43.8 Changes in Cannabis and Alcohol Use and Their Impact on ADHD Symptoms in Adolescents Receiving ADHD Pharmacotherapy and Substance Use Treatment

Abstract

Adolescents with ADHD commonly use and co-use cannabis and alcohol. Whether these substances act as complements vs substitutes is debated in the literature. Little is known about the impact of cannabis use on alcohol use disorder (AUD) treatment outcomes (and vice versa) in ADHD youth. The present study used data from the NIDA-CTN-0028 trial to investigate the relationships between change in cannabis use (CU) and alcohol use (AU) and their impact on ADHD outcomes in 303 adolescents (aged 13-18 years) meeting DSM-IV criteria for ADHD and substance use disorder (SUD) who participated in a 16-week randomized controlled multisite trial of osmotic-controlled release oral delivery system methylphenidate (OROS-MPH) vs placebo with both groups receiving CBT for SUD. In the ADHD/SUD sample, cannabis use disorders (89%) and AUD (60%) were the most common SUD diagnoses. During treatment, 79% and 48% of participants reduced and 12% and 24% of participants increased their CU and AU, respectively. After controlling for age, race, and sex, during treatment, reduction in the amount of cannabis used was positively correlated with during-treatment reductions in the number of drinks (r = 0.14; p = 0.02) and drinking days (r = 0.14; p = 0.02). Reduction in drinking days was associated with reductions in ADHD symptoms (β = 0.26; p = 0.04), and reductions in both CU and AU were associated with improvements in global functioning (β’s = 0.26-0.44; all p’s < 0.05) during treatment. Our findings indicate that reductions in CU track with reductions in AU during SUD treatment with both contributing to posttreatment improved functioning in youth with ADHD/SUD. These results provide preliminary support for a complementary relationship between CU and AU in this population. Additional research is warranted to clarify the clinical implications of different patterns of change in cannabis and alcohol use across the continuum of co-use in ADHD and non-ADHD samples.