Prospective Effects of Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, and Sex on Adolescent Substance Use and Abuse
Abstract
CONTEXT: Attention-deficit/hyperactivity disorder (ADHD), an early manifestation of externalizing behavior, may identify children at high risk for later substance abuse. However, the ADHD-substance abuse relationship often disappears when co-occurring conduct disorder (CD) is considered. OBJECTIVE: To determine whether there is a prospective relationship between ADHD and the initiation of substance use and disorders, and whether this relationship depends on the ADHD subtype (hyperactive/impulsive or inattentive), CD, or sex. DESIGN, SETTING, AND PARTICIPANTS: Dimensional and categorical measures of ADHD and CD were examined via logistic regression analyses in relation to subsequent initiation of tobacco, alcohol, and illicit drug use by 14 years of age and onset of substance use disorders by 18 years of age in a population-based sample of 11-year-old twins (760 female and 752 male twins) from the Minnesota Twin Family Study. MAIN OUTCOME MEASURES: Structured interviews were administered to adolescents and their mothers regarding substance use and to generate diagnoses. RESULTS: For boys and girls, hyperactivity/impulsivity predicted initiation of all types of substance use, nicotine dependence, and cannabis abuse/dependence (for all, P < .05), even when controlling for CD at 2 time points. By contrast, relationships between inattention and substance outcomes disappeared when hyperactivity/impulsivity and CD were controlled for, with the possible exception of nicotine dependence. A categorical diagnosis of ADHD significantly predicted tobacco and illicit drug use only (adjusted odds ratios, 2.01 and 2.82, respectively). A diagnosis of CD between 11 and 14 years of age was a powerful predictor of substance disorders by 18 years of age (all odds ratios, > 4.27). CONCLUSIONS: Hyperactivity/impulsivity predicts later substance problems, even after growth in later-emerging CD is considered, whereas inattention alone poses less risk. Even a single symptom of ADHD or CD is associated with increased risk. Failure in previous research to consistently observe relationships between ADHD and substance use and abuse outcomes could be due to reliance on less-sensitive categorical diagnoses.
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ADHD itself is associated with an increased risk for substance abuse.
“especially because ADHD by itself is associated with increased risk for substance abuse (Elkins, McGue, & Iacono, 2007; Klein et al., 2012).”
From Stimulant <scp>ADHD</scp> medication and risk for substance abuse (2014) · cites this paper as Elkins, McGue, & Iacono, 2007
Several epidemiological studies find hazard ratios for SUD in ADHD subjects compared with unaffected groups varying from 1.2 to 3, and up to 7.9 for drug dependence.
“Several epidemiological studies compare ADHD subjects with unaffected groups, and find hazard ratios for SUD varying from 1.2 to 3 [22, 35, 95] and up to 7.9 for drug dependence [68].”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [35]
Even a single symptom of ADHD or conduct disorder may be associated with an increased risk for SUD; hyperactivity symptoms uniquely contributed to subsequent initiation of all types of substance use, to nicotine dependence, and cannabis abuse/dependence, even after controlling for CD, whereas impulsivity predicted alcohol misuse.
“Even a single symptom of ADHD or conduct disorder (CD) may be associated with an increased risk for SUD [35]: hyperactivity symptoms uniquely contributed to subsequent initiation of all types of substance use, to nicotine dependence, and cannabis abuse/dependence, even after controlling for CD, whereas impulsivity predicted alcohol misuse [36].”
From European guidelines on managing adverse effects of medication for ADHD (2011) · cites this paper as [35]
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- Authors
- Elkins, I. J., McGue, M., & Iacono, W. G.
- Affiliations
- University of Minnesota (US)
- Venue
- Archives of General Psychiatry
- Publisher
- American Medical Association (AMA)
- Published
- 2007-10-01
- Volume
- 64
- Issue
- 10
- Pages
- 1145
- ISSN
- 0003-990X (ISSN-L)
- OpenAlex
- W2072775036
- Cited by
- 480
- References
- 40
- Citations by year
- 2026: 1 · 2025: 10 · 2024: 7 · 2023: 12 · 2022: 11 · 2021: 17 · 2020: 17 · 2019: 14 · 2018: 17 · 2017: 27 · 2016: 30 · 2015: 37 · 2014: 37 · 2013: 36 · 2012: 45
- FWCI
- 25.43
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Archives of General Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute on Alcohol Abuse and Alcoholism (AA-09367)
- National Institute on Drug Abuse (DA-05147, R01DA005147)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- attention deficit hyperactivity disorder, conduct disorder, adolescent substance use, substance use disorders, hyperactivity/impulsivity, inattention, sex differences, nicotine dependence, cannabis use disorder, tobacco use, illicit drug use, externalizing problems, ADHD subtypes
- MeSH terms
- Adolescent, Adolescent Behavior, Age Factors, Attention Deficit Disorder with Hyperactivity, Marijuana Abuse, Child, Diseases in Twins, Female, Follow-Up Studies, Humans, Male, Mothers, Probability, Prognosis, Prospective Studies, Psychiatric Status Rating Scales, Risk Factors, Sex Factors, Tobacco Use Disorder, Comorbidity, Prevalence, Conduct Disorder, Substance-Related Disorders
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