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Does ADHD Predict Substance-Use Disorders? A 10-Year Follow-up Study of Young Adults With ADHD

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Objective

High rates of substance-use disorders (SUD) have been found in samples of adolescents and adults with attention-deficit/hyperactivity disorder (ADHD). Predictors of SUD in children with ADHD who are at risk for the development of SUDs remain understudied. The main aims of this study were to identify clinically meaningful characteristics of children that predicted the future development of SUDs and to see whether the role of these characteristics varied by sex.

Method

Subjects were children and adolescents with (n = 268; mean age ± standard deviation = 10.9 ± 3.2 years) and without (n = 229; mean age 11.9 ± 3.3 years) DSM-III-R ADHD followed prospectively and blindly over a 10-year follow-up period onto young adult years. Subjects were assessed with structured diagnostic interviews for psychopathology and SUDs.

Results

Over the 10-year follow-up period, ADHD was found to be a significant predictor of any SUD (hazards ratio 1.47; 95% confidence interval 1.07–2.02; p = .01) and cigarette smoking (2.38; 1.61–3.53; p < .01). Within ADHD, comorbid conduct disorder (2.74; 1.66–4.52; p < .01) and oppositional defiant disorder (2.21; 1.40–3.51; p < .01) at baseline were also found to be significant predictors of SUDs. Similar results were found for cigarette-, alcohol-, and drug-use disorders. There were few meaningful sex interaction effects. No clinically significant associations were found for any social or family environment factors or for cognitive functioning factors (p > .05 for all comparisons).

Conclusions

These results indicate that ADHD is a significant risk factor for the development of SUDs and cigarette smoking in both sexes.

Section snippets

Subjects

A detailed study methodology has been previously described.26, 27 Subjects were derived from two identically designed longitudinal case-control family studies of ADHD. These studies recruited male and female probands 6 to 17 years of age with (140 boys, 140 girls) and without (120 boys, 122 girls) DSM-III-R ADHD from pediatric and psychiatric clinics. The present sample includes the 10- and 11-year follow-up for the studies of boys and girls, respectively. Of the 140 girls with ADHD and 122

Results

Overall, there were 497 probands available for study (268 cases of ADHD; mean baseline age, 10.91 ± 3.17 years) and 229 controls (mean baseline age, 11.88 ± 3.29 years). To test the first hypothesis, subjects were stratified by the presence or absence of ADHD. Subjects with ADHD without any SUD at baseline (n = 257) were significantly younger at baseline, had a significantly lower SES, and were more likely to have a parental history of an alcohol use and/or drug-use disorder compared with

Discussion

The results of this follow-up (average 10 years) study of two cohorts of children to examine early predictors for later SUD partly support our hypotheses. The present results support the hypothesis that ADHD is a risk for later SUD and the major predictive importance of early CD on subsequent SUD in ADHD youth. However, we failed to demonstrate significant associations between family, baseline cognitive, or non-CD psychiatric, treatment, subtype, or academic dysfunction and later SUD in the

References (57)

  • T. Crowley et al.

    Substance-dependent, conduct-disordered adolescent males: severity of diagnosis predicts 2-year outcome

    Drug Alcohol Depend

    (1998)
  • T.E. Wilens et al.

    Further evidence of an association between adolescent bipolar disorder with smoking and substance use disorders: a controlled study

    Drug Alcohol Depend

    (2008)
  • K.L. Medina et al.

    Memory functioning in polysubstance dependent women

    Drug Alcohol Depend

    (2006)
  • T. Wilens et al.

    Do executive function deficits predict later substance use disorders among adolescents and young adults?

    J Am Acad Child Adolesc Psychiatry

    (2011)
  • W.M. Compton et al.

    Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions

    Arch Gen Psychiatry

    (2007)
  • B.A. Johnson et al.

    Age of onset as a discriminator between alcoholic subtypes in a treatment-seeking outpatient population

    Am J Addict

    (2000)
  • G. Polanczyk et al.

    The worldwide prevalence of ADHD: a systematic review and meta-regression analysis

    Am J Psychiatry

    (2007)
  • R.C. Kessler et al.

    The prevalence and correlates of adult ADHD in the United States: Results from the national comorbidity survey replication

    Am J Psychiatry

    (2006)
  • E. Mick et al.

    The course and outcome of ADHD

    Prim Psychiatry

    (2004)
  • S. Mannuzza et al.

    Adult outcome of hyperactive boys: educational achievement, occupational rank, and psychiatric status

    Arch Gen Psychiatry

    (1993)
  • B. Molina et al.

    Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD

    J Abnorm Psychol

    (2003)
  • L. Hechtman et al.

    Controlled prospective fifteen year follow-up of hyperactives as adults: Non-medical drug and alcohol use and anti-social behaviour

    Can J Psychiatry

    (1986)
  • S. Mannuzza et al.

    Adult psychiatric status of hyperactive boys grown up

    Am J Psychiatry

    (1998)
  • J.H. Satterfield et al.

    A prospective study of delinquency in 110 adolescent boys with attention deficit disorder and 88 normal adolescent boys

    Am J Psychiatry

    (1982)
  • C.M. Szobot et al.

    Is attention-deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents?A community-based case-control study

    Addiction

    (2007)
  • R. Loeber et al.

    Developmental aspects of delinquency and internalizing problems and their association with persistent juvenile substance use between ages 7 and 18

    J Clin Child Psychol

    (1999)
  • D.M. Fergusson et al.

    Conduct problems and attention deficit behaviour in middle childhood and cannabis use by age 15

    Aust N Z J Psychiatry

    (1993)
  • D.W. Brook et al.

    Association between attention-deficit/hyperactivity disorder in adolescence and substance use disorders in adulthood

    Arch Pediatr Adolesc Med

    (2010)

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    This article can be used to obtain continuing medical education (CME) category 1 credit at jaacap.org.

    An interview with the author is available by podcast at www.jaacap.org.

    This study was funded by grant K24 DA016264 (T.W.) and in part by a grant from the United States Public Health Service (National Institute on Child Health and Human Development) and by grant 5R01 HD-36317-07 (J.B.) and in part by a grant from the Eli Lilly and Company Foundation and the Pediatric Psychopharmacology Philanthropy Fund.

    Disclosure: Dr. Wilens has received grant support from Abbott, McNeil, Eli Lilly and Co., the National Institutes of Health–National Institute on Drug Abuse, Nextwave, Merck, and Shire. He has served on the speakers' bureau for Eli Lilly and Co., McNeil, Novartis, and Shire. He has served as a consultant to Abbott, AstraZeneca, McNeil, Eli Lilly and Co., the National Institutes of Health, Nextwave, Novartis, Merck, and Shire. He receives royalties from Guildford Press. Dr. Biederman has received research support from Abbott, Alza, AstraZeneca, Bristol Myers Squibb, Celltech, Cephalon, Eli Lilly and Co., Elminda, Esai, Forest, GlaxoSmithKline, Gliatech, Janssen, McNeil, Merck, the National Alliance for Research on Schizophrenia and Depression, the National Institute on Drug Abuse, New River, the National Institute of Child Health and Human Development, the National Institute of Mental Health, Novartis, Noven, Neurosearch, Organon, Otsuka, Pfizer, Pharmacia, the Prechter Foundation, Shire, the Stanley Foundation, UCB Pharma, and Wyeth. He has served on the speakers' bureau for Fundacion Areces, Medice Pharmaceuticals, and the Spanish Child Psychiatry Association. Dr. Joshi has received research support from Abbott, Bristol Myers Squibb, Cephalon, Eli Lilly and Co., GlaxoSmithKline, Johnson and Johnson, McNeil, Merck, the National Institute of Mental Health, New River, Novartis, Organon, Otsuka, Takeda, Pfizer, and Shire. He is a member of the National Institute of Mental Health Editorial Board. He has received the Ethel DuPont Fellowship Award. He has received the Pilot Research Award from the American Academy of Child and Adolescent Psychiatry. Ms. Martelon, Mr. Bateman, Ms. Fried, and Mr. Petty report no biomedical financial interests or potential conflicts of interest.

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