Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication

Abstract

Objective: To determine long-term effects on substance use and substance use disorder (SUD), up to 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA; n = 436); to test whether medication at follow-up, cumulative psychostimulant treatment over time, or both relate to substance use/SUD; and to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group (n = 261).

Method: Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question, for which propensity score matching analysis was used.

Results: The originally randomized treatment groups did not differ significantly on substance use/SUD by the 8-year follow-up or earlier (mean age = 17 years). Neither medication at follow-up (mostly stimulants) nor cumulative stimulant treatment was associated with adolescent substance use/SUD. Substance use at all time points, including use of two or more substances and SUD, were each greater in the ADHD than in the non-ADHD samples, regardless of sex.

Conclusions: Medication for ADHD did not protect from, or contribute to, visible risk of substance use or SUD by adolescence, whether analyzed as randomized treatment assignment in childhood, as medication at follow-up, or as cumulative stimulant treatment over an 8-year follow-up from childhood. These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD, especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication. Clinical trial registration information-Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); http://clinical trials.gov/; NCT00000388.

Conflict of interest statement

Disclosure: Drs. Molina, Hoza, Epstein, Vitiello, Gibbons, Howard, Hur, Lu, and Marcus, and Ms. Houck report no biomedical financial interests or potential conflicts of interest.

Copyright © 2013 American Academy of Child and Adolescent Psychiatry. All rights reserved.

Figures

Figure 1

Proportion of Participants Using Substances (by Number of Substances) from the 24-month through 8-year Follow-up Assessments. ADHD = Attention-Deficit/Hyperactivity Disorder; LNCG = Local Normative Comparison Group.

Figure 2

Percent of Participants Reporting Alcohol, Tobacco, Marijuana, and Other Drug Use at Each of the 6- and 8-year Follow-up Assessments. ADHD = Attention-Deficit/Hyperactivity Disorder; LNCG = Local Normative Comparison Group.