Elsevier

Drug and Alcohol Dependence

Volume 133, Issue 2, 1 December 2013, Pages 535-540
Drug and Alcohol Dependence

Attitude and risk of substance use in adolescents diagnosed with Asperger syndrome

https://doi.org/10.1016/j.drugalcdep.2013.07.022Get rights and content

Abstract

Background

Adolescence is a stage of development with increased risk of drug use. Individual personality traits are among those factors that influence the onset of substance use in adolescence and its psychiatric comorbidity. Little research has been done on the comorbidity between substance abuse risk and Asperger syndrome, and none specifically in adolescence. The objective of this study is to assess the risk of drug use by adolescents with Asperger syndrome and compare it with that risk in control subjects. A secondary objective was to analyze the personality factors that may be associated with substance use in the same two groups.

Methods

We used three self-administered questionnaires, one for drug risk assessment (FRIDA) and the other two for personality trait assessment (MACI and SSS-V).

Results

Adolescents diagnosed with Asperger syndrome are at less risk for drug use derived from family and access to drugs factors. Subjects with Asperger syndrome did score higher on introversive, inhibited, doleful, and borderline tendency prototypes than healthy controls, and scored lower on all sensation-seeking traits. Being male, a diagnosis of Asperger syndrome, and unruly, introversive, and sensation-seeking traits were all independently associated with the risk of drug abuse.

Conclusions

Both identified personality factors and other variables associated with the Asperger syndrome contribute to the low risk of drug abuse observed in this population. Exploring protective factors for drug use in these subjects may prove useful for interventions with adolescents at risk for consumption.

Introduction

Adolescence is a stage of development with increased risk of onset of drug use (Sussman et al., 2004, Luengo et al., 1990). In the last few decades, there has been a major social change in relation to drug use among young people, involving both the use of new drugs and the emergence of new consumption patterns associated with leisure activities, formerly considered activities of marginal groups (Muñoz and Fatjó-Vilas, 2009). For these reasons, the perception of risk associated with drug use has declined significantly, especially among young people.

According to the literature, juvenile drug use corresponds to a multi-determined behavior pattern. Several factors, including genetic vulnerability, individual personality traits, and family and social factors seem to influence the onset of substance use in adolescence and its psychiatric comorbidity (López Larrosa, 2010, Swadi, 1999, Espada et al., 2008, Meyers, 2010). Precocity of substance use is considered one of the main predictors of abuse in adolescence (González et al., 1996, Grant et al., 2006). Generally, males start earlier and have a higher regular consumption, although this inequality gradually declines over time (García-Señorán, 1994, Kumpfer and Turner, 1991, Novacek et al., 1991). Sensation seeking, low self-esteem, rebellion and rule breaking, lack of coping strategies, zero tolerance for frustration, and impulsivity are the personality factors most consistently associated with drug use (González et al., 1996, Staiger et al., 2007). Sensation seeking is a relevant variable to distinguish adolescents who do not use drugs from those who begin to use them, not only with respect to regular use, but also to experimental use (González et al., 1996). Finally, a predisposition toward rebellion, independence, and non-compliance are factors that consistently stand out as precursors to drug use (González et al., 1996). The parenting model, overprotective maternal attitude with ineffective paternal behavior, inadequate educational practices characterized by excessive permissiveness or strictness, communication problems and stress, are related to greater drug use (Hualde, 1990). However, a series of studies have pointed to the influence of friends as the clearest predictor of drug use in adolescents (García-Señorán, 1994, Epstein et al., 1995, Brook et al., 1989, Bailey and Hubbard, 1991, García-Pindado, 1993). Furthermore, it has been demonstrated that a teen who uses drugs is more likely to have friends that also use them than a teen who does not (Epstein et al., 1995). Drug availability is been also associated with increased substance use in recent years (Kendler et al., 2011).

Asperger syndrome (AS) is a developmental disorder with a neurobiological basis, which affects social functioning and the spectrum of activities and interests. It differs from other Pervasive Developmental Disorders by its relative preservation of linguistic and cognitive development (although atypical odd use of language is frequently reported and everyday functioning is usually impaired). In the upcoming DSM-5 Asperger syndrome will be subsumed under the umbrella of Autism Spectrum Disorder.

AS is frequently comorbid with attention deficit hyperactivity disorder, affective disorders, anxiety disorders, behavioral disorders and tic disorders (Hofvander and Delorme, 2009, Russel et al., 2005, Mattila et al., 2010, Caamaño et al., 2013). Very little research has been conducted on comorbidity between substance abuse and AS. To our knowledge, there are only two studies analyzing drug abuse that include autism spectrum disorders, none of which specifically focuses on Asperger patients. Sizoo et al. (2010) analyzed substance abuse comorbidity in adult patients with autism spectrum disorder and attention deficit hyperactivity disorder, finding a higher prevalence of drug use in patients diagnosed with attention deficit hyperactivity disorder than with autism spectrum disorder (Sizoo et al., 2010). Santosh and Mijovic (2006) conducted a retrospective study of comorbidity of various neurodevelopmental disorders with drug abuse, in adolescent population, and reported a diminished risk in autism spectrum disorder (Santosh and Mijovic, 2006). Our clinical impression from working with adolescents with AS points to a negative attitude toward drug use, which seems to fit with their rigid norm-abiding style, limited social contact, and low interest in typical social activities of adolescents such as attending parties.

Therefore, our aim was to analyze the risk of drug use in adolescents with AS compared with control subjects. A secondary objective was to analyze the personality risk factors that may be associated with substance use in the two groups. Firstly, we hypothesized that patients with AS would have a lower risk of substance use and more negative attitudes toward the use of drugs than the control group (measured by the FRIDA Scale), and secondly, that personality traits such high norm abiding, and reduced prosocial attitude would be associated with less risk of substance use in AS.

Section snippets

Study design

This is a descriptive study that explores the cross-sectional relationship between personality factors and risk of substances use in adolescents with AS compared with healthy participants.

Sample

Data were collected from a clinical sample of 26 patients diagnosed with AS (22 males and 4 females, mean age 15.15 years) and 28 healthy control subjects (18 males and 10 females, mean age 15.0 years), who met the criteria for the study.

Patients with AS were recruited through an outpatient clinic that treats

Results

There were no statistical differences in gender or age between the groups (Table 1).

Asperger and healthy adolescents did not differ in FRIDA general drug use risk score (As mean score = 141.31; control mean score = 150.50). However, the two groups did differ in the FRIDA Friends and Access to Drugs factors, showing lower risk the Asperger group. On the other hand, Asperger patients scored higher in the Protective Activities factor (Fig. 1).

Discussion

We found that adolescents with AS are generally at less risk for drug use through Friends and Access to drug factors than the control group, and at higher risk due to protective factors. Subjects with AS did score higher in introversive, inhibited, doleful, and borderline tendency prototypes than healthy controls, and scored lower in all sensation-seeking traits. Being male, a diagnosis of AS, and unruly, introversive, and sensation-seeking traits were all independently associated with the risk

Conclusions

Adolescents diagnosed with AS are at lower risk for substance use, based on their personality characteristics (norm-abiding, risk-avoiding) and accessibility of drugs. The effect of these characteristics as subjects grow up needs further study.

Role of funding source

Funding for this study was provided by the Spanish Ministry of Economy and Competitiveness. Instituto de Salud Carlos III, CIBERSAM. Madrid Regional Govermment (S2010/BMD-2422 AGES) and European Union Structural Funds, Fundación Alicia Koplowitz and Fundación Mutua Madrileña. These institutions had no further role in study design; in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Contributors

Authors María Ramos and Mara Parellada designed the study and wrote the protocol. Authors Cloe Llorente, Mara Parellada, Carmen Moreno, Leticia Boada and José Romo assisted in the recruitment of patients. All the authors collaborated in the writing of the draft of the manuscript.

All authors contributed to and have approved the final manuscript.

Conflict of interest

María Ramos reports no biomedical financial interests or potential conflicts of interest.

Leticia Boada reports no biomedical financial interests or potential conflicts of interest.

Carmen Moreno has received grant/research support from Fundación Alicia Koplowitz, Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), and has served as a consultant for Bristol-Myers Squibb and Janssen.

Cloe Llorente reports no biomedical financial interests or potential

Acknowledgements

We thank all the families and patients who have collaborated on the study. Moreover, we would like to thank Gonzalo Cabello, Ruth Vidriales and Marta Jaramillo who, very kindly, also helped to collect part of the sample of this study; and Jose María Bellón for his help with the statistics.

Supported by the Spanish Ministry of Economy and Competitiveness. Instituto de Salud Carlos III, CIBERSAM. Madrid Regional Govermment (S2010/BMD-2422 AGES) and European Union Structural Funds, Fundación Alicia

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