Addiction Research and Theory December 2007; 15(6): 561574

Substance use early initiation among violent and nonviolent antisocial adolescents

MONIQUE BOLOGNINI, BERNARD PLANCHEREL, MARK E. WINNINGTON, MATHIEU BERNARD, PHILIPPE STEPHAN, & OLIVIER HALFON
SUPEA, University Child and Adolescent Psychiatric Clinic, Lausanne, Switzerland (Received 28 August 2006; revised 12 March 2007; in final form 20 April 2007)

Abstract The relationship between delinquency and substance use and abuse has been much studied. Investigating this relationship as a function to the type of adolescent delinquent behavior presented, whether antisocial or violent, might help explain this complex issue. To this end, 211 adolescents completed the Adolescent Drug Abuse Diagnosis (ADAD), a multidimensional evaluation instrument that provided information regarding their substance use and antisocial behavior. Subjects were separated into three groups (violent, antisocial, and control) as a function of their reported antisocial behavior. The three groups were compared on the lifetime use of tobacco, alcohol and cannabis, and any illicit substance. The ages of initiation for these substances were also examined. Results indicated a high percentage of lifetime and problem substance use among violent and antisocial adolescents. However, on the issue of substance use initiation age, the violent adolescents consistently began using substances significantly earlier than both control and antisocial adolescents. Keywords: Substance initiation, substance use, violence, antisocial behavior, adolescence

The association of substance use or abuse and delinquency in adolescence is well established and has been much studied (Dawkins 1997; Stice et al. 1998; Goulden and Sondhi 2001; Tubman et al. 2004), as has that between substance use or abuse and violence (Wagner 1996; Ellickson et al. 1997; White 1997; Boles and Miotto 2003), in delinquent, addict and community samples. Substance use and abuse also appear to be strongly comorbid with disruptive behavior disorders (conduct disorder, oppositional defiant disorder, and Attention Deficit Hyperactivity Disorder (ADHD)), with comorbidity rates averaging
Correspondence: Monique Bolognini, SUPEA Research unit, Bugnon 25A, Tel.: 41-21 314 74 92. Fax: 41-21 314 74 81. E-mail: Monique.Bolognini@chuv.ch ISSN 1606-6359 print/ISSN 1476-7392 online 2007 Informa UK Ltd. DOI: 10.1080/16066350701428803 CH-1005 Lausanne, Switzerland.

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46% and an average odds ratio of 4 for abuse over a large number of community studies (Armstrong and Costello 2002). In addition, the co-occurrence of substance use and delinquent behavior is associated to higher levels of each behavior (Tubman et al. 2004). Despite these results, the nature of the relationship between substance use and the various adolescent problem behaviors is still unclear. A number of theories have been proposed, in particular regarding the relationship between substance use and violent or aggressive behavior (see White (1997) and Wagner (1996) for reviews). First, substance use may be a cause of delinquency, an approach exemplified by Goldsteins tripartite model (Goldstein 1985; Menard and Mihalic 2001; Boles and Miotto 2003), which focuses on the psychopharmacological effects of substances (alcohol in particular) as well as the systemic and economic factors which connect substance use and delinquency. A second theory holds that, since the onset of delinquent behavior generally precedes the onset of substance use, delinquency causes substance use (Stice et al. 1998; Bui et al. 2000; Adalbjarnardottir and Rafnsson 2002; Clark et al. 2002). The third theory suggests that substance use and delinquent behavior interact and directly influence each other through circular processes or feedback mechanisms (White et al. 1999; Huang et al. 2001; Welte et al. 2001; Mason and Windle 2002). Finally, a fourth model posits a spurious relationship between substance use and delinquency or violence (Wagner 1996; White 1997; Welte et al. 2001), either because delinquent behavior and substance use share common risk factors, such a peer influence, or because they cluster together as part of the wide range of deviant behaviors that adolescents experiment with during that stage of the life cycle (Jessor and Jessor 1977). Results of longitudinal studies of the relationship between substance use and delinquency have provided inconclusive results. Most of the models receive some degree of support, although the effects are generally quite small, and a number of studies find no conclusive evidence of a relationship. In fact, it seems increasingly likely the nature, direction, and strength of the relation between delinquency and substance use could vary as function of the specific characteristics and developmental history of the populations studied (Welte et al. 2001). This is particularly significant given the recent research into the development of both antisocial behavior and substance use. Research regarding the development of adolescent antisocial behavior initially focused on an age of onset model, distinguishing between early (childhood) and late (adolescent) onset of problems (Moffitt 1993). However, increasing evidence points to several different developmental pathways that differ not so much on the basis of age of onset, but rather as to the different types of antisocial behavior presented during adolescence. Specifically, the presence or absence of violent behavior appears to be an important element in distinguishing between subgroups of antisocial adolescents (Kjelsberg, 2002). Later research by Moffitt et al. (1996), Moffitt et al. (2002) and Eley et al. (2003) seems to some extent to support this violent and nonviolent antisocial division, as do the results of both Loeber et al. (1993), Loeber and Hay (1997) and Nagin and Tremblay (1999). The results of these studies suggest that there are at least two pathways in the development of adolescent antisocial behavior, one that leads from chronic aggression in childhood to overt (aggressive) delinquent behavior in adolescence, while the other leads from chronic opposition in childhood to covert delinquency in adolescence, with substantial but not complete overlap between these two pathways. Similarly, results from the Australian Temperament Project (Smart et al. 2003) point to three distinct pathways to antisocial behavior in adolescence: a nonviolent antisocial pathway, a violent antisocial pathway,

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and a dual pathway, in which violent and nonviolent antisocial behaviors are combined. In addition, the subgrouping of antisocial behavior into violent and nonviolent behavior appears to be valid, in regard to both the developmental history and the adult criminal career of the subgroups (Kjelsberg 2002). Similarly, research into the development of substance use has also highlighted several distinct pathways to substance use and abuse, primarily based on the age of onset of substance use. Wills et al. (1996) identified several pathways for alcohol, tobacco, and cannabis use among adolescents, including nonusers, minimal experimenters, late starters, and escalators. Flory et al. (2004) studied the evolution of marijuana and alcohol use during adolescence, and identified similar pathways, namely an early onset, a late onset and a nonuser group. On the whole, age of onset appears to be one of the most reliable predictors of later substance use problems (McGue et al. 2001). In addition, the use of developmentally based grouping does not appear to add much predictive validity as compared with the use of static variables like gender, age of onset (Flory et al. 2004), and early onset groups can therefore be identified using static techniques. The early-onset delinquency and overt/violent pathways appear to share a number of risk factors with the early onset substance use group, including high levels of behavior disinhibition and impulsivity, hyperactivity, as well as frequent contact with antisocial peers (Taylor et al. 2000; Smart et al. 2003). Adolescents who present with violent behavior during adolescence thus appear to represent a subgroup of delinquents who are at high risk for substance use, and more specifically for early onset substance use. The late onset pathway and nonviolent antisocial adolescents appear to present with fewer such risk factors, or present them at lower levels than the violent adolescents. Therefore, they should be at lower risk for substance use and early onset substance use than violent adolescents.

Method Population The study was carried out in the French speaking part of Switzerland in 20032004.1 In order to compare adolescents with violent behavior, adolescents with antisocial behavior, and nondelinquent adolescents, the population was recruited in different contexts: inpatient and outpatients Care Units and closed residencies, general population, leisure centers, and schools. The delinquent criminal behavior section of the ADAD (see method), which includes a self-report of offenses committed during the three months prior to the interview and the number of lifetime arrests for the same offenses, was used in order to create the groups (cf. Table 1). (a) Participants with violent behavior, who reported at least one instance of assault, rape, attempted homicide and homicide/manslaughter during the three months prior to the interview, or one lifetime instance of being punished for such a crime. This group (n 36) represented 17.1% of the total sample. Given the relatively short period examined for the reported antisocial behavior (three months), one instance of violent behavior was considered sufficient for grouping, as was one lifetime instance of punishment. (b) Participants with antisocial behavior such as truancy, graffiti writing, shoplifting, drug sales, driving while intoxicated, other major traffic violations, auto theft,

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Table I. Distribution of subjects according to groups and gender. Type of behavior Control Gender Males Females Total n 45 44 89 % 35.4 52.4 42.2 n 54 32 86 Antisocial % 42.5 38.1 40.8 n 28 8 36 Violent % 22.0 9.5 17.1 n 127 84 211 Total % 100.0 100.0 100.0

vandalism, burglary, larceny and receiving stolen goods, possession of a weapon, or stealing from someone. This group (n 86) accounted for 40.8% of the sample. (c) Participants reporting no significant antisocial or violent behavior (control group). This group (n 89) represented 42.2% of the sample. The total sample consisted of 211 adolescents (84 girls and 127 boys), aged 14 to 20 years (mean age: 16.6 years). All subjects gave written consent to take part in the study. Ethical committee approval was obtained. Subjects were given S.Fr.50. incentive for the time spent on the interview carried out by trained psychologists.

Instruments The participants were interviewed using the French-language version of the ADAD (Adolescent Drug Abuse Diagnosis, Bolognini et al. 2001), an adaptation of the ASI (Addiction Severity Index, McLellan et al. 1980). The ADAD is a multidimensional substance-use evaluation instrument developed by Friedman and Utada (1989), which takes the form of a 150-item structured interview evaluating the subjects problems or difficulties in nine life areas (medical, school, professional, social, family, psychological, legal, alcohol use, and drug use) known or thought to be related to substance use problems. These areas are given a Severity Rating on a 10-point scale by the interviewer, based on the interviewers clinical evaluation, as well as on items within each subscale and the subjects own subjective evaluation of any problems he encounters and his perceived need for treatment. The Severity Rating is a summary value indicating the level of problems encountered by the interviewee as well as his need for treatment, should it be appropriate. The ratings can be used to determine the degree of the problems experienced in the life areas investigated, as well as the need for treatment: no problem (01), slight (23), moderate (45), considerable (67) and extreme (89).

Procedure Substance use. The data regarding substance use was drawn from the Drug and Alcohol Use section of the French version of the ADAD, which assesses the frequency of substance use over the past month and at peak use, the duration of the peak use period, and the age of initiation of substance use. These data provided the prevalence of lifetime use as well as the ages of initiation of the use of the various substances. The age of first use of any substance was taken to be the lowest reported age among all the substances evaluated and the age of first illicit substance contact took into account all the substances excluding

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tobacco and alcohol. Finally, the age of earliest illicit substance contact excluding cannabis was based on the earliest reported use of any substance excluding tobacco, alcohol, and cannabis. Problem substance use was evaluated based on the ADAD Severity Rating scores for drug and alcohol use. Participants with a score of 4 or more in one scale were considered to present with problem drug use or problem alcohol use, and those presenting with scores of 4 or more in both areas were labeled dual problem users. Those with a score lower than 4 in both scales were labeled limited substance users.

Confounding factors. Common confounding factors were checked for the three behavior groups: the groups were not significantly different regarding socio-economic status of head of the household, paternal and maternal education, use of substances or alcohol by either parent, mental disorders in either parent, adopted versus biological child status, all as reported by the interviewee. There was no significant age difference between participants in the violent, antisocial, and control groups. There was however a significant difference between groups regarding gender (2(2) 8.333, p < 0.01), with a higher proportion of males in the antisocial and violent groups (cf. Table I). It might therefore be postulated that part of the results obtained comparing the three groups would be more related to a gender factor than a behavior characteristic of the three groups. It is the reason why results in Tables IIIV are given first without taking into account gender, and then separately for boys and girls.

Statistical analysis. In order to evaluate the differences between violent, antisocial, and control adolescents, the proportions of adolescents reporting lifetime substance use of tobacco, alcohol, cannabis, and any substance (including or excluding cannabis), and the proportion of adolescents reporting problem use of alcohol or drugs (as evaluated by the ADAD), were compared using 2-tests. Similarly, the groups were also compared regarding the age of tobacco, alcohol and cannabis initiation, as well as the ages of first substance contact and first illicit substance contact (including or excluding cannabis) using ANOVA tests and factoring in both the type of adolescent problem behavior and the level of substance use (problem or non-problem drug use, as evaluated using the ADAD).

Hypotheses As mentioned in the introduction section, violent adolescents were expected to have more frequently used substances during their lifetime and to present more frequently with problem drug and alcohol use than both antisocial and nondelinquent adolescents. We first compared adolescents presenting with violent behavior, adolescents presenting with frequent nonviolent antisocial behavior, and nondelinquent adolescents. The three groups were also compared as to the age of onset of tobacco, alcohol and marijuana use, as well as the age of first contact with any illicit substance. Adolescents presenting with violent behavior were expected to have an earlier onset of substance use for each substance investigated than the antisocial and nondelinquent groups. The antisocial group was also expected to have initiated substance use earlier than the nondelinquent group, although not earlier than the violent adolescents.

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Table II. ADAD Severity Rating scores according to groups. Type of behavior problem ADAD areas Medical School Social Family Psychological Legal Drug Alcohol Notes:
a,b,c

Control 2.06 2.51a,b 2.46a,b 3.51a,b 3.31a,b 1.18a,b 2.22a,b 2.01a

Antisocial 2.18 4.61a 3.82a 4.96a 4.55a 4.09a,c 4.95a 3.10a

Violent 1.64 4.83b 4.17b 5.06b 4.81b 5.47b,c 4.42b 2.72

means are significantly different according to Tukeys test, p < 0.05.

Table III.

Prevalence of lifetime substance use by type of adolescent antisocial behavior. Control (n 89) % n 58 29 29 82 39 43 59 29 30 59 29 30 21 10 11 Antisocial (n 86) % 89.5a 85.2a 96.9a 97.7a 98.1a,b 96.9 96.5a 96.3a 96.9a 96.5a 96.3a 96.9a 53.5a 50.0a 59.4a n 77 46 31 84 53 31 83 52 31 83 52 31 46 27 19 Violent (n 36) % 91.7b 89.3b 100.0b 83.3a 78.6a 100.0 91.7b 89.3b 100.0 91.7b 89.3b 100.0 47.2b 46.4b 50.0 n 33 25 8 30 22 8 33 25 8 33 25 8 17 13 4

Tobacco Males Females Alcohol Males Females Cannabis Males Females Any illicit substance Males Females Any illicit substance excluding cannabis Males Females Notes:
a,b

65.2a,b 64.4a,b 65.9a,b 92.1 86.7b 97.7 66.3a,b 64.4a,b 68.2a 66.3a,b 64.4a,b 68.2a 23.6a,b 22.2a,b 25.0a

groups are significantly different based on Pearsons chi-square test, p < 0.01.

Results ADAD Severity Rating scores in different areas according to groups Severity Rating scores were compared for the three groups: the control group, the antisocial behavior, and the violent groups. The areas considered are Medical, School, Social, Family, Psychological, Legal, Drug, and Alcohol. As shown in Table II, the post hoc test shows that for all dimensions, except Medical, there is a significant difference between the control group and the other groups. However, there is no difference between the antisocial and violent group: as expected, the only score that differs for the two groups refers to the Legal area. Association between substance use and type of antisocial behavior Table III presents the proportions of lifetime use of various substances and of problem use levels among violent, nonviolent antisocial and control adolescents. The groups were

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Table IV. Prevalence of problem substance use by type of adolescent antisocial behavior. Control (n 89) % Problem drug use Males Females Problem alcohol use Males Females Any problem use Males Females Dual problem use Males Females Notes:
a,b

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Antisocial (n 86) % 77.9a 81.5a 71.9a 48.8a 46.3a 53.1a 86.0a 87.0a 84.4a 40.7a 40.7a 40.6a n 67 44 23 42 25 17 74 47 27 35 22 13

Violent (n 36) % 69.4b 64.3 87.5b 36.1b 35.7b 37.5 75.0b 71.4b 87.5b 30.6b 28.6 37.5b n 25 18 7 13 10 3 27 20 7 11 8 8

n 31 19 12 15 7 8 37 21 16 09 5 4

34.8a,b 42.2a 27.3a,b 16.9a,b 15.6a,b 18.2a 41.6a,b 46.7a,b 36.4a,b 10.1a,b 11.1a 9.1a,b

groups are significantly different based on Pearsons chi-square test, p < 0.01.

compared two by two, and each comparison was tested for statistical significance using the Pearson 2-test. Results show that compared with the control adolescents, the proportion of lifetime tobacco, cannabis and any illicit substance use was significantly different for control and for violent adolescents (respectively 2 9.089; 8.494; 8.494, and 6.762, p < 0.01), with violent adolescents having a much higher lifetime proportion rate, approximately 2 times those of the control group. The proportion of violent adolescents who reported lifetime tobacco or cannabis use, as well as the use of any illicit substance did not differ significantly from that of antisocial adolescents. Nevertheless, there were significant differences between groups regarding the lifetime proportion of alcohol use, with more antisocial adolescents (97.7%) reporting it than violent adolescents (83.3%). The proportion of antisocial adolescents who reported lifetime use of tobacco, cannabis and any illicit substance use (including and excluding cannabis) was significantly different from that of the control group (respectively 2 14.727; 26.103; 26.103, and 16.541, p < 0.01), and the proportion rates were roughly over 2 times as high among antisocial adolescents as among controls. There were no significant differences between the groups regarding the lifetime use of alcohol and of any substance, although the proportions of lifetime users were slightly higher in the antisocial group. Regarding gender lifetime substance use, there is no difference when the groups are compared for tobacco, even if proportions are higher in antisocial and violent girls compared to boys. The differences are slightly more important for alcohol use: the three groups differ significantly but the global difference is more result of difference due to the group of antisocial boys using more alcohol than the violent group boys. The proportion of different types of problem substance use among violent, antisocial, and control adolescents is presented in Table IV. The proportion of all types of problem use was significantly different among violent adolescents as compared with control adolescents (in order, 2 12.418; 5.468; 11.463; 7.970; p < 0.01). The violent adolescents clearly presented with a higher proportion of problem use, roughly 2 times that of control adolescents.

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Table V. ANOVA (3 2) results for the ages of initiation as a function of the type of adolescent antisocial behavior and the level of substance use. Level of substance use Effect

Type of behavior problem

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Age of 13.3 13.7 12.8 14.2 14.3 14.0 14.1 14.2 13.9 12.9 13.0 12.7 13.9 14.0 13.8 15.1 15.2 (2.0) 15.0 (1.5) 14.5 (2.1) 14.3 (.5) 16.0 (1.4) 16.5 (.7) 15.1 (2.0) 15.0 (1.4) ns ns ns ns (1.7)b (1.9)b (1.4) (1.6) (1.8) (1.2)b (1.6)b (1.9) (1.2) (1.7)a (1.9)b (1.2) (1.8)a (2.0) (1.2) (1.8) 11.8 11.7 11.9 13.4 13.7 12.6 13.3 13.3 13.2 11.8 11.8 11.6 13.2 13.2 13.2 14.5 13.4 13.2 13.6 14.5 14.4 14.5 14.4 14.4 14.5 13.7 13.6 13.9 14.4 14.4 14.5 15.8 (1.8) (2.1) (1.4) (1.2) (1.1) (1.2) (1.3) (1.5) (1.1) (1.6) (1.7) (1.4) (1.3) (1.5) (1.1) (1.3) 13.1 13.2 12.9 14.1 14.2 13.9 14.0 14.0 14.1 12.7 12.7 12.7 13.9 13.9 13.9 15.1 (2.0) (2.2) (1.5) (1.7) (1.8) (1.4) (1.7) (1.8) (1.3) (1.9) (2.1) (1.5) (1.7) (2.0) (1.3) (1.8) 6.51** 4.37* ns 3.98* ns 3.83* 7.05** 3.20* 6.27** 10.20** 4.89** 7.16** 6.45** ns 5.68** ns (2.1)a,b (2.3)a,b (1.5)a (1.9)a (1.9) (1.8)a,b (1.7)a,b (1.8)a (1.5)a (2.2)b (2.3)a,b (1.8)a (1.8)b (1.9) a (1.5)a (1.8) ns ns ns ns ns ns ns ns ns 4.62* ns ns ns ns ns ns

Limited Problem Control Antisocial Violent substance use substance use Type of behavior Level of Behavior problem Level Mean (SD) Mean (SD) Mean (SD) Mean (SD) Mean (SD) problem F substance use F of substance use F ns ns ns ns ns ns ns ns ns ns ns ns ns ns ns ns ns ns

Tobacco initiation Males Females Alcohol initiation Males Females Cannabis initiation Males Females Earliest substance contact Males Females Earliest illicit substance contact Males Females Earliest illicit substance contact (excluding cannabis) Males Females

13.6 13.6 13.7 14.6 14.7 14.6 14.7 14.6 14.7 13.8 13.7 13.9 14.6 14.6 14.6 15.7

(1.7)a (1.9)a (1.5)a (1.2)a (1.2) (1.2)a (1.2)a (1.3)a (1.0)a (1.5)a,b (1.6)a (1.4)a (1.2)a,b (1.3)a (1.0)a (1.5)

16.0 (1.5) 15.5 (1.5)

Notes: *p < 0.05; **p < 0.01; ns not significant; a,b means are significantly different according to Tukeys test, p < 0.05; c unequal variance according to Levenes test, p < 0.05.

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Although the proportion of problem use was slightly lowerby approximately 10% in each caseamong violent adolescents than among antisocial adolescents, the groups were not significantly different. Finally, the proportion of all types of problem use was significantly different for antisocial adolescents compared to control adolescents (respectively, 2 32.936; 20.371; 37.293; 21.738; p < 0.01), with the antisocial adolescents presenting proportion scores 23 times higher than those of control adolescents. Overall, the proportion of problem use was highest among the antisocial adolescents, followed by the violent adolescents. Both groups presented with a significantly greater proportion of all types of problem use than the control adolescents, whatever the adolescents gender. However, the percentage of adolescent girls with substance use is higher in the violent group.

Relationship between type of behavior problem and age of onset The ages of onset for tobacco, alcohol, and cannabis use as well as the age of the first contact with any substance and that of first contact with an illicit substance (cannabis included) were examined for both the behavior groups and the substance use groups, and the results of the 3 2 ANOVAs that were performed are presented in Table V. Sex was also initially factored into the ANOVA model, but since its main effects and interactions were not significant, it was removed. As can be seen from Table V, the violent group consistently initiated their use of substances earlier than both the control and the antisocial groups. On the other hand, the ages of initiation did not differ as a function of the level of substance use, except in the case of the age of the earliest substance contact. In the case of the age of tobacco use initiation, the differences between the behavior groups were significant (F2,166 6.51, p < 0.01), with the violent group having initiated tobacco use statistically significantly earlier than the control and antisocial behavior groups, according to Tukeys test ( p < 0.01). The differences in age of initiation of tobacco use between substance use groups were not significant and there was no interaction effect between behavior groups and substance use groups. The differences in age of initiation of alcohol use between behavior groups were significant (F2,187 3.98, p < 0.05), and Tukeys indicated that members of the violent group initiated their substance use significantly earlier than the control group ( p < 0.05). However, the differences between substance use groups were not significant and there was no interaction effect. The behavior groups also differed significantly on the basis of the age of cannabis initiation (F2,169 7.05, p < 0.01), with the violent behavior group initiating significantly earlier than both the control and the antisocial behavior groups ( p < 0.01 in each case). The difference was not significant for the substance use groups, and there were no main or interaction effects due to the level of substance use. However, both behavior and substance use groups differed significantly regarding the earliest age of substance contact. In the case of the behavior groups (F2,201 10.20, p < 0.01), Tukeys test revealed that all the pairwise differences among means were significant, p < 0.05, the violent adolescents initiating before the antisocial adolescents, who in turn initiated before the control adolescents. The substance use groups were significantly different as to their age of initiation (F1,201 4.62, p < 0.05), but there was no interaction effect from the type of behavior problem and the level of substance use. The mean age of the first illicit substance contact (any substance excluding alcohol and tobacco) was significantly different for the behavior groups (F2,169 6.45, p < 0.01), with the

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control adolescents initiating their illicit substance use significantly later than both the antisocial behavior group and the violent behavior group, according to Tukeys test. The two substance use groups did not significantly differ as to the age of initiation of illicit substance, and there were no interaction effects between the level of substance use and the type of behavior problem. Finally, the mean age of first contact with an illicit substance excluding cannabis did not differ either as a function of the type of antisocial behavior or as a function of the level of substances use. There were no interaction effects. Nonetheless, the violent adolescents initiated their illicit substance use more than a year before the control group. Concerning gender, there are some slight differences regarding tobacco and alcohol age of first contact: the mean age of adolescent girls in the antisocial group is younger compared to boys, and it is also the case for adolescent girls regarding the age when they begin to use alcohol. However, there are few differences concerning the first contact with an illicit or licit substance, including or excluding cannabis. A variance analysis did not show any significant interaction between groups and gender.

Discussion Within a global perspective, it was observed that violent and antisocial behavior might be explained by different factors such as family, social, psychological or peer group relationships, as shown when comparing the three groups for the different ADAD areas scores. Moreover, the results of this study indicated that the lifetime use of tobacco and cannabis, as well as that of any substance and of any illicit substance (including and excluding cannabis) was greater among violent and antisocial adolescents than among nonviolent nonantisocial adolescents. In addition, the differences were very strong in relationship to cannabis and other illicit substance use, pointing to a much greater frequency of illicit substance use among antisocial and violent adolescents than among controls. Similarly, drug and/or alcohol abuse, as well as dual problem use, was more frequent among violent and antisocial adolescents than among the control group. This was expected, given the strong relationship between substance use and delinquent behavior in general. However, contrary to expectation, lifetime alcohol use was lower for violent adolescents than for both antisocial and control adolescents. In addition, all types of problem use, except for tobacco, were also lower for violent adolescents than for antisocial adolescents. Therefore, while violent adolescents are clearly at greater risk of substance use and of problem substance use compared to control adolescents, they appear to be at a similar if not slightly lower risk than antisocial adolescents. Regarding the ages of substance use initiation, the results of the study indicated that when violent adolescents initiated their substance use, they did so earlier than both antisocial and control adolescents, and this irrespective of gender and of the presence or absence of problem substance use. Violent adolescents consistently initiated their substance use more than a year and up to two years earlier than control adolescents. The comparison with the antisocial group was more contrasted, but the violent adolescents nonetheless initiated their substance use at least eight months earlier than the antisocial adolescents. These results are similar to those obtained by Prinz and Kerns (2003) for early onset among juvenile delinquents in general, and by Taylor et al. (2002) for early and late onset delinquents: the early onset delinquents showed earlier onset and a more

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rapid development of substance dependence symptoms than both late onset delinquents and nondelinquent boys. The association between early onset substance use and violent behavior is especially worrying as early onset of substance use appears to be associated with problem substance use, greater frequency of substance use, continued substance use during adolescence and beyond, as well as increased risk for later substance abuse and dependence (Anthony and Petronis 1995; Fergusson and Horwood 1997; DeWit et al. 2000; Grant et al. 2001; Babor et al. 2002; Lynskey et al. 2003; Sung et al. 2004). It is also associated with a number of other problems during adolescence, such as school dropout, unemployment and engaging in a variety of health risk behaviors (Fergusson and Horwood 1997; DuRant et al. 1999). Finally early age of onset is also linked with delinquent behavior, affiliation with delinquent peers, and the development of mental health problems such as antisocial personality disorder and conduct disorder (Fergusson and Horwood 1997; Zhang et al. 1997). While the lack of longitudinal data makes it impossible to draw conclusions as to the exact nature and direction of the relationship between substance use, violent behavior, and antisocial behavior, these results are of interest in that they point to a strong association between early onset of substance use and violent behavior during adolescence. It remains to be determined whether this is because early onset of substance is actually a risk factor for later violence or because the early onset of substance use is the result of a common cause or shared risk factors, but these results support the idea of a specific, developmental, association between violent behavior and substance use. In addition, these results appear to indicate that the relationship between delinquency and substance use varies as a function of the type of delinquent behavior presented: age of onset is lowest for violent adolescents and highest for control adolescents, with antisocial adolescents in the middle, pointing to the possible influence of underlying common variables that play a large role in the development of violent behavior, and a lesser but not inconsiderable role in the development of antisocial behavior. Furthermore, the greater proportion of substance use and problem substance use among antisocial adolescents than among violent adolescents points to the possibility of their having specific risk factors that influence substance use, and problem use in particular, above and beyond those of the violent adolescents. This might also be the result of the reciprocal influence of substance use and antisocial behavior, which might not be as strong for the more serious types of delinquency, such as violent behavior (Welte et al. 2001). In conclusion, there appear to be significant differences in the relationship of the antisocial and violent subgroups in their relationship with substances, from the point of view of use, problem use, and age of onset. Further investigation into the relationship between developmental pathways leading to antisocial or violent behavior during adolescence and the development of substance use is warranted.

Limitations There are some limitations to the results presented here. First of all, the data are selfreported, which raises the question of their validity. However, despite the potential for reporting biases, self-report data appear quite reliable in the areas of substance use (Brener et al. 2003), age of initiation (Johnson and Mott 2001) and violent and delinquent behavior. In addition, the ADAD is a structured interview instrument, and such instruments are thought to produce higher quality data due to the clarity and precision that can be assured among the data collected between participants.

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The sample size is also an issue, regarding the number of female participants and the size of some of the groups. The inclusion of female adolescents in the analyses is problematic, as both their substance use and antisocial or violent behavior patterns might be different from those of male adolescents. However, gender was initially included in the analysis for differences in the age of onset, and did not produce any significant effects. Moreover on the basis of the results, it cannot be stated that gender is a confusing factor, which would explain the differences observed between the violent, antisocial, and control groups.

Implications Most longitudinal research into the relationship between substance use and delinquency has focused on the period of adolescence. The results presented here suggest that research should investigate the relationship between the developmental pathways that lead to antisocial or violent behavior and the onset of substance use during late childhood and preadolescence. While such research is fraught with ethical issues, it would probably help elucidate the complex relationship that unites substance use and antisocial or violent behavior. Finally, these results highlight the importance of early prevention of substance use, especially that of legal substances such as tobacco or alcohol, as well as cannabis. This type of prevention should probably start already in late childhood and preadolescence, and should be targeted especially for children at risk of violent or antisocial behavior. Indeed, it appears that among violent adolescents 58% of had started smoking, 20% had started drinking and 30% had started smoking cannabis before age 13. This difference is enormous when compared to the mere 22%, 6%, and 2% of control adolescents who had done the same. Delaying the onset of substance use could potentially reduce the risk of later dependence (Grant et al. 2001).

Note
[1] Research financed by the Swiss Federal Office of Public Health, ref. 3189.002.0.

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