Psychostimulant Treatment and Risk for Substance Abuse Among Young Adults with a History of Attention-Deficit/Hyperactivity Disorder: APopulation-Based, Birth Cohort Study
ABSTRACT The aim of this study was to evaluate the association between stimulant treatment and the risk for substance abuse among young adults with a childhood diagnosis of attention- deficit/hyperactivity disorder (ADHD).
Subjects included 295 research-identified ADHD incidence cases treated with psychostimulant medication and 84 ADHD cases not treated with psychostimulants. These subjects are from a 1976-1982 population-based birth cohort, retrospectively, followed from birth until emigration, death, or last follow-up (mean = 17.2 years of follow-up). Medical and school records were reviewed for documented substance abuse and psychostimulant treatment. The association was evaluated using logistic regression models.
Socioeconomic characteristics at birth, and comorbidities, were similar between treated and untreated ADHD cases. Sixty (20.3%) of treated ADHD cases had documented substance abuse compared to 23 (27.4%) of cases not treated (OR = 0.7; 95% CI = 0.4-1.2). Among treated ADHD boys, 21.8% had substance abuse compared to 36.4% not-treated ADHD boys (OR = 0.5; 95% CI = 0.3-0.9). Among treated ADHD girls, 15.2% had substance abuse compared to 10.3% not-treated ADHD girls (OR = 1.5; 95% CI = 0.4-6.1).
While these results cannot demonstrate cause and effect, our findings indicate that psychostimulant treatment of childhood ADHD is associated with reduced risk for later substance abuse among boys with ADHD.
- SourceAvailable from: Claudio Toma
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- "Along this line, among the patients with ADHD that are more vulnerable to develop SUD later in life are those who have comorbid CD or ODD. Additionally, there is evidence that co-occurrence of ADHD and CD symptoms contributes in an epistatic manner to a more severe form of SUD as compared to ADHD or CD alone (Flory et al., 2003; Katusic et al., 2005; Klein et al., 2012; Kollins, 2008). More recently, there has been growing interest in studying the role of post-transcriptional regulatory elements in the susceptibility to different complex disorders. "
ABSTRACT: Attention deficit-hyperactivity disorder (ADHD) is a neuropsychiatric disorder characterized by inappropriate and impaired levels of hyperactivity, impulsivity and inattention. Around 75% of adults with ADHD show comorbidity with other psychiatric disorders such as disruptive behavior disorders or substance use disorders (SUDs). Recently, there has been growing interest in studying the role of microRNAs (miRNAs) in the susceptibility to complex disorders. Interestingly, converging evidence suggests that single nucleotide polymorphisms (SNPs) within miRNAs or miRNA target sites may modulate the miRNA-mediated regulation of gene expression through the alteration of the miRNA maturation, structure or expression pattern as well as the silencing mechanisms of target genes. Genetic studies and animal models support the involvement of the serotonin receptor (HTR1B) in ADHD. We evaluated the contribution of one SNP in the miR-96 target site at HTR1B and eight tagSNPs within the genomic region containing this miRNA in 695 adults with ADHD (266 and 396 subjects with and without comorbid SUD, respectively), 403 subjects with SUD without life-time diagnosis of ADHD and 485 sex-matched controls from Spain. Single and multiple marker analyses revealed association between two SNPs located at the 3' region of miR-96 (rs2402959 and rs6965643) and ADHD without SUD. Our results provide preliminary evidence for the contribution of two sequence variants at the miR-183-96-182 cluster to ADHD without comorbid SUD, and emphasize the need to take comorbidities into account in genetic studies to minimize the effect of heterogeneity and to clarify these complex phenotypes.European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 07/2013; 23(11). DOI:10.1016/j.euroneuro.2013.07.002 · 5.40 Impact Factor
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- "Rapidly accumulating research has shown that childhood symptoms of ADHD produce academic and social impairments not only in childhood, but also in adolescence (Barkley, 1998; Barkley, Murphy, & Fischer, 2008; Mannuzza & Klein, 1999). For example, children diagnosed with ADHD are at increased risk of engaging in delinquency and substance use as adolescents (Barkley, Fischer, Edelbrock, & Smallish, 1990; Biederman et al., 1996; Gittelman, Mannuzza, Shenker, & Bonagura, 1985; Katusic et al., 2005; Mannuzza et al., 1991; Molina et al., 2007; Molina & Pelham, 2003; Satterfield, Hoppe, & Schell, 1982; Sibley et al., in press). However, very little research has been conducted to understand the factors that might mitigate this ADHD-related risk. "
ABSTRACT: Several domains of parenting have been identified as important for adolescent well-being. Whether these same domains are equally beneficial for adolescents with ADHD histories remains an empirical and clinically important question. This study examined whether parental knowledge of their teen's activities and whereabouts, consistency, support, and parent-adolescent conflict are associated with substance use and delinquency similarly for adolescents with and without a diagnosis of ADHD in childhood. A sample of 242 adolescents, 142 diagnosed with ADHD in childhood and prospectively followed into adolescence, and 100 without ADHD in childhood, were the focus of study. The relations between adolescent-reported outcomes (i.e., substance use and delinquency) and parenting behaviors were tested using latent variable modeling to determine both the effects of general (common) and specific (unique) parenting behaviors for participants with and without a history of ADHD. Adolescents' report of parental knowledge was a significant correlate of delinquency and substance use above and beyond other parenting variables and the variance in common across the parenting variables. More knowledge was associated with less delinquency and substance use for all participants, but parental knowledge was more strongly associated with alcohol use for adolescents with versus without childhood ADHD. These correlational findings suggest that, despite the increased difficulty of parenting youths with ADHD histories, actions taken by parents and youth to increase parental awareness may provide some protection against behavioral transgressions known to be elevated in this population. (PsycINFO Database Record (c) 2012 APA, all rights reserved)Psychology of Addictive Behaviors 08/2012; 26(3):585-598. DOI:10.1037/a0026818 · 2.09 Impact Factor
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- "A ttention-deficit/hyperactivity disorder (ADHD), which has a prevalence rate of *8% in children (Faraone et al. 2003) and 4.4% in adults (Kessler et al. 2006), is characterized by symptoms of inattention, impulsivity, and hyperactivity and is associated with significant impairment in functioning, including poorer performance in educational and occupational settings and higher rates of other psychiatric disorders (Spencer et al. 2007). The prevalence of a substance use disorder (SUD) in individuals with ADHD is estimated to be *22% in adolescents (Katusic et al. 2005) and 15% in adults (Kessler et al. 2006). Psychostimulants are the mainstay pharmacologic treatment for ADHD. "
ABSTRACT: Psychostimulants are effective treatments for attention-deficit/hyperactivity disorder (ADHD) but may be associated with euphoric effects, misuse/diversion, and adverse effects. These risks are perceived by some clinicians to be greater in substance-abusing adolescents relative to non-substance-abusing adults. The present study evaluates the subjective effects, misuse/diversion, and adverse effects associated with the use of osmotic-release oral system methylphenidate (OROS-MPH), relative to placebo, for treating ADHD in adolescents with a substance use disorder (SUD) as a function of substance use severity and compared these risks with those associated with the treatment of ADHD in adults without a non-nicotine SUD. Datasets from two randomized placebo-controlled trials of OROS-MPH for treating ADHD, one conducted with 303 adolescents (13-18) with at least one non-nicotine SUD and one with 255 adult smokers (18-55), were analyzed. Outcome measures included the Massachusetts General Hospital Liking Scale, self-reported medication compliance, pill counts, and adverse events (AEs). Euphoric effects and misuse/diversion of OROS-MPH were not significantly affected by substance use severity. The euphoric effects of OROS-MPH did not significantly differ between the adolescent and adult samples. Adults rated OROS-MPH as more effective in treating ADHD, whereas adolescents reported feeling more depressed when taking OROS-MPH. The adolescents lost more pills relative to the adults regardless of treatment condition, which suggests the importance of careful medication monitoring. Higher baseline use of alcohol and cannabis was associated with an increased risk of experiencing a treatment-related AE in OROS-MPH, but baseline use did not increase the risk of serious AEs or of any particular category of AE and the adolescents did not experience more treatment-related AEs relative to the adults. With good monitoring, and in the context of substance abuse treatment, OROS-MPH can be safely used in adolescents with an SUD despite non-abstinence.Journal of child and adolescent psychopharmacology 10/2011; 21(5):455-63. DOI:10.1089/cap.2011.0014 · 3.07 Impact Factor