43.7 Sex-Based Differences in Clinical Profiles and Cannabis Abstinence in Adolescents Receiving Combination Treatment for ADHD and Comorbid Cannabis Use Disorder

Abstract

Recent studies indicate sex-based differences in clinical presentation and treatment response for both ADHD and cannabis use disorders (CUDs). Given the high rate of comorbidity of ADHD and CUD, the present study sought to investigate whether sex differences are present in adolescents (ages 13-18 years) with co-occurring ADHD and CUD. This post hoc analysis examined sex-based differences in baseline clinical profiles, cannabis abstinence, and ADHD and substance use disorder (SUD) treatment outcomes in 271 adolescents (19% female, mean age = 16.5 years) meeting DSM-IV criteria for ADHD and comorbid CUD. The sample represents a subset of participants from a 16-week multisite randomized controlled trial of osmotic-release methylphenidate (OROS-MPH) + CBT vs placebo + CBT for the treatment of ADHD and nontobacco SUD (CTN-0028). Compared to males, females with ADHD and CUD had lower self-reported ADHD symptoms and higher global functioning measured via Children's Global Assessment Scale (CGAS) scores at baseline. Both males and females showed significant reductions in days of cannabis use and ADHD symptoms following treatment. There was no evidence of differential improvement in ADHD and nontobacco/noncannabis substance use outcomes with treatment, with persistent sex differences in ADHD symptoms and CGAS scores. Female participants showed greater reductions in cannabis use compared to males, but these differences did not reach statistical significance (eg, reduction in days of cannabis use: –12.0 vs –9.4 days; p = 0.07; end-of-treatment cannabis abstinence: 35% vs 25%; p = 0.13). Sex-based differences in the severity of ADHD symptoms and global functioning are present in adolescents with ADHD and comorbid CUD and largely persist during OROS-MPH + CBT treatment. Identifying overlapping and distinct mechanisms of behavioral change in males and females with co-occurring ADHD and CUD may guide sex-specific and sex-shared intervention development.