Substance Use and the Development of Antisocial Personality in Depressed Adolescents

Kasen et al¹ recently reported on the relationship between major depressive disorder in adolescence and personality disorders in young adulthood. They observed, in particular, an increased risk of antisocial personality disorder (ASPD) independently of an initial comorbidity with conduct disorder. In their hypotheses for explaining the link between depression and ASPD, they did not mention the role of substance abuse. Depressed adolescents often developed substance use disorders,² probably through efforts at self-medication. Substance use effects, such as impulsivity and aggressive and irresponsible behaviors, and substance use consequences, such as school failure; impairment of social functioning; delinquency induced by a need for money; and frequentation with peers with comorbid substance use and conduct disorders, leading to exposure to antisocial models of social cognition and behavior, may contribute to the development of ASPD. Substance use may be the major mediator between depression and ASPD during adolescence and young adulthood.