Adolescent Substance Misusers with and without Delinquency: Death, Mental and Physical Disorders, and Criminal Convictions from Age 21 to 45

• Teenage alcohol or drug use increased the risk of substance misuse from age 21 to 45.
• Teenage alcohol misuse without delinquency predicted convictions for violent crimes.
• Teenage drug use without delinquency predicted non-violent crimes and psychosis.
• The development of psychosis was associated with teenage cannabis use.

Little is known about adult outcomes of males who as adolescents sought treatment for alcohol misuse or drug use, and who additionally were engaging or not engaging in other forms of delinquency. Since the rates of negative outcomes vary in the general population, the study determined whether the sub-groups of clinic attendees fared differently as compared to males of the same age who had not sought treatment for substance misuse from age 21 to 45. Adolescent males who consulted the only substance misuse clinic in a Swedish city between 1968 and1971 were divided into four groups: ALCOHOL no drug use, no criminal offending (n = 52); ALCOHOL + D no drug use, plus criminal offending (n = 105); DRUG use, no criminal offending (n = 92); and DRUG + D plus criminal offending (n = 474). These four groups were compared to a general population sample (GP) of males matched on age and birthplace, who did not seek treatment for SM in adolescence. National Swedish registers provided data on death, hospitalizations for substance misuse (SM), mental and physical disorders, and criminal convictions. Compared to the GP, and after controlling for co-occurring adult outcomes, ALCOHOL showed elevated risks for SM hospitalization and convictions for violent crimes, and DRUG showed elevated risks for SM hospitalization, convictions for non-violent crimes, and hospitalization for psychosis. ALCOHOL + D and DRUG + D showed increased risk for SM hospitalization, violent and non-violent convictions, and DRUG + D additionally, for death, and hospitalizations for psychosis and physical illness. Misuse of alcohol without drug use or other delinquency in adolescence was associated with increased risk for convictions for violent crimes during the subsequent 25 years, in addition to SM, while adolescent drug use without other forms of delinquency was associated with increased risks for convictions for non-violent crimes, hospitalizations for SM, and non-affective psychosis. Cannabis use, with and without delinquency, was associated with subsequent hospitalization for non-affective psychosis. Consistent with contemporary studies, most adolescents treated for SM from 1968–1971 presented delinquency that was associated with an increase in risk of all adverse outcomes to age 45.