Attention-deficit/hyperactivity disorder and risk for drug use disorder: a population-based follow-up and co-relative study
Open accessAbstract
Background.: Although the association between attention-deficit/hyperactivity disorder (ADHD) and drug use disorder (DUD) is well documented, it is unclear whether it is causal or results from familial confounding. Method.: In this study we included all 551 164 individuals born in Sweden between 1991 and 1995 and used linked data from multiple nationwide registries to identify those with ADHD prior to age 15 years (1.71%). We used Cox proportional hazards models to investigate the future risk for DUD as a function of an ADHD registration and then compared the results from the entire population with the results from a co-relative design. Using the Swedish Multi-Generation Register, we identified all full-sibling, half-sibling and first-cousin pairs discordant for ADHD. Results.: In the population sample, ADHD had a substantially increased risk for future DUD with a hazard ratio (HR) of 3.34 after accounting for gender and parental education. Examining discordant cousin pairs, discordant half-siblings and discordant siblings, those with ADHD had HRs for DUD of 3.09, 2.10 and 2.38 respectively. Controlling for the number of ADHD registrations, ADHD patients with and without stimulant treatment were similarly associated with later DUD risk. Conclusions.: ADHD diagnosed before 15 years of age was strongly related to future risk for DUD. The magnitude of this association was modestly reduced in relative pairs discordant for ADHD, suggesting that the ADHD–DUD association is partly causal and partly a result of familial confounding. We found no evidence to suggest that this association resulted from stimulant treatment.
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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 [6]
A Swedish study of over half a million people found a more than threefold association between ADHD and subsequent drug use disorders after adjusting for sex and parental education.
“A Swedish study of over half a million people found a more than threefold association between ADHD and subsequent drug use disorders after adjusting for sex and parental education”
From The World Federation of ADHD International Consensus Statement: 208 Evidence-based conclusions about the disorder (2021) · cites this paper as Sundquist et al., 2015
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- Authors
- Sundquist, J., Ohlsson, H., Sundquist, K., & Kendler, K. S.
- Affiliations
- Lund University (SE)
- Virginia Commonwealth University (US)
- Corresponding author
- Sundquist, J.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2014-08-14
- Volume
- 45
- Issue
- 5
- Pages
- 977-983
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- PMC
- PMC4329095
- OpenAlex
- W2100411144
- Semantic Scholar
- 37c8da3435fed474126a8b8227ecb76e30216e7f
- Cited by
- 56
- References
- 40
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 8 · 2023: 12 · 2022: 5 · 2021: 4 · 2020: 3 · 2018: 2 · 2017: 6 · 2016: 6 · 2015: 1
- FWCI
- 3.31
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Vetenskapsrådet
- National Institute on Drug Abuse (R01DA030005)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- attention deficit hyperactivity disorder, drug use disorders, substance use, familial confounding, causal inference, stimulant medication, childhood ADHD, risk factors
- MeSH terms
- Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Family, Female, Humans, Male, Registries, Risk Factors, Sweden, Cohort Studies, Causality, Proportional Hazards Models, Substance-Related Disorders, Siblings, Young Adult
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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