Attention deficit hyperactivity and oppositional defiant disorder symptoms in adolescence and risk of substance use disorders—A general population‐based birth cohort study

Abstract

BackgroundExternalizing symptoms are associated with risk of future substance use disorder (SUD). Few longitudinal studies exist using general population‐based samples which assess the spectrum of attention deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptoms.Aims/ObjectivesWe aimed to study the associations between adolescent ADHD symptoms and subsequent SUD and additionally examine whether the risk of SUD is influenced by comorbid oppositional defiant disorder (ODD) symptoms.MethodsThe Northern Finland Birth Cohort 1986 was linked to nationwide health care register data for incident SUD diagnoses until age 33 years (n = 6278, 49.5% male). ADHD/ODD‐case status at age 16 years was defined using parent‐rated ADHD indicated by Strengths and Weaknesses of ADHD symptoms and Normal Behaviors (SWAN) questionnaire with 95% percentile cut‐off. To assess the impact of ODD comorbidity on SUD risk, participants were categorized into four groups based on their ADHD/ODD case status. Cox‐regression analysis with hazard ratios (HRs) and 95% confidence intervals (CIs) were used to study associations between adolescent ADHD/ODD case statuses and subsequent SUD.ResultsIn all, 552 participants (8.8%) presented with ADHD case status at the age of 16 years, and 154/6278 (2.5%) were diagnosed with SUD during the follow‐up. ADHD case status was associated with SUD during the follow‐up (HR = 3.84, 95% CI 2.69–5.50). After adjustments for sex, family structure, and parental psychiatric disorder and early substance use the association with ADHD case status and SUD remained statistically significant (HR = 2.60, 95% CI 1.70–3.98). The risk of SUD remained elevated in individuals with ADHD case status irrespective of ODD symptoms.ConclusionsADHD in adolescence was associated with incident SUD in those with and without symptoms of ODD. The association of ADHD and SUD persisted even after adjustment for a wide range of potential confounds. This emphasizes the need to identify preventative strategies for adolescents with ADHD so as to improve health outcomes.

Associations of Symptoms of ADHD and Oppositional Defiant Disorder (ODD) in Adolescence With Occupational Outcomes and Incomes in Adulthood

“…No other previous studies have examined the relationship between symptoms of ODD and sick leave. Previous studies among the NFBC1986 have suggested that symptoms of ADHD and ODD are associated with substance use disorder, different types of injuries and an increased risk of undergoing psychiatric hospitalization during one’s lifetime ( Hurtig et al, 2016 ; Mustonen et al, 2023 ; Nordström et al, 2013 ), all of which are likely causes of increased sick leave from work.…”

A Multi-Level Analysis of Biological, Social, and Psychological Determinants of Substance Use Disorder and Co-Occurring Mental Health Outcomes

“…Attention-deficit hyperactivity disorder (ADHD) is found in around 25% of people with SUD [36]. ADHD is also considered an important risk factor for the development of SUD, as it promotes early use of illicit substance use, thus being an important predictor of the development of substance use disorder [38]. According to some data, the presence of an ADHD disorder would increase an individual's vulnerability to developing a psychoactive substance abuse disorder by a factor of two [33].…”