Childhood ADHD and risk for substance dependence in adulthood: a longitudinal, population-based study.

Sharon Levy,Robert C Colligan,Jill M Killian,Robert G Voigt,Amy L Weaver,William J Barbaresi,Slavica K Katusic,Efthimios M C Skoulakis

doi:10.1371/journal.pone.0105640

Abstract

BackgroundAdolescents with attention-deficit/hyperactivity disorder (ADHD) are known to be at significantly greater risk for the development of substance use disorders (SUD) compared to peers. Impulsivity, which could lead to higher levels of drug use, is a known symptom of ADHD and likely accounts, in part, for this relationship. Other factors, such as a biologically increased susceptibility to substance dependence (addiction), may also play a role.ObjectiveThis report further examines the relationships between childhood ADHD, adolescent- onset SUD, and substance abuse and substance dependence in adulthood.MethodIndividuals with childhood ADHD and non-ADHD controls from the same population-based birth cohort were invited to participate in a prospective outcome study. Participants completed a structured neuropsychiatric interview with modules for SUD and a psychosocial questionnaire. Information on adolescent SUD was obtained retrospectively, in a previous study, from medical and school records. Associations were summarized using odds ratios (OR) and 95% CIs estimated from logistic regression models adjusted for age and gender.ResultsA total of 232 ADHD cases and 335 non-ADHD controls participated (mean age, 27.0 and 28.6 years, respectively). ADHD cases were more likely than controls to have a SUD diagnosed in adolescence and were more likely to have alcohol (adjusted OR 14.38, 95% CI 1.49–138.88) and drug (adjusted OR 3.48, 95% CI 1.38–8.79) dependence in adulthood. The subgroup of participating ADHD cases who did not have SUD during adolescence were no more likely than controls to develop new onset alcohol dependence as adults, although they were significantly more likely to develop new onset drug dependence.ConclusionsOur study found preliminary evidence that adults with childhood ADHD are more susceptible than peers to developing drug dependence, a disorder associated with neurological changes in the brain. The relationship between ADHD and alcohol dependence appears to be more complex.

Highlights

Individuals with attention-deficit/hyperactivity disorder (ADHD) are known to be at significantly greater risk for the development of substance use disorders (SUD) compared to their non-ADHD peers. [1,2,3] The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) had defined two types of SUDs: substance abuse and substance dependence. [4] (The nomenclature was changed to mild, moderate- or severe- SUD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), [5] with ‘‘substance abuse’’ roughly correlating to moderate SUD and ‘‘substance dependence’’ to severe SUD
Our study found preliminary evidence that adults with childhood ADHD are more susceptible than peers to developing drug dependence, a disorder associated with neurological changes in the brain
Our study provides initial evidence that individuals with childhood ADHD remain more susceptible than peers to developing new onset drug dependence, a disorder associated with neurological changes in the brain, in adulthood

Summary

Introduction

Individuals with attention-deficit/hyperactivity disorder (ADHD) are known to be at significantly greater risk for the development of substance use disorders (SUD) compared to their non-ADHD peers. [1,2,3] The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-Text Revision (DSM-IV-TR) had defined two types of SUDs: substance abuse (substance use that interferes with daily functioning or is associated with recurrent problems) and substance dependence (manifested by an intense desire for the drug of choice and loss of control over use). [4] (The nomenclature was changed to mild-, moderate- or severe- SUD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), [5] with ‘‘substance abuse’’ roughly correlating to moderate SUD and ‘‘substance dependence’’ to severe SUD. [4] (The nomenclature was changed to mild-, moderate- or severe- SUD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), [5] with ‘‘substance abuse’’ roughly correlating to moderate SUD and ‘‘substance dependence’’ to severe SUD In this manuscript we will use the terms ‘‘abuse’’ and ‘‘dependence’’ because we are reporting on data from a standardized neuropsychiatric interview that was validated based on DSM-IV terms and definitions.) Research over the past decade has revealed that substance dependence (addiction, or severe SUD) is a neurologically-based disorder resulting from disruption of neurons in the reward center of the brain. Other factors, such as a biologically increased susceptibility to substance dependence (addiction), may play a role

Methods

Results

Discussion

Conclusion