The proposed study focuses on vulnerability to drug abuse in high-risk youth. This prospective study of 600 families, with adolescents aged 11-13 (at year 01) has as its overall goal to determine how family risk factors (parental psychoactive substance use disorders, depression, marital disruption) and predisposing childhood vulnerability factors (conduct disorder, attention deficit disorder, depression), interacting with familial and extrafamilial mediating factors, contribute to the onset and course of psychoactive substance use disorders in youth. Specifically, the proposed study will examine the prevalence and chronology of psychoactive substance abuse disorders, problem behaviors (deviance, school functioning), and other comorbid psychiatric conditions. This study relies on a prospective design with independent samples drawn from a large HMO combining features of other previously used research strategies (family high-risk) to examine vulnerability to drug abuse. The study sample consists of 600 consecutively selected families (at least one 11-13 year old (01)) seeking treatment for the first time for chemical dependency and/or mental health units of the HMO. Eligibility determination will be based on intake and diagnostic data about family psychoactive substance abuse disorders and other psychiatric conditions. Families will be assigned to one of three groups. Group one consists of adult males and females with a diagnosis of either substance abuse disorder or substance abuse disorder and depression. The second group consists of adults with a diagnosis of depression and no other comorbid conditions. A comparison group (Group 3) of families, with no member in treatment for PSUD and/or depression, will be drawn from random. Our overall measurement strategy uses multiple measures, multiple methods of data collection, and obtains data from multiple respondents. All family members are interviewed. Diagnoses in the adults are based on the SCID (year 01). Childhood vulnerability is based on the Achenbach and Edelbrock Child Behavior Profile instrument and medical records (year 01). Standardized measures are used to obtain data about familial and extrafamilial mediating factors. For major outcome variables at year 05 -- drug use, deviance and school functioning -- standardized self-report measures are used. For psychoactive substance use disorders in the adolescent, depression and conduct disorder, structured psychiatric interviews (DISCII) parent and adolescent forms and medical records are used. Multivariate statistical techniques (MANOVA, logistic regression, survival analysis, and structural equation models are employed.
