ADHD Symptoms Predict Cannabis and Alcohol Problems Differently in Men and Women
In a survey of 5,080 Canadian adults, hyperactive symptoms predicted problematic cannabis use in men while inattentive symptoms predicted it in women, suggesting sex-specific pathways from ADHD to substance misuse.
Quick Facts
What This Study Found
ADHD and substance misuse frequently co-occur, but this study asked whether specific ADHD symptom profiles (hyperactivity, inattention, impulsivity) predicted substance problems differently in men versus women.
After controlling for age, education, and other psychiatric symptoms, the patterns were strikingly sex-specific:
In men: hyperactive symptoms were linked to problematic alcohol use, and both hyperactive and impulsive symptoms were linked to problematic cannabis use.
In women: inattentive symptoms were the predictor for both problematic alcohol and cannabis use, while hyperactivity and impulsivity were not significant.
Across all models, externalizing behavior (conduct problems, antisocial behavior) was the strongest overall predictor, and younger age was consistently associated with higher risk.
Key Numbers
5,080 respondents. Hyperactivity predicted problematic alcohol use in both sexes and cannabis in men. Impulsivity predicted cannabis problems in men only. Inattention predicted both alcohol and cannabis problems in women only. Externalizing behavior was the strongest predictor across all models.
How They Did This
Cross-sectional telephone survey of 5,080 adults aged 18+ in Ontario, Canada, from 2011-2013. ADHD symptoms were measured using the Adult ADHD Self-Report Screener (ASRS-V1.1) plus additional items. Substance problems were assessed with AUDIT (alcohol) and ASSIST (cannabis). Logistic regression stratified by sex.
Why This Research Matters
These sex-specific patterns suggest that ADHD-related substance use risk operates through different mechanisms in men and women. This has implications for screening and prevention: inattentive women with ADHD may be at risk for substance problems that clinicians might miss if they focus only on the hyperactive/impulsive presentations more common in men.
The Bigger Picture
Women with ADHD are already underdiagnosed because they more often present with inattentive rather than hyperactive symptoms. This study adds another dimension: the inattentive symptoms that make ADHD harder to spot in women are also the ones that predict substance misuse risk. This creates a double disadvantage in detection and prevention.
What This Study Doesn't Tell Us
Cross-sectional design cannot determine temporal ordering. Self-reported ADHD symptoms rather than clinical diagnosis. Telephone survey may have response bias. Canadian-specific sample may not generalize globally.
Questions This Raises
- ?Why do inattentive symptoms predict substance problems in women but not men?
- ?Would treating inattentive ADHD in women reduce their substance misuse risk?
- ?Are these sex differences consistent across cultures?
Trust & Context
- Key Stat:
- Inattention predicted substance problems in women; hyperactivity/impulsivity in men
- Evidence Grade:
- Large population-representative sample with validated measures and sex-stratified analysis, but cross-sectional design limits causal inference.
- Study Age:
- Published in 2016 using 2011-2013 Canadian data. Understanding of sex differences in ADHD and substance use has continued to develop.
- Original Title:
- Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: sex differences in a representative, population survey.
- Published In:
- BMC psychiatry, 16, 50 (2016)
- Authors:
- Kolla, Nathan J(3), van der Maas, Mark(2), Toplak, Maggie E, Erickson, Patricia G, Mann, Robert E, Seeley, Jane, Vingilis, Evelyn
- Database ID:
- RTHC-01199
Evidence Hierarchy
A snapshot of a population at one point in time.
What do these levels mean? →Frequently Asked Questions
Does ADHD increase the risk of cannabis problems?
Yes, but in a sex-specific way. In men, hyperactive and impulsive symptoms predicted problematic cannabis use. In women, inattentive symptoms were the predictor.
Why do men and women differ in this relationship?
The different symptom pathways suggest ADHD contributes to substance risk through different mechanisms in each sex. Impulsive/hyperactive men may use cannabis for excitement-seeking, while inattentive women may use it for self-medication of different symptoms.
Read More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-01199APA
Kolla, Nathan J; van der Maas, Mark; Toplak, Maggie E; Erickson, Patricia G; Mann, Robert E; Seeley, Jane; Vingilis, Evelyn. (2016). Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: sex differences in a representative, population survey.. BMC psychiatry, 16, 50. https://doi.org/10.1186/s12888-016-0746-4
MLA
Kolla, Nathan J, et al. "Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: sex differences in a representative, population survey.." BMC psychiatry, 2016. https://doi.org/10.1186/s12888-016-0746-4
RethinkTHC
RethinkTHC Research Database. "Adult attention deficit hyperactivity disorder symptom profi..." RTHC-01199. Retrieved from https://rethinkthc.com/research/kolla-2016-adult-attention-deficit-hyperactivity
Access the Original Study
Study data sourced from PubMed, a service of the U.S. National Library of Medicine, National Institutes of Health.
This study breakdown was produced by the RethinkTHC research team. We analyze and report published research findings without making health recommendations. All interpretations are based solely on the published abstract and study data.