Adult attention-deficit/hyperactivity disorder, risky substance use and substance use disorders: a follow-up study among young men

  • Natalia Estévez-LamorteEmail author
  • Simon Foster
  • Dominique Eich-Höchli
  • Franz Moggi
  • Gerhard Gmel
  • Meichun Mohler-Kuo
Original Paper


We investigated whether adult attention-deficit/hyperactivity disorder (ADHD) predicts risky substance use and substance use disorders (SUDs), and its impact on the course of these problematic substance use patterns. Our sample included 4975 Swiss men (mean age 20 ± 1.2 years) who participated in the baseline and 15-month follow-up assessments of the Cohort Study on Substance Use Risk Factors. We examined: (1) the contribution of ADHD, as assessed at baseline, on the risky use of alcohol, nicotine and cannabis, and their corresponding use disorders (AUD, NUD, CUD) at follow-up; and (2) the association between ADHD and the course of outcomes (i.e., absence, initiation, maturing out, persistence) over 15 months. All analyses were adjusted for socio-demographics and co-morbidity. Men with ADHD were more likely to exhibit persistent risky alcohol and nicotine use, and to mature out of risky cannabis use. ADHD at baseline was positively linked to AUD and negatively to CUD at follow-up, but not to NUD. For all SUDs, ADHD had a positive association with use persistence and maturing out. Comparing these two trajectories revealed that early age of alcohol use initiation distinguished between persistence and maturing out of AUD, while the course of NUD and CUD was related to ADHD symptoms and SUD severity at baseline. Already in their early twenties, men with ADHD are especially likely to exhibit persistent problematic substance use patterns. Substance-specific prevention strategies, particularly implemented before early adulthood, may be crucial to reducing the development and persistence of pathological patterns in such individuals.


Adult attention-deficit/hyperactivity disorder Risky substance use Substance use disorder Alcohol Nicotine Cannabis 



We thank Joseph Studer, Charlotte Eidenbenz and Laura Werlen for their valuable input. This study has been supported by the Swiss National Science Foundation (grant number: 33CS30_139467) and by the Hartmann Müller-Foundation (grant number: 1708).

Compliance with ethical standards

Ethical standards

The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and have, therefore, been performed in accordance with the Declaration of Helsinki 1964 and its later amendments. All participants gave their informed consent prior to their inclusion in the study.

Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.


  1. 1.
    Faraone SV, Biederman J, Spencer T et al (2000) Attention-deficit/hyperactivity disorder in adults: an overview. Biol Psychiatry 48:9–20. CrossRefPubMedGoogle Scholar
  2. 2.
    Ebejer JL, Medland SE, van der Werf J et al (2012) Attention deficit hyperactivity disorder in Australian adults: prevalence, persistence, conduct problems and disadvantage. PLoS One. CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Brod M, Schmitt E, Goodwin M et al (2012) ADHD burden of illness in older adults: a life course perspective. Qual Life Res 21:795–799. CrossRefPubMedGoogle Scholar
  4. 4.
    Das D, Cherbuin N, Butterworth P et al (2012) A population-based study of attention deficit/hyperactivity disorder symptoms and associated impairment in middle-aged adults. PLoS One 7:1–9. CrossRefGoogle Scholar
  5. 5.
    De Zwaan M, Gruß B, Müller A et al (2012) The estimated prevalence and correlates of adult ADHD in a German community sample. Eur Arch Psychiatry Clin Neurosci 262:79–86. CrossRefPubMedGoogle Scholar
  6. 6.
    Baker L, Prevatt F, Proctor B (2012) Drug and alcohol use in college students with and without ADHD. J Atten Disord 16:255–263. CrossRefPubMedGoogle Scholar
  7. 7.
    Klein RG (2012) Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Arch Gen Psychiatry 69:1. CrossRefGoogle Scholar
  8. 8.
    Sibley MH, Pelham WE, Molina BSG et al (2012) When diagnosing ADHD in young adults emphasize informant reports, DSM Items, and impairment. J Consult Clin Psychol 80:1052–1061. CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Sibley MH, Pelham WE, Molina BSG et al (2012) Diagnosing ADHD in adolescence. J Consult Clin Psychol 80:139–150. CrossRefPubMedGoogle Scholar
  10. 10.
    Charach A, Yeung E, Climans T, Lillie E (2011) Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. J Am Acad Child Adolesc Psychiatry 50:9–21. CrossRefPubMedGoogle Scholar
  11. 11.
    Lee SS, Humphreys KL, Flory K et al (2011) Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clin Psychol Rev 31:328–341. CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Estévez N, Dey M, Eich-Höchli D et al (2015) Adult attention-deficit/hyperactivity disorder and its association with substance use and substance use disorders in young men. Epidemiol Psychiatr Sci. CrossRefPubMedGoogle Scholar
  13. 13.
    Wilens TE, Upadhyaya HP (2007) Impact of substance use disorder on ADHD and its treatment. J Clin Psychiatry 68:e20CrossRefGoogle Scholar
  14. 14.
    Humfleet GL, Prochaska JJ, Mengis M et al (2005) Preliminary evidence of the association between the history of childhood attention-deficit/hyperactivity disorder and smoking treatment failure. Nicotine Tob Res 7:453–460. CrossRefPubMedGoogle Scholar
  15. 15.
    Galéra C, Pingault J-B, Fombonne E et al (2013) Attention problems in childhood and adult substance use. J Pediatr 163:1677–1683.e1. CrossRefPubMedGoogle Scholar
  16. 16.
    Serra-Pinheiro M, Coutinho ESF, Souza IS et al (2012) Is ADHD a risk factor independent of conduct disorder for illicit substance use? A meta-analysis and metaregression investigation. J Atten Disord. CrossRefPubMedGoogle Scholar
  17. 17.
    Kessler RC, Berglund P, Demler O et al (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62:593–602. CrossRefPubMedGoogle Scholar
  18. 18.
    Gotham HJ, Sher KJ, Wood PK (2003) Alcohol involvement and developmental task completion during young adulthood. J Stud Alcohol 64:32–42CrossRefGoogle Scholar
  19. 19.
    Rehm J, Taylor B, Room R (2006) Global burden of disease from alcohol, illicit drugs and tobacco. Drug Alcohol Rev 25:503–513. CrossRefPubMedGoogle Scholar
  20. 20.
    Toumbourou J, Stockwell T, Neighbors C et al (2007) Interventions to reduce harm associated with adolescent substance use. Lancet 369:1391–1401. CrossRefPubMedGoogle Scholar
  21. 21.
    De Alwis D, Lynskey MT, Reiersen AM, Agrawal A (2014) Attention-deficit/hyperactivity disorder subtypes and substance use and use disorders in NESARC. Addict Behav 39:1278–1285. CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Vogel T, Dom G, van de Glind G et al (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 111:1867–1878. CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Studer J, Baggio S, Mohler-Kuo M et al (2013) Examining non-response bias in substance use research—are late respondents proxies for non-respondents? Drug Alcohol Depend 132:316–323. CrossRefPubMedGoogle Scholar
  24. 24.
    Kessler RC, Adler L, Ames M et al (2005) The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med 35:245–256. CrossRefPubMedGoogle Scholar
  25. 25.
    Kessler RC, Adler L, Gruber MJ et al (2007) Validity of the World Health Organization Adult ADHD Self-Report Scale (ASRS) screener in a representative sample og health plan members. Int J Methods Psychiatr Res 16:52–65. CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Iacus SM, Porro G (2007) Missing data imputation, matching and other applications of random recursive partitioning. Comput Stat Data Anal 52:773–789. CrossRefGoogle Scholar
  27. 27.
    Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dunbar GC (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 20):22–33 (quiz 34–57) PubMedGoogle Scholar
  28. 28.
    Bech P, Rasmussen N, Olsen LR et al (2001) The sensitivity and specificity of the major depression inventory, using the present state examination as the index of diagnostic validity. J Affect Disord 66:159–164. CrossRefPubMedGoogle Scholar
  29. 29.
    Olsen LR, Jensen DV, Noerholm V et al (2003) The internal and external validity of the major depression inventory in measuring severity of depressive states. Psychol Med 33:351–356CrossRefGoogle Scholar
  30. 30.
    Gmel G, Gaume J, Willi C et al (2010) Challenging the “inoffensiveness” of regular cannabis use by its associations with other current risky substance use—a census of 20-year-old Swiss men. Int J Environ Res Public Health 7:46–59. CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Knight JR, Wechsler H, Kuo M et al (2002) Alcohol abuse and dependence among U.S. college students. J Stud Alcohol 63:263–270CrossRefGoogle Scholar
  32. 32.
    Bucholz KK, Cadoret R, Cloninger CR et al (1994) A new, semi-structured psychiatric interview for use in genetic linkage studies: a report on the reliability of the SSAGA. J Stud Alcohol 55:149–158CrossRefGoogle Scholar
  33. 33.
    Hesselbrock M, Easton C, Bucholz KK et al (1999) A validity study of the SSAGA–a comparison with the SCAN. Addiction 94:1361–1370CrossRefGoogle Scholar
  34. 34.
    Hasin DS, O’Brien CP, Auriacombe M et al (2013) DSM-5 criteria for substance use disorders: recommendations and rationale. Am J Psychiatry 170:834–851. CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Heatherton TF, Kozlowski LT, Frecker RC, Fagerström KO (1991) The Fagerström Test for Nicotine Dependence: a revision of the Fagerström Tolerance Questionnaire. Br J Addict 86:1119–1127CrossRefGoogle Scholar
  36. 36.
    Bleich S, Havemann-Reinecke U, Kornhuber J (2002) Fagerström-test für nikotinabhängigkeit (ftna). Beltz test, GöttingenGoogle Scholar
  37. 37.
    Huang CL, Lin HH, Wang HH (2008) Evaluating screening performances of the Fagerstrom tolerance questionnaire, the Fagerstrom test for nicotine dependence and the heavy smoking index among Taiwanese male smokers. J Clin Nurs 17:884–890. CrossRefPubMedGoogle Scholar
  38. 38.
    Adamson SJ, Sellman JD (2003) A prototype screening instrument for cannabis use disorder: the Cannabis Use Disorders Identification Test (CUDIT) in an alcohol-dependent clinical sample. Drug Alcohol Rev 22:309–315. CrossRefPubMedGoogle Scholar
  39. 39.
    Annaheim B, Scotto TJ, Gmel G (2010) Revising the Cannabis Use Disorders Identification Test (CUDIT) by means of Item Response Theory. Int J Methods Psychiatr Res 19:142–155. CrossRefPubMedGoogle Scholar
  40. 40.
    Galéra C, Bouvard MP, Melchior M et al (2010) Disruptive symptoms in childhood and adolescence and early initiation of tobacco and cannabis use: the Gazel Youth study. Eur Psychiatry 25:402–408. CrossRefPubMedGoogle Scholar
  41. 41.
    Estévez N, Eich-Höchli D, Dey M et al (2014) Prevalence of and associated factors for adult attention deficit hyperactivity disorder in young Swiss men. PLoS One. CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Molina BSG, Pelham WE (2003) Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. J Abnorm Psychol 112:497–507CrossRefGoogle Scholar
  43. 43.
    Pingault J-B, Côté SM, Galéra C et al (2012) Childhood trajectories of inattention, hyperactivity and oppositional behaviors and prediction of substance abuse/dependence: a 15-year longitudinal population-based study. Mol Psychiatry 806–812. CrossRefGoogle Scholar
  44. 44.
    Hu M-C, Davies M, Kandel DB (2006) Epidemiology and correlates of daily smoking and nicotine dependence among young adults in the United States. Am J Public Health 96:299–308. CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Dey M, Gmel G, Studer J, Mohler-Kuo M (2014) Health-risk behaviors and quality of life among young men. Qual Life Res 23:1009–1017. CrossRefPubMedGoogle Scholar
  46. 46.
    Moura HF, Faller S, Benzano D et al (2013) The effects of ADHD in adult substance abusers. J Addict Dis 32:252–262. CrossRefPubMedGoogle Scholar
  47. 47.
    Kokotailo P (1995) Physical health problems associated with adolescent substance abuse. NIDA Res Monogr 156:112–129PubMedGoogle Scholar
  48. 48.
    Perkins HW (2002) Surveying the damage: a review of research on consequences of alcohol misuse in college populations. J Stud Alcohol. CrossRefGoogle Scholar
  49. 49.
    Chaiton MO, Cohen JE, O’Loughlin J, Rehm J (2009) A systematic review of longitudinal studies on the association between depression and smoking in adolescents. BMC Public Health 9:356. CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    Degenhardt L, Hall W, Lynskey M (2003) Exploring the association between cannabis use and depression. Addiction 98:1493–1504CrossRefGoogle Scholar
  51. 51.
    Levy S, Katusic SK, Colligan RC et al (2014) Childhood ADHD and risk for substance dependence in adulthood: a longitudinal, population-based study. PLoS One 9:e105640. CrossRefPubMedPubMedCentralGoogle Scholar
  52. 52.
    Wilens TE (2007) The nature of the relationship between attention-deficit/hyperactivity disorder and substance use. J Clin Psychiatry 68(Suppl 1):4–8PubMedGoogle Scholar
  53. 53.
    Wilson JJ (2007) ADHD and substance use disorders: developmental aspects and the impact of stimulant treatment. Am J Addict 16(Suppl 1):5–11. CrossRefPubMedGoogle Scholar
  54. 54.
    Biederman J, Petty CR, Woodworth KY et al (2012) Adult outcome of attention-deficit/hyperactivity disorder: a controlled 16-year follow-up study. J Clin Psychiatry 73:941–950. CrossRefPubMedGoogle Scholar
  55. 55.
    Wilens TE, Adamson J, Sgambati S et al (2007) Do individuals with ADHD self-medicate with cigarettes and substances of abuse? Results from a controlled family study of ADHD. Am J Addict 16(Suppl 1):14–21. CrossRefPubMedGoogle Scholar
  56. 56.
    Frei A, Hornung R, Eich D (2010) [Tobacco consumption of adults diagnosed with ADHD]. Nervenarzt 81:860–866. CrossRefPubMedGoogle Scholar
  57. 57.
    Loflin M, Earleywine M, De Leo J, Hobkirk A (2014) Subtypes of attention deficit-hyperactivity disorder (ADHD) and cannabis use. Subst Use Misuse 49:427–434. CrossRefPubMedGoogle Scholar
  58. 58.
    Elkins IJ, McGue M, Iacono WG (2007) Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry 64:1145–1152. CrossRefPubMedGoogle Scholar
  59. 59.
    Bidwell LC, Henry E, Willcutt EG et al (2014) Childhood and current ADHD symptom dimensions are associated with more severe cannabis outcomes in college students. Drug Alcohol Depend 135:88–94. CrossRefPubMedGoogle Scholar
  60. 60.
    Ameringer KJ, Leventhal AM (2013) Associations between attention deficit hyperactivity disorder symptom domains and DSM-IV lifetime substance dependence. Am J Addict 22:23–32. CrossRefPubMedGoogle Scholar
  61. 61.
    Faraone SV, Biederman J (2005) What is the prevalence of adult ADHD? Results of a population screen of 966 adults. J Atten Disord 9:384–391. CrossRefPubMedGoogle Scholar
  62. 62.
    Bitter I, Simon V, Bálint S et al (2010) How do different diagnostic criteria, age and gender affect the prevalence of attention deficit hyperactivity disorder in adults? An epidemiological study in a Hungarian community sample. Eur Arch Psychiatry Clin Neurosci 260:287–296. CrossRefPubMedGoogle Scholar
  63. 63.
    Lee C-T, Clark TT, Kollins SH et al (2015) Attention Deficit Hyperactivity Disorder symptoms and smoking trajectories: Race and gender differences. Drug Alcohol Depend 148:180–187. CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.La Source, School of Nursing SciencesUniversity of Applied Sciences and Arts, Western SwitzerlandLausanneSwitzerland
  2. 2.Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry ZurichUniversity of ZurichZurichSwitzerland
  3. 3.Swiss Research Institute for Public Health and AddictionZurichSwitzerland
  4. 4.Epidemiology, Biostatistics and Prevention InstituteZurichSwitzerland
  5. 5.University Hospital of Psychiatry ZurichZurichSwitzerland
  6. 6.University Hospital of PsychiatryUniversity of BernBernSwitzerland
  7. 7.Alcohol Treatment CentreLausanne University Hospital CHUVLausanneSwitzerland
  8. 8.Addiction SwitzerlandLausanneSwitzerland
  9. 9.Centre for Addiction and Mental HealthTorontoCanada
  10. 10.University of the West of EnglandBristolUK

Personalised recommendations