Behavioral Predictors of Substance-Use Initiation in Adolescents With and Without Attention-Deficit/Hyperactivity Disorder
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OBJECTIVE. Our goal was to examine substance-use initiation in healthy adolescents and in adolescents who have been diagnosed with attention-deficit/hyperactivity disorder. METHODS. Seventy-eight adolescents (28 healthy and 50 with attention-deficit/hyperactivity disorder) participated in an ongoing longitudinal study of predictors of substance use. The substances most commonly reported were tobacco, alcohol, and marijuana. Aggression, conduct problems, hyperactivity, impulsivity, inattention, anxiety/depression, social difficulties, and somatic complaints were assessed at study entry and tested as predictors for later substance use. RESULTS. With an average of 4 years into the study, 37 adolescents had not used any substances, 41 had experimented with at least 1 substance, and 29 experimented with >1 substance. Psychiatric diagnoses (attention-deficit/hyperactivity disorder, attention-deficit/hyperactivity disorder and conduct disorder, and attention-deficit/hyperactivity disorder and depression/anxiety) did not influence reports of substance use. Distinct behavioral measures collected at study entry predicted use of different substances. In a multivariate analysis, aggression had the greatest association with tobacco smoking and marijuana use. Impulsivity was associated with alcohol use. Severity of drug exposure, indexed by the number of substances used, was predicted by aggression. CONCLUSIONS. This 4-year longitudinal study captured the onset of substance use, not abuse. Behavioral predictors differed with the type of substance used. These behavioral characteristics may raise suspicion among pediatricians for enhanced risk for substance-use initiation.
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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 [36]
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- Authors
- Ernst, M., Luckenbaugh, D. A., Moolchan, E. T., Leff, M. K., Allen, R., Eshel, N., London, E. D., & Kimes, A.
- Affiliations
- Mood and Anxiety Disorders Program, National Institute of Mental Health, Bethesda, Maryland
- National Institutes of Health (US)
- National Institute on Drug Abuse (US)
- University of California, Los Angeles (US)
- Venue
- Pediatrics
- Publisher
- American Academy of Pediatrics (AAP)
- Published
- 2006-06-01
- Volume
- 117
- Issue
- 6
- Pages
- 2030-2039
- ISSN
- 0031-4005 (ISSN-L)
- 1098-4275
- OpenAlex
- W1975368442
- Cited by
- 137
- References
- 77
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 4 · 2023: 7 · 2022: 7 · 2021: 3 · 2020: 3 · 2019: 4 · 2018: 2 · 2017: 3 · 2016: 5 · 2015: 9 · 2014: 9 · 2013: 10 · 2012: 16
- FWCI
- 7.96
- Type
- journal article
- Language
- en
- Open access
- green
- escholarship.org
- Locations
- PEDIATRICS (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- substance use initiation, attention deficit hyperactivity disorder, adolescents, aggression, impulsivity, smoking, alcohol consumption, cannabis use, conduct disorder, anxiety and depression, behavioral predictors
- MeSH terms
- Adolescent, Adolescent Behavior, Attention Deficit Disorder with Hyperactivity, Child, Female, Humans, Longitudinal Studies, Male, Substance-Related Disorders
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