Adolescent Substance Use in the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder (ADHD) (MTA) as a Function of Childhood ADHD, Random Assignment to Childhood Treatments, and Subsequent Medication
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Objectives To determine long-term effects on substance use and substance use disorder (SUD), up to 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA; n=436); to test whether (a) medication at follow-up, (b) cumulative psychostimulant treatment over time, or (c) both relate to substance use/SUD; to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group (n=261). Method Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question, for which propensity score matching analysis was used. Results The originally randomized treatment groups did not differ significantly on substance use/SUD by the 8 year follow-up or earlier (M age = 17 years). Neither medication at follow-up (mostly stimulants) nor cumulative stimulant treatment was associated with adolescent substance use/SUD. Substance use at all time points, including use of two or more substances and SUD, were each greater in the ADHD than non-ADHD samples, regardless of sex. Conclusions Medication for ADHD did not protect from, nor contribute to, visible risk of substance use or SUD by adolescence, whether analyzed as randomized treatment assignment in childhood, as medication at follow-up, or as cumulative stimulant treatment over an 8 year follow-up from childhood. These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD, especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication. Clinical trial registration information—Multimodal Treatment Study of Children with Attention Deficit and Hyperactivity Disorder (MTA); http://clinical trials.gov/; NCT00000388.
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No significant differences were found among treated versus untreated groups on rates of substance use or SUD.
“No significant differences among Tx versus groups on rates of or substance use”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Molina et al. (2013)
The Results section, “Associations with Treatment,” reports no significant association between treatment assignment or medication use and substance use or SUD. But the paper compares assigned treatment groups and, in its cumulative-treatment analysis, groups with more versus fewer days of stimulant treatment—not treated versus untreated groups. No page numbers are available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredThe Multimodal Treatment Study follow-up and a meta-analysis found no link between medication and substance use or problems.
“For example, follow-up data from the Multimodal Treatment Study of Attention-Deficit/Hyperactivity Disorder and a meta-analysis showed no medication associations with substance use or problems (16, 17).”
From ADHD Medication and Substance-Related Problems (2017) · cites this paper as [17]
Molina et al. (2013) found no indications for a harmful or beneficial effect of stimulant treatment on developing SUD in adolescence when comparing children in the MTA-cohort with high versus low exposure to stimulant treatment.
“Molina et al. (2013) compared children in the MTA-cohort with high versus low exposure to stimulant treatment and found no indications for a harmful or beneficial effect of treatment for developing SUD in adolescence [56].”
From Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review (2021) · cites this paper as [56]
Two studies used nonstimulants, including atomoxetine and guanfacine.
“Two studies used nonstimulants, including atomoxetine and guanfacine (Molina et al. 2013; Quinn et al. 2017).”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Molina et al. 2013
Neither randomized treatment assignment nor proportion of days medicated in the past year was a predictor of SUD at the 6- and 8-year assessments.
“Neither randomized Tx assignment nor proportion of days medicated in the past year was a predictor of SUD at the 6- and 8-year assessments”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as Molina et al. (2013)
Medication does not seem to increase risk of substance use when initiated early.
“In other words, medication does not seem to increase risk of substance use when initiated early (Molina et al., 2013, Volkow and Swanson, 2008).”
From Sensitive periods of substance abuse: Early risk for the transition to dependence (2017) · cites this paper as Molina et al., 2013
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References 92 · Cited by 246
Research works printed but not linked: 1
- [4]Molina BSG Evans SW Hoza B Delinquency and substance use in ADHD: Adolescent and young adult outcomes in developmental context Attention Deficit Hyperactivity Disorder: State of the Science and Best Practices 2011 Vol. 2 Kingston, NJ Civic Research Institute
- Authors
- Molina, B. S. G., Hinshaw, S. P., Eugene Arnold, L., Swanson, J. M., Pelham, W. E., Hechtman, L., Hoza, B., Epstein, J. N., Wigal, T., Abikoff, H. B., Greenhill, L. L., Jensen, P. S., Wells, K. C., Vitiello, B., Gibbons, R. D., Howard, A., Houck, P. R., Hur, K., Lu, B., & Marcus, S.
- Affiliations
- University of Pittsburgh (US)
- University of California, Berkeley (US)
- University of California, Irvine (US)
- Florida International University (US)
- McGill University (CA)
- University of Vermont (US)
- University of Cincinnati (US)
- New York University (US)
- Columbia University (US)
- Mayo Clinic (US)
- Duke University (US)
- National Institutes of Health (US)
- University of Chicago (US)
- Edward Hines, Jr. VA Hospital (US)
- Corresponding author
- Molina, Brooke S.G.
- ORCID
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2013-03
- Volume
- 52
- Issue
- 3
- Pages
- 250-263
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC3589108
- OpenAlex
- W2096729555
- Semantic Scholar
- 238890677d5b62b65e23f5055b3c9a03e28e1972
- Cited by
- 246
- References
- 92
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 9 · 2023: 8 · 2022: 15 · 2021: 14 · 2020: 18 · 2019: 22 · 2018: 16 · 2017: 33 · 2016: 31 · 2015: 21 · 2014: 34 · 2013: 10 · 2012: 1
- FWCI
- 22.67
- Type
- journal article
- Language
- en
- Open access
- green
- europepmc.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Institutional Research Information System University of Turin (University of Turin) (submittedVersion)
- Funders
- National Institutes of Health (n01mh12011-0-0-1, n01mh012009-007, n01mh12008-0-0-1, n01mh12010-0-0-1, n01mh12004-0-0-0, n01mh12007-0-0-0, n01mh012012-001)
- U.S. Public Health Service (HHSN271200800006-C, HHSN271200800009-C, HHSN271200800008-C, HHSN271200800005-C, HHSN271200800007-C, HHSN271200800003-C, HHSN271200800004-C)
- National Institute of Mental Health (U01MH50461, N01 MH012007, U01MH50440, U01MH050467, N01 MH012009, U01 MH50477, N01 MH012011, U01MH050440, N01 MH012012, U01MH050453, N01 MH012010, U01MH50467, U01MH050461, F32MH012004, U01MH50453, N01 MH012004, N01 MH012008)
- National Institute on Drug Abuse (HHSN271200800003C, HHSN271200800006C, N01 DA085550, DA-8-5552, N01 DA085552, DA-8-5549, DA-8-5551, DA-8-5553, HHSN271200800008C, N01 DA085549, DA-8-5550, HHSN271200800005C, DA-8-5554, N01 DA085551, N01 DA085548, HHSN271200800007C, HHSN271200800009C, N01 DA085553, DA-8-5548, HHSN271200800004C)
- 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
- adolescent substance use, substance use disorders, attention deficit hyperactivity disorder, stimulant medication, long-term treatment outcomes, substance use prevention, substance use comorbidity
- MeSH terms
- Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Behavior Therapy, Child, Combined Modality Therapy, Female, Follow-Up Studies, Humans, Male, Psychiatric Status Rating Scales, Regression Analysis, Time Factors, Comorbidity, Treatment Outcome, Substance-Related Disorders
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