Cannabis use disorder in ADHD adolescents increased hospital costs, length of stay, and alcohol abuse risk while reducing treatment utilization
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.
Quick Facts
What This Study 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).
Key Numbers
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 They Did This
Retrospective analysis of Nationwide Inpatient Sample (NIS) 2010-2014. ADHD as primary diagnosis, CUD as secondary. Binomial logistic regression for adjusted odds ratios.
Why This Research 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 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.
What This Study Doesn't 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.
Questions This Raises
- ?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?
Trust & Context
- Key Stat:
- 17-fold higher alcohol abuse risk, yet 55% less psychiatric medication used
- Evidence Grade:
- Moderate. Large national database with adjusted analyses, but retrospective design and low CUD prevalence limit precision.
- Study Age:
- Published in 2018. Integrated treatment approaches for ADHD with substance use disorders continue to develop.
- Original Title:
- Is Cannabis Use Associated With the Worst Inpatient Outcomes in Attention Deficit Hyperactivity Disorder Adolescents?
- Published In:
- Cureus, 10(1), e2033 (2018)
- Authors:
- Patel, Rikinkumar S(7), Patel, Priya, Shah, Kaushal, Kaur, Mandeep, Mansuri, Zeeshan, Makani, Ramkrishna
- Database ID:
- RTHC-01787
Evidence Hierarchy
Looks back at existing records to find patterns.
What do these levels mean? →Frequently Asked 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 More on RethinkTHC
Cite This Study
https://rethinkthc.com/research/RTHC-01787APA
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
MLA
Patel, Rikinkumar S, et al. "Is Cannabis Use Associated With the Worst Inpatient Outcomes in Attention Deficit Hyperactivity Disorder Adolescents?." Cureus, 2018. https://doi.org/10.7759/cureus.2033
RethinkTHC
RethinkTHC Research Database. "Is Cannabis Use Associated With the Worst Inpatient Outcomes..." RTHC-01787. Retrieved from https://rethinkthc.com/research/patel-2018-is-cannabis-use-associated
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.