Stimulant treatment profiles predicting co-occurring substance use disorders in individuals with attention-deficit/hyperactivity disorder

Abstract

Adolescents with attention-deficit/hyperactivity disorder (ADHD) are at increased risk of developing substance use disorders (SUDs) and nicotine dependence (ND). It remains unclear whether and how stimulant treatment may affect this risk. We aimed to investigate how stimulant use profiles influence the risk of SUDs and ND, using a novel data-driven community detection analysis to construct different stimulant use profiles. Comprehensive lifetime stimulant prescription data and data on SUDs and ND were available for 303 subjects with ADHD and 219 controls, with a mean age 16.3 years. Community detection was used to define subgroups based on multiple indicators of treatment history, start age, treatment duration, total dose, maximum dose, variability, stop age. In stimulant-treated participants, three subgroups with distinct medication trajectories were distinguished (late-and-moderately dosed, n = 91; early-and-moderately dosed, n = 51; early-and-intensely dosed, n = 103). Compared to stimulant-naïve participants (n = 58), the early-and-intense treatment group had a significantly lower risk of SUDs and ND (HR = 0.28, and HR = 0.29, respectively), while the early-and-moderate group had a significantly lower risk of ND only (HR = 0.30). The late-and-moderate group was at a significantly higher risk of ND compared to the other two treatment groups (HR = 2.66 for early-and-moderate, HR = 2.78 for early-and-intense). Our findings show that in stimulant-treated adolescents with ADHD, long-term outcomes are associated with treatment characteristics, something that is often ignored when treated individuals are compared to untreated individuals.Electronic supplementary materialThe online version of this article (10.1007/s00787-019-01283-y) contains supplementary material, which is available to authorized users.

Attention Deficit Hyperactivity Disorder Increases Nicotine Addiction Severity in Adults Seeking Treatment for Substance Use Disorders: The Role of Personality Disorders

“…For instance, a study showed that early and consequent treatment with stimulants can decrease the risk for subsequent smoking, daily smoking, and AUD/SUD. Therefore, it can be hypothesized that undertreatment of ADHD may lead to more symptoms or increased rates of comorbidity, which in turn increases the risks for these 3 outcomes [52]. Similarly, comorbid ADHD complicates treatment of SUD [53].…”

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

“…Childhood ADHD is a prominent risk factor for substance misuse and the development of SUD in adolescence and early adulthood, even when the most common comorbidities during childhood – conduct disorder and oppositional defiant disorder – are accounted for (e.g., [3, 4]). Some studies suggest that stimulant treatment of children with ADHD has a protective effect on the development of SUD in adolescence and early adulthood (e.g., [5, 6]), but other studies did not find such a protective effect (e.g., [7, 8]).…”

Stop What You're Doing!—An fMRI Study on Comparisons of Neural Subprocesses of Response Inhibition in ADHD and Alcohol Use Disorder

“…ADHD medication could be examined also regarding its direct effect on response inhibition in general. Since individuals with AUD or ADHD show impaired response inhibition, and stimulant treatment of ADHD in children might help to prevent later SUDs ( 88 ), a stimulant medication could be beneficial for those individuals with AUD or ADHD to improve inhibitory control. Not only should a treatment of AUD or ADHD per se be considered, but also the inhibitory deficits through medication or behavioral training should be addressed specifically.…”