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.
Read this if you have ADHD and want to understand your risk for substance use, or if you work in addiction prevention.
ADHD increased odds of starting amphetamines 3.81x and ADHD medication misuse 4.45x, independent of conduct disorder.
What the researchers 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.
Why it 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 numbers in context
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 the study worked
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.
What this study cannot 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.
How to read the evidence
Strong evidence from a large, prospective longitudinal study with validated screening instruments and appropriate statistical controls.
When this study was published
Published in 2016. The ADHD-substance use relationship continues to be actively studied.
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.
Questions still open
- 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?
Common questions
Does ADHD lead to drug use?
Is it the ADHD itself or the behavior problems that come with it?
Read the original research
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
Citation
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
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