The generalizability of the structure of substance abuse and antisocial behavioral syndromes: A systematic review

Psychiatry Res. 2018 Jan;259:412-421. doi: 10.1016/j.psychres.2017.11.007. Epub 2017 Nov 4.


Background: Although several authors have suggested that a single externalizing spectrum encompassing both antisocial behavioral syndromes and substance use disorder is to be preferred, this assumption has not been evaluated systematically throughout studies.

Purpose: The objective was to establish the generalizability of transdiagnostic models of externalizing disorders across different types of disorders and populations, in regard to the strength of the evidence.

Method: We conducted a systematic literature review using combinations of two sets of keywords: 1) "antisocial", "externalizing", "conduct disorder", "disruptive behavior disorder", "substance abuse", "substance-related disorder", "cannabis", "cocaine", "hallucinogen", "alcoholism", "opioid"; 2) "latent structure", "factor analysis", "multivariate analysis".

Results: Models supporting a superordinate factor appeared dominant in a limited set of different populations, on which the majority of the research sample was focused.

Conclusions: Although the externalizing spectrum model is a promising angle for future research and treatment, extending research on this model in a higher diversity of populations is recommended to enhance the understanding and applicability of the externalizing spectrum model.

Keywords: Antisocial; Factor structure; Substance abuse; Systematic review.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Antisocial Personality Disorder / diagnosis*
  • Attention Deficit and Disruptive Behavior Disorders / diagnosis*
  • Conduct Disorder / diagnosis*
  • Humans
  • Substance-Related Disorders / diagnosis*
  • Syndrome