Externalizing disorders including ADHD, conduct disorder, oppositional defiant disorder, and antisocial personality disorder (ASPD) are common among children, adolescents, and young adults with a family history of alcohol dependence (Clark et al. 1997; Earls and Powell 1988; Earls et al. 1988; Hill and Muka 1996; Hill et al. 1999a; Hill et al. 2008; Kuperman et al. 1999; Merikangas et al. 1998; Ohannessian et al. 2004; Reich et al. 1993). In high-risk youth, these disorders generally precede the initiation of alcohol use and are predictive of subsequent abuse and dependence (Chassin et al. 1999; Hill et al. 2000a; Hill et al. 2008; King and Chassin 2008; Marshal et al. 2007). Prospective longitudinal studies in populations not selected for familial risk for AUD further suggest that AUD is often secondary to childhood externalizing behavioral problems (Biederman et al. 1997, 1998). For example, Mannuzza et al. (1993) found that boys diagnosed with ADHD in childhood had significantly higher rates of SUD in adolescence and young adulthood. Ten year follow-up of 6–17 year old boys with ADHD has confirmed that higher rates of adult SUD occur in association with an earlier ADHD diagnosis (Biederman et al. 2008).
