Substance use increased in teens with ADHD

By Mark Cowen, senior medwireNews Reporter

Adolescents with attention deficit hyperactivity disorder (ADHD) have significantly higher rates of substance abuse and cigarette use than their peers without the condition, US research shows.

The researchers also found that, contrary to previous studies, medications for ADHD do not reduce the risk for substance abuse and substance use disorder (SUD) among teenagers.

"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," say Brooke Molina (University of Pittsburgh, Pennsylvania) and colleagues.

The findings come from an 8-year follow-up study of 436 children with ADHD who participated in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder and 261 of their classmates without the condition.

Children with ADHD, who were aged a mean of 8.5 years at baseline, were assigned to one of four treatment groups - medication management, behavior therapy, combined medication management and behavior therapy, and community comparison.

At a mean age of 15 years, 35% of participants with ADHD reported using one or more substances compared with 20% of those without the condition. Furthermore, 10% of the ADHD group met criteria for a substance abuse or dependence disorder compared with just 3% of the non-ADHD group.

At the age of 17 years, 13% of participants with ADHD met criteria for marijuana abuse or dependence compared with 7% of those without ADHD.

Daily cigarette smoking at the 8-year follow up was also significantly higher in participants with than without ADHD, at 17% versus 8%.

Overall, substance use at all time points during follow up was greater in participants with ADHD than in those without, regardless of gender.

The researchers note that neither medication management nor behavior therapy was associated with an increase or decrease in the use of substances among the ADHD group.

Molina et al conclude in Journal of the American Academy of Child and Adolescent Psychiatry: "Children with ADHD have increased risk of substance use, in particular tobacco and marijuana, against a backdrop of high rates of alcohol use for all teens, and our standard treatments (short-term psychosocial, medication) for ADHD have not, to date, countered this risk."

They add: "Given the ubiquity of medicinal treatment for ADHD and our failure to find relations between ADHD medication treatment and adolescent substance use/SUD, the findings argue for additional research on neurobiological and psychosocial factors that fuel the vulnerability and can inform the types of treatment so urgently needed."

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