Cannabis use disorder in ADHD adolescents increased hospital costs, length of stay, and alcohol abuse risk while reducing treatment utilization | Research

The takeaway

An analysis of 11,232 ADHD adolescent hospitalizations found that comorbid cannabis use disorder nearly doubled hospitalization costs and length of stay, increased alcohol abuse risk 17-fold, and paradoxically reduced utilization of psychotropic medications and behavioral therapy.

Child and adolescent psychiatrists; ADHD treatment providers; hospital administrators addressing dual-diagnosis youth.

17-fold higher alcohol abuse risk, yet 55% less psychiatric medication used

What the researchers found

Researchers analyzed 11,232 ADHD adolescent hospital admissions from 2010-2014, of which 1.79% had comorbid cannabis use disorder.

CUD prevalence was highest in ages 15-18 (73%) and in white adolescents (71%).

ADHD adolescents with CUD had significantly worse hospitalization outcomes:

- 1.8 times higher odds of hospitalization costs exceeding the median ($12,247)

- 2.1 times higher odds of inpatient stays exceeding 5 days

- Higher rates of transfer to acute care hospitals and skilled nursing facilities

Paradoxically, CUD was associated with reduced utilization of treatments:

- Psychotropic medication use reduced by 55% (aOR = 0.448)

- Behavioral therapy use reduced by 59% (aOR = 0.412)

CUD dramatically increased alcohol abuse risk: 17-fold higher odds (aOR = 17.141).

Why it matters

The finding that ADHD adolescents with CUD receive less psychiatric treatment despite having worse outcomes is a critical clinical gap. Whether this reflects treatment resistance, clinical avoidance, or system failures, it points to a population being underserved at a critical developmental stage.

The numbers in context

11,232 ADHD hospitalizations, 1.79% with CUD. aOR for costs >$12,247: 1.835 (p=0.002). aOR for stay >5 days: 2.099 (p<0.001). aOR for alcohol abuse: 17.141 (p<0.001). Psychotropic med use reduced: aOR 0.448 (p=0.017). Behavioral therapy reduced: aOR 0.412 (p=0.048).

How the study worked

Retrospective analysis of Nationwide Inpatient Sample (NIS) 2010-2014. ADHD as primary diagnosis, CUD as secondary. Binomial logistic regression for adjusted odds ratios.

What this study cannot tell us

Retrospective database study with inherent coding limitations. Cannot determine why treatment utilization was lower. Small percentage with CUD (1.79%) may reflect under-detection. Cannot assess outpatient treatment or follow-up.

How to read the evidence

Moderate. Large national database with adjusted analyses, but retrospective design and low CUD prevalence limit precision.

When this study was published

Published in 2018. Integrated treatment approaches for ADHD with substance use disorders continue to develop.

The bigger picture

ADHD is one of the strongest risk factors for substance use in adolescence, and cannabis use disorder complicates ADHD management substantially. The treatment utilization gap suggests clinicians may not know how to effectively treat the dual diagnosis, or may be avoiding pharmacotherapy due to substance use concerns.

Questions still open

Why do ADHD adolescents with CUD receive less psychiatric treatment? Would integrated ADHD-CUD treatment programs improve outcomes? Does treating ADHD effectively reduce cannabis use disorder risk?

Common questions

Why do ADHD adolescents with cannabis problems get less treatment?

The study did not determine the reason, but possibilities include: clinicians may be reluctant to prescribe stimulant medications to adolescents with substance use disorders, behavioral therapy may be less engaged when substance use is active, or the complexity of dual diagnosis may overwhelm standard treatment protocols.

How strong is the ADHD-cannabis connection?

ADHD is a well-established risk factor for cannabis use, partly through impulsivity and partly through self-medication. This study shows that when both conditions co-occur, outcomes are significantly worse, reinforcing the importance of addressing both simultaneously.

Read the original research

Is Cannabis Use Associated With the Worst Inpatient Outcomes in Attention Deficit Hyperactivity Disorder Adolescents?

Cureus, 10(1), e2033

View on PubMed ↗Publisher’s paper ↗

Citation

Patel, Rikinkumar S; Patel, Priya; Shah, Kaushal; Kaur, Mandeep; Mansuri, Zeeshan; Makani, Ramkrishna. (2018). Is Cannabis Use Associated With the Worst Inpatient Outcomes in Attention Deficit Hyperactivity Disorder Adolescents?. Cureus, 10(1), e2033. https://doi.org/10.7759/cureus.2033