Adolescent ADHD, stimulant medication and adult substance abuse

Abstract

The purpose of this research was to identify risk factors for future substance abuse (SA) and/or substance dependence (SD) among young boys with attention deficit/hyperactivity disorder (ADHD). The prevalence of childhood ADHD among adult substance abusers has been well documented and stimulant medication therapy is considered to be a protective factor. However, this population remains at high risk for developing SA disorder in adulthood. Thus, since stimulant therapy alone does not eliminate the risk of future SA, it is important to determine other factors that contribute to this problem in this population. The specific questions addressed in this research were 1) What risk factors predict SA problems in later life for adolescent boys who were diagnosed with ADHD? ; 2) Do boys diagnosed with ADHD and receiving stimulant medication have the same risk factors for SA as undiagnosed/unmedicated (normal) boys? and 3) Is the medication effect at reducing SA in later years dependent or independent of the response to the pharmacological treatment for behavioral symptoms of ADHD? This study evaluated data collected in a longitudinal study (1968 to present) of boys diagnosed with ADHD at the University of Iowa Hospital outpatient psychiatric clinic. Longitudinal regression and odds-ratios were used to measure the strength of correlation of risk factors to adult SD outcomes in three groups: diagnosed medicated boys, diagnosed unmedicated boys and a comparison group of undiagnosed, unmedicated (normal) boys. It was hypothesized that specific risk factors could be identified in the two groups of diagnosed boys (medicated and unmedicated). It was further hypothesized that poor response to medication would predict higher rates of adult substance abuse. and thus be an indicator for early prevention/intervention need for the poor responders. Results indicated that few of the evidence-based risk factors identified for the general adolescent population were significant predictors of adult SD for these adolescents diagnosed with ADHD. Other identified risk factors did not appear to be influenced by the effects of the medication. Response to stimulant medication was not related to the outcome of adult substance dependence, indicating that the protective factor exists regardless of medication response.