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Cited by 875Attention Deficit Hyperactivity DisorderSubstance Abuse Treatment and OutcomesChild and Adolescent Psychosocial and Emotional Development

Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review

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Lee, Steve S., Humphreys, Kathryn L., Flory, Kate, Liu, Rebecca, Glass, Kerrie·2011·Clinical Psychology Review
DOI 10.1016/j.cpr.2011.01.006PMC PMC3180912
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Abstract

Given the clinical and public health significance of substance disorders and the need to identify their early risk factors, we examined the association of childhood attention-deficit/hyperactivity disorder (ADHD) with substance use (e.g., nicotine, alcohol) and abuse/dependence outcomes (nicotine, alcohol, marijuana, cocaine, other). To strengthen a potential causal inference, we meta-analyzed longitudinal studies that prospectively followed children with and without ADHD into adolescence or adulthood. Children with ADHD were significantly more likely to have ever used nicotine and other substances, but not alcohol. Children with ADHD were also more likely to develop disorders of abuse/dependence for nicotine, alcohol, marijuana, cocaine, and other substances (i.e., unspecified). Sex, age, race, publication year, sample source, and version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) used to diagnose ADHD did not significantly moderate the associations with substance outcomes that yielded heterogeneous effect sizes. These findings suggest that children with ADHD are significantly more likely to develop substance use disorders than children without ADHD and that this increased risk is robust to demographic and methodological differences that varied across the studies. Finally, few studies addressed ADHD and comorbid disruptive behavior disorders (DBD), thus preventing a formal meta-analytic review. However, we qualitatively summarize the results of these studies and conclude that comorbid DBD complicates inferences about the specificity of ADHD effects on substance use outcomes.

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  • A meta-analysis of 12 studies with over 5,400 people found that those with ADHD were almost three times more likely to be nicotine-dependent, and a combined analysis of 11 studies with almost 2,400 participants found a 50% greater likelihood of developing a drug or alcohol use disorder.

    “A meta-analysis of twelve studies covering over 5,400 people found that those with ADHD were almost three times more likely to be nicotine-dependent. Combining eleven studies with almost 2,400 participants, those with ADHD were 50% more likely to develop a drug or alcohol use disorder than those without ADHD”

    From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Lee et al., 2011

    Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

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  • Childhood ADHD is a risk factor for early substance use initiation and the development of substance use disorders in adolescence and early adulthood.

    “Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development of substance abuse and substance use disorders (SUD) in adolescence and (early) adulthood.”

    From Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review (2021) · cites this paper as [1]

    The Discussion reports that childhood ADHD prospectively predicted substance use disorders in adolescence and adulthood, supporting the citing sentence’s claim about substance abuse and SUD. The supplied paraphrase also claims earlier substance-use initiation, but the Limitations section says the meta-analysis did not address whether ADHD is associated with earlier onset of substance use or disorders. (LLM, conf=0.88)

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  • In all four meta-analyses, childhood ADHD was associated with an increased risk of SUD in adolescence or early adulthood compared with non-ADHD controls, with mean odds ratios ranging from 1.34 to 3.48 for different types of SUD.

    “In all four meta-analyses, childhood ADHD was associated with an increased risk of SUD in adolescence or early adulthood, compared with non-ADHD controls, with mean odds-ratios (OR) ranging from 1.34 to 3.48 (small-to-moderate association) for different types of SUD.”

    From Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review (2021) · cites this paper as [1]

    The Results sections report higher odds of several substance use disorders in adolescence or adulthood among those with childhood ADHD than among controls. But the paper describes one meta-analysis covering multiple outcomes, not four meta-analyses, and its reported odds ratios do not establish the claimed 1.34–3.48 range: for example, marijuana abuse/dependence has a recalculated OR of 1.58 and nicotine dependence an OR of 2.82. Page numbers were not available in our copy. (LLM, conf=0.89)

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  • Research following individuals over time indicates that substance use disorder risk remains a concern in ADHD, partly due to shared genetic influences between the two conditions.

    “Prospective studies show that risk of substance use disorders is a persisting concern in ADHD (4, 5), at least in part because the two disorders share genetic influences (6–8).”

    From ADHD Medication and Substance-Related Problems (2017) · cites this paper as [5]

  • Patients with ADHD are more likely to develop SUDs.

    “Patients with ADHD are more likely to develop SUDs [11] at a younger age [12].”

    From Prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among Substance Use Disorder (SUD) Populations: Meta-Analysis. (2023) · cites this paper as [11]

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Authors
Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K.
Affiliations
  • University of California, Los Angeles (US)
  • University of South Carolina (US)
Corresponding author
Lee, Steve S.
ORCID
Venue
Clinical Psychology Review
Publisher
Elsevier BV
Published
2011-04
Volume
31
Issue
3
Pages
328-341
ISSN
0272-7358 (ISSN-L)
DOI
10.1016/j.cpr.2011.01.006
PMC
PMC3180912
OpenAlex
W1999130725
Semantic Scholar
1ed864969f3dfd94eb927126c49bde3717ba6c48
Cited by
875
References
137
Citations by year
2026: 39 · 2025: 63 · 2024: 61 · 2023: 58 · 2022: 52 · 2021: 63 · 2020: 70 · 2019: 58 · 2018: 54 · 2017: 61 · 2016: 84 · 2015: 58 · 2014: 64 · 2013: 48 · 2012: 31
FWCI
6.41
Type
journal article
Language
en
Open access
Licence
Locations
  • Clinical Psychology Review (publishedVersion)
  • PubMed (publishedVersion)
  • PubMed Central (acceptedVersion)
Funders
  • National Institute on Alcohol Abuse and Alcoholism (R03AA020186)
  • National Institute on Drug Abuse (RL1DA024853)
  • National Institute of Dental and Craniofacial Research (UL1DE019580)
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, substance use disorders, substance abuse, substance dependence, nicotine use, alcohol consumption, cannabis use, cocaine use, adolescence, adulthood, disruptive behavior disorders, comorbidities, risk factors, prospective longitudinal study
MeSH terms
Adult, Attention Deficit Disorder with Hyperactivity, Child, Humans, Substance-Related Disorders

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