Age of Onset, Duration, and Type of Medication Therapy for Attention-Deficit/Hyperactivity Disorder and Substance Use During Adolescence: A Multi-Cohort National Study
Open accessAbstract
Objective To examine whether age of onset, duration, or type of medication therapy for attention-deficit/hyperactivity disorder (ADHD) is associated with substance use during adolescence. Method Nationally representative samples of high school seniors were surveyed via self-administered questionnaires. The sample consisted of 40,358 individuals from ten independent cohorts (2005-2014) and represented a population that was 52% female, 62% White, 10% African-American, 14% Hispanic, and 14% other. Design-based logistic regression analyses were used to test the associations between age of onset, duration, and type of ADHD medication therapy and recent substance use, controlling for potential confounding factors. Results Individuals who initiated stimulant medication therapy for ADHD later (ages 10-14 and 15 years and older) and for shorter duration (2 years or less and 3-5 years) as well as those who reported only non-stimulant medication therapy for ADHD had significantly greater odds of substance use in adolescence relative to individuals who initiated stimulant medication therapy for ADHD earlier (aged 9 or less) and for longer duration (6 or more years). The odds of substance use generally did not differ between population controls (youth without ADHD and unmedicated youth with ADHD) and individuals who initiated stimulant medication for ADHD early (aged 9 or less) and for longer duration (6 or more years). Conclusion Relative to later onset and shorter duration of stimulant treatment for ADHD, early onset and longer duration of stimulant treatment for ADHD was associated with a risk of substance use during adolescence that is lower and similar to that in the general population.
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More recent studies report that medication treatment is linked to lower substance-related risk.
“In fact, several more recent studies have found that medication treatment is associated with decreased substance-related risk (18–20).”
From ADHD Medication and Substance-Related Problems (2017) · cites this paper as [20]
The Discussion (Duration of stimulant medication therapy; page unavailable) reports lower subsequent substance-use rates with early, sustained ADHD stimulant treatment. The claim omits that qualification: the Results and Discussion describe higher substance-use rates among adolescents who began stimulant treatment later or received it for a shorter period, relative to the early, sustained-treatment group. The study supports an association for a particular treatment pattern, not medication treatment generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThere is evidence that stimulant therapy for ADHD is not associated with an increase in the risk for overall SUD, especially for longer duration stimulant medication treatment.
“While there is evidence that stimulant therapy for ADHD is not associated with an increase in the risk for overall SUD, 6 especially for longer duration stimulant medication treatment, [26][27][28]”
From Is Age of Onset and Duration of Stimulant Therapy for ADHD Associated with Cocaine, Methamphetamine, and Prescription Stimulant Misuse? (2024) · cites this paper as [27]
The Introduction says clinical evidence suggests childhood stimulant therapy does not increase subsequent risk of substance use or SUDs. The Discussion reports lower rates of substance use in late adolescence with longer treatment duration, but this study does not establish the corresponding association for diagnosed SUDs. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMcCabe et al. (2016) found that a longer duration of treatment (6 years or more) was associated with a lower risk for SUDs.
“In addition, McCabe et al. (2016) found that a longer duration of treatment (6 years or more) was associated with a lower risk for SUDs (McCabe et al. 2016).”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as McCabe et al. 2016
The Abstract Results and Discussion (pages not specified) report that adolescents who began ADHD stimulant treatment early and continued for six or more years had lower rates of substance use than those treated later or for shorter periods. The study measured substance-use behaviors, not diagnosed substance use disorders (SUDs), and its six-year comparison combines longer duration with early treatment onset. (LLM, conf=0.88)
Experimental — accuracy not yet measuredTwo studies (8%) found that earlier initiation of treatment for ADHD was associated with significantly lower odds of developing an SUD.
“Two studies (8%) did not report on the effects of stimulants on ADHD but found that earlier initiation of treatment for ADHD was associated with significantly lower odds of developing an SUD (Mannuzza et al. 2003; McCabe et al. 2016).”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as McCabe et al. 2016
The Abstract Results and Discussion report significantly lower odds of substance use during adolescence with earlier, longer-duration stimulant treatment than with later, shorter-duration treatment. The Methods > Measures section shows that this study measured substance-use behaviors, not whether participants developed a substance use disorder (SUD). The SUD findings mentioned in the Introduction concern earlier studies, so the SUD-specific claim is not established by McCabe et al.’s results. (LLM, conf=0.91)
Experimental — accuracy not yet measuredIn general, the prevalence of substance use was highest among individuals who reported the latest onset and shortest duration of prescription stimulant medication therapy for ADHD (aOR for Controls 1.8 (95% CI [1.3-2.6])).
“In general, the prevalence of substance use was highest among individuals who reported the latest onset and shortest duration of prescription stimulant medication therapy for ADHD (aOR for Controls 1.8 (95% CI [1.3-2.6])”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as McCabe et al. (2016)
The Results section states verbatim that substance-use prevalence was generally highest among those with the latest onset and shortest duration of prescription stimulant therapy. It refers to adjusted analyses in Table 3, but the passages in our copy do not give the claimed aOR for controls of 1.8 (95% CI 1.3–2.6); that numerical comparison remains unverified. (LLM, conf=0.85)
Experimental — accuracy not yet measured
In ADHD, early-onset and longer-duration treatment resulted in improved outcomes relative to later-onset and shorter duration treatments.
“For instance, findings in ADHD converge to show that the early-onset and longer-durations of treatment resulted in improved outcomes relative to later-onset and shorter duration treatments (McCabe et al. 2016).”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as McCabe et al. 2016
The Results and Discussion report that earlier onset and longer duration of ADHD stimulant medication therapy were associated with lower adolescent substance use than later onset and shorter duration. The claim omits that the outcome was substance use and says treatment “resulted in” improvement, whereas this study reports an association, not a causal effect. (LLM, conf=0.88)
Experimental — accuracy not yet measuredNo significant differences were found among treated versus untreated groups on rates of SUD.
“No | significant differences among Tx versus groups on rates of SUD”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as McCabe et al. (2016)
The Discussion (page unavailable) reports no significant difference in most substance-use behaviors between adolescents who began stimulant treatment early and continued it for at least six years and population controls. It does not establish no difference between treated and untreated ADHD groups generally, and the reported outcomes are substance-use behaviors rather than rates of substance use disorder (SUD). (LLM, conf=0.87)
Experimental — accuracy not yet measuredIndividuals who initiated treatment earlier (<9 years old) and for a longer duration (6 years or more) had significantly lower risk for substance use compared to individuals who initiated treatment later (>9 years old) and for a shorter duration (<6 years).
“Individuals who initiated Tx earlier ( < 9 years old) and for a longer duration (6 years or more) had significantly lower risk for substance use compared to individuals who initiated Tx later ( > 9 years old) and for a shorter duration ( < 6 years)”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as McCabe et al. (2016)
The Abstract Results and Results section report significantly greater odds of adolescent substance use with later, shorter-duration ADHD stimulant treatment than with earlier treatment lasting at least six years. The source defines the early group as age 9 or younger, not younger than 9, and its comparison concerns stimulant medication rather than treatment generally. (LLM, conf=0.84)
Experimental — accuracy not yet measuredIndividuals who initiated treatment earlier (≤9 years of age) had significantly lower odds of marijuana and other substance use compared to those who initiated treatment later (>9 years of age).
“Individuals who initiated Tx earlier ( £ 9 years of age) had significantly lower odds of marijuana and other substance use compared to those who initiated Tx later ( > 9 years of age)”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as McCabe et al. (2016)
The odds of substance use and substance-related problems were significantly greater among those who initiated earlier nonmedical use of stimulant medications relative to later nonmedical initiation.
“The odds of substance use and substance-related problems were significantly greater among those who initiated earlier nonmedical use of stimulant medications relative to later nonmedical initiation”
From The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders (2022) · cites this paper as McCabe et al. (2016)
The Results and Discussion compare ages of initiation of prescribed stimulant therapy for ADHD, not ages of initiation of nonmedical stimulant use. I searched for earlier versus later nonmedical initiation, but found no passage testing its association with substance use or substance-related problems. The finding about prescribed treatment cannot establish the claimed finding about nonmedical use. (LLM, conf=0.76)
Experimental — accuracy not yet measured
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Self-citation
- Authors
- McCabe, S. E., Dickinson, K., West, B. T., & Wilens, T. E.
- Affiliations
- University of Michigan (US)
- Harvard University (US)
- Corresponding author
- McCabe, Sean Esteban
- Venue
- Journal of the American Academy of Child & Adolescent Psychiatry
- Publisher
- Elsevier BV
- Published
- 2016-06
- Volume
- 55
- Issue
- 6
- Pages
- 479-486
- ISSN
- 0890-8567 (ISSN-L)
- PMC
- PMC4921895
- OpenAlex
- W2326529389
- Semantic Scholar
- 1527332613ebca527b25d6b0377c35580548c6f2
- Cited by
- 82
- References
- 43
- Citations by year
- 2026: 6 · 2025: 10 · 2024: 9 · 2023: 12 · 2022: 4 · 2021: 7 · 2020: 9 · 2019: 12 · 2018: 5 · 2017: 7 · 2016: 1
- FWCI
- 7.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of the American Academy of Child & Adolescent Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute on Drug Abuse (R01DA036541, R01DA031160)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cognitive Neuroscience › Neuroethics, Human Enhancement, Biomedical Innovations
- Keywords
- attention deficit hyperactivity disorder, ADHD medication, stimulant medication, non-stimulant medication, age of onset, treatment duration, adolescent substance use, high school seniors
- MeSH terms
- Adolescent, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Male, United States, Cohort Studies, Age of Onset, Substance-Related Disorders
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