathology: IV. Specificity of psychosocial risk factors for depression and substance abuse in older adolescents. Journal of the American Academy of Child and Adolescent Psychiatry 34, pp. 1221–1229.

    Article  PubMed  CAS  Google Scholar 

  • Lynskey, M.T., Health, A.C., Bucholz, K.K., Slutskey, W.S., Madden, P.A., Nelson, E.C., Stratham, D.J., and Martin, N.G. (2003). Escalation of drug use in early onset cannabis users vs. co-twin controls. Journal of the American Medical Association 289, pp. 427–433.

    Article  PubMed  Google Scholar 

  • McKay, D., Abramowitz, J.S., Calamari, J.E., Kyrios, M., Radomsky, A., Sookman, D., Taylor S. and S. Wilhelm. (2004). A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms, Clinical Psychology Review 24(3), pp. 283–313.

    Article  PubMed  Google Scholar 

  • Merikangas, K.R., Mehta, R.L., Molnar, B.E., Walters, E.E., Swendsen, J.D., Aguilar-Gaziola, S., Bijl, R.V., Borges, G., Caraveo-Anduaga, J.J., DeWit, D.J., Kolody, B., Vega, W.A., Wittchen, H.U., and Kessler, R.C. (1998). Comorbidity of substance use disorders with mood and anxiety disorders: Results of the international consortium in psychiatric epidemiology. Addictive Behaviors 23, pp. 893–907.

    Article  PubMed  CAS  Google Scholar 

  • Merikangas, K.R., Stolar, M., Stevens, D.E., Goulet, J., Priesig, M., Fenton, B., and Rounsaville, B.J. (1998). Familial transmission of substance use disorders. Archives of General Psychiatry 55, pp. 973–979.

    Article  PubMed  CAS  Google Scholar 

  • Moss, H.B., Lynch, K.G., Hardie, T.L., and Baron, D.A. (2002). Family functioning and peer affiliation in children of fathers with antisocial personality disorder and substance dependence: associations with problem behaviors. American Journal of Psychiatry 159, pp. 607–614.

    Article  PubMed  Google Scholar 

  • Neumark, Y.D. and Anthony, J.C. (1997). Childhood misbehavior and the risk of injection drug use. Drug and Alcohol Dependence 48, pp. 193–197.

    Article  PubMed  CAS  Google Scholar 

  • Pomerleau, C.S., Pomerleau, O.F., Namenek, R.J., and Marks, J.L. (1999). Initial exposure to nicotine in college-age women smokers and never-smokers: a replication and extension. Journal of Addictive Disorders 18, pp. 13–19.

    Article  CAS  Google Scholar 

  • Regier, D.A., Farmer, M.E., Rae, D.S., Locke, B.Z., Keith, S.J., and Judd, L.L. (1990). Comorbidity of mental disorders with alcohol and other drug abuse: Results from the Epidemiologic Catchment Area (ECA) study. Journal of the American Medical Association 262, pp. 2511–2518.

    Article  Google Scholar 

  • Reinherz, H.Z., Giaconia, R.M., Hauf, A.M., Wasserman, M.S., and Paradis, A.D. (2000). General and specific childhood risk factors for depression and drug disorders by early adulthood. American Academy of Child and Adolescent Psychiatry 39, pp. 223–231.

    Article  CAS  Google Scholar 

  • Robins, L.N. and McEvoy, L. (1990). Conduct problems as predictors of substance abuse. In L. Robins and M. Rutter (Eds.), Straight and Deviant Pathways from Childhood to Adulthood. New York: Cambridge University Press, pp. 182–204.

    Google Scholar 

  • Robins, L.N. and Przybeck, T.R. (1985). Age of onset of drug use as a factor in drug and other disorders. In C.L. Jones and R.L. Battjes, (Eds.). Etiology of Drug Abuse: Implications for Prevention. NIDA Research Monograph 56, National Institute on Drug Abuse, Rockville, MD., pp. 178–193.

    Google Scholar 

  • Schuckit, M.A., Tipp, J.E., Smith, T.L., Shapiro, E., Hesselbrock, V.M., Bucholz, K.K., Reich, T., Nurnberger Jr., J.I. (1995). An evaluation of Type A and B alcoholics. Addiction 90(9), pp. 1189–1204.

    Article  PubMed  CAS  Google Scholar 

  • Spence, S.H. (1997). Structure of anxiety symptoms among children: A confirmatory factor-analytic study. Journal of Abnormal Psychology 106(2), pp. 280–297.

    Article  PubMed  CAS  Google Scholar 

  • Storr, C.L., Reboussin, B.A., and Anthony, J.C. (2004). Early childhood misbehavior and the estimated risk of becoming tobacco-dependent. American Journal of Epidemiology 160, pp. 126–130.

    Article  PubMed  Google Scholar 

  • Substance Abuse and Mental Health Services Administration. (2003). Results from the 2002 National Survey on Drug Use and Health: National Findings. (Office of Applied Studies, NHSDA Series H-22, DHHS Publication No. SMA 03-3836). Rockville, MD.

    Google Scholar 

  • Swendsen, J.D. and Merikangas, K.R. (2000). The comorbidity of depression and substance use disorders. Clinical Psychology Review 20, pp. 173–189.

    Article  PubMed  CAS  Google Scholar 

  • Toomey, R. and Eaves, L. (1998). Co-occurrence of abuse of different drugs in men: the role of drug-specific and shared vulnerabilities. Archives of General Psychiatry 55, pp. 967–972.

    Article  PubMed  Google Scholar 

  • Tsuang, M.T., Lyons, M.J., Meyer, J.M., Doyle, T., Eisen, S.A., Goldberg, J., True, W., Lin, N., Toomey, R., and Eaves, L. (1998). Co-occurrence of Abuse of Different Drugs in Men: The Role of Drug-Specific and Shared Vulnerabilities. Archives of General Psychiatry 55, pp. 967–972.

    Article  PubMed  CAS  Google Scholar 

  • Tsuang, M.T., Lyons, M.J., Meyer, J.M., Doyle, T., Eisen, S.A., Goldberg, J., True, W., Lin, N., Warner, L.A., Kessler, R.C., Hughes, M., Anthony, J.C., and Nelson, C.B. (1995). Prevalence and correlates of drug use and dependence in the United States: results from the National Comorbidity Survey. Archives of General Psychiatry 52, 219–229.

    Google Scholar 

  • Wagner, F.A. and Anthony, J.C. (2002). From first drug use to drug dependence: Developmental periods of risk for dependence upon marijuana, cocaine, and alcohol. Neuropsychopharmacology 26(4), pp. 479–488.

    Article  PubMed  Google Scholar 

  • White, H.R., Xie, M., Thompson, W., Loeber, R., and Stouthamer-Loeber, M. (2001). Psychopathology as a predictor of adolescent drug use trajectories. Psychology of Addictive Behaviors 15, pp. 210–218.

    Article  PubMed  CAS  Google Scholar 

  • World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: Clinical descriptions and diagnostic guidelines. WHO, Geneva.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, Maryland

    Meyer D. Glantz, Kevin P. Conway & James D. Colliver

Authors
  1. Meyer D. Glantz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Kevin P. Conway
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. James D. Colliver
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute for Health and Social Policy, The University of Akron, Akron, OH, USA

    Zili Sloboda

Rights and permissions

Reprints and permissions

Copyright information

© 2005 Springer Science + Business Media, Inc.

About this chapter

Cite this chapter

Glantz, M.D., Conway, K.P., Colliver, J.D. (2005). Drug Abuse Heterogeneity and the Search for Subtypes. In: Sloboda, Z. (eds) Epidemiology of Drug Abuse. Springer, Boston, MA. https://doi.org/10.1007/0-387-24416-6_2

Download citation

  • DOI: https://doi.org/10.1007/0-387-24416-6_2

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-387-24415-0

  • Online ISBN: 978-0-387-24416-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation