ADHD News & Research

Substance Abuse Linked to Adolescent ADHD with Comorbid Conduct Disorders

Substance-related problems, including alcohol and illicit drug abuse, are more common among teens with ADHD and comorbid conduct disorders, according to self-reported surveys and registry data from a Norwegian study that suggests ADHD alone does not increase substance abuse risks.

July 12, 2022

Adolescents with ADHD and high conduct problems are more likely to develop substance-related problems (SRPs) — including “seven-fold increased odds for illicit drug use” and increased odds for frequent alcohol intoxication, says a new report. Teens with ADHD and high conduct problems who also experienced negative life events such as the death of a loved one or trauma from violence face the highest risk for SRPs, according to a study published recently in the Journal of Attention Disorders. 1

The study assessed the severity of self-reported conduct problems and its association with SRPs in 9,411 Norwegian adolescents aged 16 to 19. Researchers linked data from a large population-based study conducted in 2012 with registry-based data gathered between 2008 and 2018.

Adolescents with ADHD were grouped into three categories: ADHD only, ADHD plus low conduct problems, and ADHD plus high conduct problems. SRPs were measured on five variables: illicit drug use, high-level alcohol consumption, frequent alcohol intoxication, a positive CRAFFT score (potential drug or alcohol related problems), and level of total symptoms as measured by the first four variables.

Of the 170 adolescents with ADHD, 29% screened positive for conduct disorder compared to 10% of the full survey sample. Adolescents with ADHD plus high conduct problems were more often boys (65.3%) and they experienced higher rates of SRPs. Nearly 29% of adolescents had three or more indicators of SRPs compared to the survey sample (4.7%) and ADHD only subgroup (3.9%).

Previous research suggests that children with ADHD face an increased risk for comorbid disorders, including disruptive behavior diagnoses like conduct disorders and oppositional-defiant disorders.2, 3 An estimated 44% to 90% of children and adolescents with ADHD have at least one comorbid disorder.48

“Our findings thus lend support to the notion that the risk of SRPs among ADHD-diagnosed adolescents can largely be attributed to co-existing conduct problems and that ADHD in itself does not increase the risk of adolescent illicit drug use beyond the effect of conduct-related disorders,” the researchers wrote.1

Of the adolescents that indicated conduct disorders in the ADHD plus high conduct problems subgroup, only about 10% had received a formal diagnosis.

“The results underline the need for CAMHS and other relevant health services to enhance identification of adolescents with ADHD and severe conduct problems, and by this ensure access to interventions that may contribute to break negative cycles related to substance abuse,” the researchers wrote.

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1Heradstveit, O., Askeland, K. G., Bøe, T., Lundervold, A. J., Elgen, I. B., Skogen, J. C., Pedersen, M. U., & Hysing, M. (2022). Substance-Related Problems in Adolescents with ADHD-Diagnoses: The Importance of Self-Reported Conduct Problems. Journal of Attention Disorders.

2Elia, J., Ambrosini, P., Berrettini, W. (2008). ADHD characteristics: I. Concurrent co-morbidity patterns in children & adolescents. Child and Adolescent Psychiatry and Mental Health, 2(1), 15–19.

3Pfiffner, L. J., McBurnett, K., Rathouz, P. J., Judice, S. (2005). Family correlates of oppositional and conduct disorders in children with attention deficit/hyperactivity disorder. Journal of Abnormal Child Psychology, 33(5), 551–563.

4Barkley, R. A. (1998). Attention-deficit hyperactivity disorder. Scientific American, 279(3), 66–71.

5Biederman, J., Newcorn, J., Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry, 148(5), 564–577.

6Mitchison, G. M., Njardvik, U. (2019). Prevalence and gender differences of ODD, anxiety, and depression in a sample of children with ADHD. Journal of Attention Disorders, 23(11), 1339–1345.

7Szatmari, P., Offord, D. R., Boyle, M. H. (1989). Ontario Child Health Study: Prevalence of attention deficit disorder with hyperactivity. Journal of child psychology and psychiatry, 30(2), 219–230.

8Willcutt, E. G., Pennington, B. F., Chhabildas, N. A., Friedman, M. C., Alexander, J. (1999). Psychiatric comorbidity associated with DSM-IV ADHD in a nonreferred sample of twins. Journal of the American Academy of Child and Adolescent Psychiatry, 38(11), 1355–1362.