ADHD Was a Risk Factor for Starting New Substances, Independent of Conduct Problems
Among 5,103 young Swiss men, those with ADHD were more likely to initiate new substance use over 15 months, particularly amphetamines, but their existing alcohol, tobacco, and cannabis use did not escalate.
Quick Facts
What This Study Found
In a large cohort of 5,103 Swiss Army conscripts followed over 15 months, men screening positive for ADHD (4.2%) showed heavier baseline substance use and significantly higher rates of alcohol, tobacco, and cannabis use disorders compared to men without ADHD.
However, the pattern over time was nuanced. While ADHD men used more of these substances, their use did not escalate over the follow-up period. The rates remained stable rather than increasing.
Where ADHD made the biggest difference was in initiating new substances. Men with ADHD were significantly more likely to start using amphetamines (OR = 3.81) and to begin non-medical use of ADHD medication (OR = 4.45). These associations were independent of conduct disorder in early adolescence, meaning ADHD itself, not just the behavioral problems that sometimes accompany it, was the risk factor.
Key Numbers
5,103 participants. ADHD prevalence: 4.2% (n=215). ADHD associated with cannabis use disorder (chi-squared = 48.43, p < 0.001). Amphetamine initiation OR = 3.81 (2.20-6.60). ADHD medication misuse initiation OR = 4.45 (2.06-9.60). All associations independent of conduct disorder.
How They Did This
Two-wave longitudinal cohort study of 5,103 male Swiss Army conscripts (mean age 20.0) from 21 cantons. ADHD was assessed using the Adult ADHD Self-Report Scale and conduct disorder using the MINI International Neuropsychiatric Interview Plus at baseline. Substance use was measured by questionnaire at baseline and 15-month follow-up.
Why This Research Matters
This study disentangles ADHD from conduct disorder in predicting substance use trajectories. The finding that ADHD independently predicts initiation of new substances (not just continued use of existing ones) suggests that the novelty-seeking and impulsivity associated with ADHD drive the exploration of new drugs, which has important prevention implications.
The Bigger Picture
ADHD and substance use have long been linked, but the assumption that conduct disorder (behavioral problems, rule-breaking) drives the substance use pathway has persisted. This study demonstrates that ADHD itself is the risk factor, independent of conduct problems, suggesting that treating ADHD symptoms directly may be a more effective prevention strategy than targeting behavior alone.
What This Study Doesn't Tell Us
All-male military conscript sample limits generalizability to women and non-military populations. ADHD was assessed by self-report screening, not clinical diagnosis. The 15-month follow-up is relatively short. Swiss substance use patterns and drug availability may differ from other countries.
Questions This Raises
- ?Would effective ADHD treatment reduce the risk of initiating new substances?
- ?Does the ADHD-substance initiation link extend to women?
- ?Is the higher rate of ADHD medication misuse among ADHD men indicative of self-medication or diversion?
Trust & Context
- Key Stat:
- ADHD increased odds of starting amphetamines 3.81x and ADHD medication misuse 4.45x, independent of conduct disorder.
- Evidence Grade:
- Strong evidence from a large, prospective longitudinal study with validated screening instruments and appropriate statistical controls.
- Study Age:
- Published in 2016. The ADHD-substance use relationship continues to be actively studied.
- Original Title:
- Is attention deficit/hyperactivity disorder among men associated with initiation or escalation of substance use at 15-month follow-up? A longitudinal study involving young Swiss men.
- Published In:
- Addiction (Abingdon, England), 111(10), 1867-78 (2016)
- Authors:
- Vogel, Tanja, Dom, Geert(2), van de Glind, Geurt, Studer, Joseph, Gmel, Gerhard, Strik, Werner, Moggi, Franz
- Database ID:
- RTHC-01291
Evidence Hierarchy
Follows a group of people over time to track how outcomes develop.
What do these levels mean? →Frequently Asked Questions
Does ADHD lead to drug use?
This study found ADHD was associated with higher existing substance use and greater likelihood of starting new substances, particularly stimulants. However, substance use in ADHD men did not escalate over 15 months, suggesting ADHD increases the breadth but not necessarily the depth of substance use.
Is it the ADHD itself or the behavior problems that come with it?
Both contribute, but this study showed ADHD independently predicted substance initiation even after controlling for conduct disorder. This means the attention, impulsivity, and novelty-seeking features of ADHD themselves, not just associated behavioral problems, drive the substance use risk.
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Cite This Study
https://rethinkthc.com/research/RTHC-01291APA
Vogel, Tanja; Dom, Geert; van de Glind, Geurt; Studer, Joseph; Gmel, Gerhard; Strik, Werner; Moggi, Franz. (2016). Is attention deficit/hyperactivity disorder among men associated with initiation or escalation of substance use at 15-month follow-up? A longitudinal study involving young Swiss men.. Addiction (Abingdon, England), 111(10), 1867-78. https://doi.org/10.1111/add.13422
MLA
Vogel, Tanja, et al. "Is attention deficit/hyperactivity disorder among men associated with initiation or escalation of substance use at 15-month follow-up? A longitudinal study involving young Swiss men.." Addiction (Abingdon, 2016. https://doi.org/10.1111/add.13422
RethinkTHC
RethinkTHC Research Database. "Is attention deficit/hyperactivity disorder among men associ..." RTHC-01291. Retrieved from https://rethinkthc.com/research/vogel-2016-is-attention-deficithyperactivity-disorder
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.