In a study of 5,677 Swiss men, ADHD was associated with earlier initiation of alcohol, nicotine, and cannabis, riskier use patterns, and higher rates of substance use disorders, even after controlling for antisocial personality.
Young adults with ADHD, parents, and clinicians managing co-occurring ADHD and substance use.
ADHD independently predicted substance use risk even after controlling for antisocial personality
What the researchers found
Researchers examined the relationship between ADHD and substance use in 5,677 Swiss men (average age 20) from a representative cohort study.
Men with ADHD were more likely to have used nicotine, cannabis, and other illicit drugs (but not alcohol) at some point. ADHD was positively associated with earlier initiation of alcohol, nicotine, and cannabis, with riskier use patterns for these substances, and with alcohol use disorders and nicotine and cannabis dependence.
Importantly, antisocial personality disorder (ASPD) was also strongly associated with these patterns. After adjusting for ASPD, the ADHD associations were reduced but remained significant, suggesting that ADHD has an independent contribution to substance use risk beyond its overlap with antisocial behavior.
Why it matters
This large, representative study clarifies that ADHD independently contributes to substance use risk in young men, even after accounting for the substantial overlap with antisocial personality. This has implications for targeted prevention in ADHD populations.
The numbers in context
5,677 Swiss men (mean age 20). ADHD associated with lifetime nicotine, cannabis, and illicit drug use (but not alcohol). ADHD associated with earlier initiation of alcohol, nicotine, and cannabis. Associations reduced but remained significant after ASPD adjustment.
How the study worked
Cross-sectional analysis from the Cohort Study on Substance Use Risk Factors (C-SURF), a representative sample of 5,677 Swiss men (mean age 20). ADHD was assessed with the Adult ADHD Self-Report Screener. Substance use was assessed for alcohol, nicotine, cannabis, and other drugs, controlling for demographics, depression, and ASPD.
What this study cannot tell us
Only male participants were included. ADHD was assessed by self-report screener rather than clinical diagnosis. The cross-sectional design cannot determine whether ADHD causes earlier or riskier substance use. Swiss military recruitment-based sampling may not represent all young men.
How to read the evidence
This is a large representative cohort study with comprehensive adjustment for confounders, providing strong cross-sectional evidence on the ADHD-substance use relationship.
When this study was published
Published in 2016. The evidence on ADHD and substance use has continued to accumulate.
The bigger picture
The ADHD-substance use link is well-established, but this study advances the field by demonstrating that the association persists even after controlling for antisocial personality, which has been a major confound in prior research. Early intervention for ADHD could potentially reduce substance use vulnerability.
Questions still open
- Would ADHD treatment in adolescence reduce later substance use risk? Are the patterns similar in young women with ADHD?
Common questions
Does ADHD cause drug use?
Does treating ADHD reduce substance use risk?
Read the original research
Adult attention-deficit/hyperactivity disorder and its association with substance use and substance use disorders in young men.
Epidemiology and psychiatric sciences, 25(3), 255-66
Citation
Estévez, N; Dey, M; Eich-Höchli, D; Foster, S; Gmel, G; Mohler-Kuo, M. (2016). Adult attention-deficit/hyperactivity disorder and its association with substance use and substance use disorders in young men.. Epidemiology and psychiatric sciences, 25(3), 255-66. https://doi.org/10.1017/S2045796015000360
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