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Attention-deficit/hyperactivity disorder and risk for drug use disorder: a population-based follow-up and co-relative study

Published online by Cambridge University Press:  14 August 2014

J. Sundquist ,
H. Ohlsson ,
K. Sundquist  and
K. S. Kendler
J. Sundquist*
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
H. Ohlsson
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden
K. Sundquist
Affiliation:
Center for Primary Health Care Research, Lund University, Malmö, Sweden Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA, USA
K. S. Kendler
Affiliation:
Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA Department of Human and Molecular Genetics, Virginia Commonwealth University, Richmond, VA, USA
*
* Address for correspondence: J. Sundquist, M.D., Ph.D., Center for Primary Health Care Research, Lund University, Malmö, Sweden. (Email: jan.sundquist@med.lu.se)
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Abstract

Background.

Although the association between attention-deficit/hyperactivity disorder (ADHD) and drug use disorder (DUD) is well documented, it is unclear whether it is causal or results from familial confounding.

Method.

In this study we included all 551 164 individuals born in Sweden between 1991 and 1995 and used linked data from multiple nationwide registries to identify those with ADHD prior to age 15 years (1.71%). We used Cox proportional hazards models to investigate the future risk for DUD as a function of an ADHD registration and then compared the results from the entire population with the results from a co-relative design. Using the Swedish Multi-Generation Register, we identified all full-sibling, half-sibling and first-cousin pairs discordant for ADHD.

Results.

In the population sample, ADHD had a substantially increased risk for future DUD with a hazard ratio (HR) of 3.34 after accounting for gender and parental education. Examining discordant cousin pairs, discordant half-siblings and discordant siblings, those with ADHD had HRs for DUD of 3.09, 2.10 and 2.38 respectively. Controlling for the number of ADHD registrations, ADHD patients with and without stimulant treatment were similarly associated with later DUD risk.

Conclusions.

ADHD diagnosed before 15 years of age was strongly related to future risk for DUD. The magnitude of this association was modestly reduced in relative pairs discordant for ADHD, suggesting that the ADHD–DUD association is partly causal and partly a result of familial confounding. We found no evidence to suggest that this association resulted from stimulant treatment.

Keywords

ADHDCox regressiondrug use disordersSwedish national cohort

Information

Type
Original Articles
Information
Psychological Medicine , Volume 45 , Issue 5 , April 2015 , pp. 977 - 983
Copyright
Copyright © Cambridge University Press 2014 

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References

Angold, A, Erkanli, A, Egger, HL, Costello, EJ (2000). Stimulant treatment for children: a community perspective. Journal of the American Academy of Child and Adolescent Psychiatry 39, 975–984; discussion 984–994.CrossRefGoogle ScholarPubMed
APA (1987). Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised. American Psychiatric Association: Washington, DC.Google Scholar
Asherson, P, Gurling, H (2012). Quantitative and molecular genetics of ADHD. Current Topics in Behavioral Neurosciences 9, 239–272.Google Scholar
Biederman, J, Wilens, T, Mick, E, Faraone, SV, Weber, W, Curtis, S, Thornell, A, Pfister, K, Jetton, JG, Soriano, J (1997). Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry 36, 21–29.CrossRefGoogle ScholarPubMed
Boyle, MH, Offord, DR, Racine, YA, Szatmari, P, Fleming, JE, Links, PS (1992). Predicting substance use in late adolescence: results from the Ontario Child Health Study follow-up. American Journal of Psychiatry 149, 761–767.Google ScholarPubMed
Chang, Z, Lichtenstein, P, Larsson, H (2012). The effects of childhood ADHD symptoms on early-onset substance use: a Swedish twin study. Journal of Abnormal Child Psychology 40, 425–435.CrossRefGoogle ScholarPubMed
Edwards, AC, Kendler, KS (2012). Twin study of the relationship between adolescent attention-deficit/hyperactivity disorder and adult alcohol dependence. Journal of Studies on Alcohol and Drugs 73, 185–194.Google Scholar
Elkins, IJ, McGue, M, Iacono, WG (2007). Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Archives of General Psychiatry 64, 1145–1152.Google Scholar
Faraone, SV, Wilens, TE (2007). Effect of stimulant medications for attention-deficit/hyperactivity disorder on later substance use and the potential for stimulant misuse, abuse, and diversion. Journal of Clinical Psychiatry 68 (Suppl. 11), 15–22.Google Scholar
Hibell, B, Guttormsson, U, Ahlström, S, Balakireva, O, Bjarnason, T, Kokkevi, A (2007). The 2007 ESPAD Report: Substance Use Among Students in 35 European Countries. The Swedish Council for Information on Alcohol and Other Drugs (CAN): Sweden.Google Scholar
Hicks, BM, Iacono, WG, McGue, M (2012). Index of the transmissible common liability to addiction: heritability and prospective associations with substance abuse and related outcomes. Drug and Alcohol Dependence 123 (Suppl. 1), S18–S23.Google Scholar
Hicks, BM, Krueger, RF, Iacono, WG, McGue, M, Patrick, CJ (2004). Family transmission and heritability of externalizing disorders: a twin-family study. Archives of General Psychiatry 61, 922–928.Google Scholar
Iacono, WG, Carlson, SR, Taylor, J, Elkins, IJ, McGue, M (1999). Behavioral disinhibition and the development of substance-use disorders: findings from the Minnesota Twin Family Study. Development and Psychopathology 11, 869–900.CrossRefGoogle ScholarPubMed
Kellam, SG, Ensminger, ME, Simon, MB (1980). Mental health in first grade and teenage drug, alcohol, and cigarette use. Drug and Alcohol Dependence 5, 273–304.Google Scholar
Kendler, KS, Karkowski, LM, Neale, MC, Prescott, CA (2000). Illicit psychoactive substance use, heavy use, abuse, and dependence in a US population-based sample of male twins. Archives of General Psychiatry 57, 261–269.Google Scholar
Kendler, KS, Myers, J (2014). The boundaries of the internalizing and externalizing genetic spectra in men and women. Psychological Medicine 44, 647–655.Google Scholar
Kessler, RC, Adler, L, Barkley, R, Biederman, J, Conners, CK, Demler, O, Faraone, SV, Greenhill, LL, Howes, MJ, Secnik, K, Spencer, T, Ustun, TB, Walters, EE, Zaslavsky, AM (2006). The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. American Journal of Psychiatry 163, 716–723.CrossRefGoogle ScholarPubMed
Knopik, VS, Heath, AC, Jacob, T, Slutske, WS, Bucholz, KK, Madden, PA, Waldron, M, Martin, NG (2006). Maternal alcohol use disorder and offspring ADHD: disentangling genetic and environmental effects using a children-of-twins design. Psychological Medicine 36, 1461–1471.CrossRefGoogle ScholarPubMed
Kollins, SH, McClernon, FJ, Fuemmeler, BF (2005). Association between smoking and attention-deficit/hyperactivity disorder symptoms in a population-based sample of young adults. Archives of General Psychiatry 62, 1142–1147.CrossRefGoogle Scholar
Kraus, L, Augustin, R, Frischer, M, Kummler, P, Uhl, A, Wiessing, L (2003). Estimating prevalence of problem drug use at national level in countries of the European Union and Norway. Addiction 98, 471–485.CrossRefGoogle ScholarPubMed
Kringlen, E, Torgersen, S, Cramer, V (2001). A Norwegian psychiatric epidemiological study. American Journal of Psychiatry 158, 1091–1098.Google Scholar
Krueger, RF (1999). The structure of common mental disorders. Archives of General Psychiatry 56, 921–926.Google Scholar
Krueger, RF, Markon, KE, Patrick, CJ, Iacono, WG (2005). Externalizing psychopathology in adulthood: a dimensional-spectrum conceptualization and its implications for DSM-V. Journal of Abnormal Psychology 114, 537–550.Google Scholar
Larsson, H, Chang, Z, D'Onofrio, BM, Lichtenstein, P (2013). The heritability of clinically diagnosed attention deficit hyperactivity disorder across the lifespan. Psychological Medicine. Published online: 10 October 2013 . doi:10.1017/S0033291713002493.Google Scholar
Lawlor, DA, Mishra, GD (2009). Family Matters: Designing, Analysing and Understanding Family-based Studies in Life Course Epidemiology. Oxford University Press: Oxford.Google Scholar
Looby, A (2008). Childhood attention deficit hyperactivity disorder and the development of substance use disorders: valid concern or exaggeration? Addictive Behaviors 33, 451–463.Google Scholar
Mannuzza, S, Klein, RG, Bessler, A, Malloy, P, LaPadula, M (1993). Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry 50, 565–576.CrossRefGoogle ScholarPubMed
Markon, KE, Krueger, RF (2005). Categorical and continuous models of liability to externalizing disorders: a direct comparison in NESARC. Archives of General Psychiatry 62, 1352–1359.Google Scholar
Marshal, MP, Molina, BS, Pelham, WE Jr. (2003). Childhood ADHD and adolescent substance use: an examination of deviant peer group affiliation as a risk factor. Psychology of Addictive Behaviors 17, 293–302.Google Scholar
Merikangas, KR, Stolar, M, Stevens, DE, Goulet, J, Preisig, MA, Fenton, B, Zhang, H, O'Malley, SS, Rounsaville, BJ (1998). Familial transmission of substance use disorders. Archives of General Psychiatry 55, 973–979.CrossRefGoogle ScholarPubMed
Milberger, S, Biederman, J, Faraone, SV, Wilens, T, Chu, MP (1997). Associations between ADHD and psychoactive substance use disorders. Findings from a longitudinal study of high-risk siblings of ADHD children. American Journal on Addictions 6, 318–329.Google ScholarPubMed
Molina, BS, Pelham, WE Jr. (2003). Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. Journal of Abnormal Psychology 112, 497–507.Google Scholar
Polanczyk, G, de Lima, MS, Horta, BL, Biederman, J, Rohde, LA (2007). The worldwide prevalence of ADHD: a systematic review and metaregression analysis. American Journal of Psychiatry 164, 942–948.CrossRefGoogle ScholarPubMed
Szobot, CM, Bukstein, O (2008). Attention deficit hyperactivity disorder and substance use disorders. Child and Adolescent Psychiatric Clinics of North America 17, 309–323, viii.Google Scholar
Tsuang, MT, Lyons, MJ, Eisen, SA, Goldberg, J, True, W, Lin, N, Meyer, JM, Toomey, R, Faraone, SV, Eaves, L (1996). Genetic influences on DSM-III-R drug abuse and dependence: a study of 3,372 twin pairs. American Journal of Medical Genetics 67, 473–477.Google Scholar
Urcelay, GP, Dalley, JW (2012). Linking ADHD, impulsivity, and drug abuse: a neuropsychological perspective. Current Topics in Behavioral Neurosciences 9, 173–197.Google Scholar
Wilens, TE, Adamson, J, Sgambati, S, Whitley, J, Santry, A, Monuteaux, MC, Biederman, J (2007). Do individuals with ADHD self-medicate with cigarettes and substances of abuse? Results from a controlled family study of ADHD. American Journal on Addictions 16 (Suppl. 1), 14–21; quiz 22–23.Google Scholar
Wolke, D, Waylen, A, Samara, M, Steer, C, Goodman, R, Ford, T, Lamberts, K (2009). Selective drop-out in longitudinal studies and non-biased prediction of behaviour disorders. British Journal of Psychiatry 195, 249–256.Google Scholar
Young, SE, Stallings, MC, Corley, RP, Krauter, KS, Hewitt, JK (2000). Genetic and environmental influences on behavioral disinhibition. American Journal of Medical Genetics 96, 684–695.Google Scholar