Gender Differences in Associations Between Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

  • Cæcilie Ottosen
    Affiliations
    National Centre for Register-based Research, Aarhus University, Aarhus, Denmark, Centre for Intergrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus
    Search for articles by this author
  • Liselotte Petersen
    Affiliations
    National Centre for Register-based Research, Aarhus University, Aarhus, Denmark, Centre for Intergrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus
    Search for articles by this author
  • Janne Tidselbak Larsen
    Affiliations
    National Centre for Register-based Research, Aarhus University, Aarhus, Denmark, Centre for Intergrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus
    Search for articles by this author
  • Søren Dalsgaard
    Correspondence
    Correspondence to Søren Dalsgaard, MD, PhD, Associate Professor, National Centre for Register-based Research, Aarhus University, Fuglesangs Allé 4, Building K, 8210 Aarhus V, Denmark
    Affiliations
    National Centre for Register-based Research, Aarhus University, Aarhus, Denmark, Centre for Intergrated Register-based Research at Aarhus University (CIRRAU), Aarhus, Denmark and the Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus

    Hospital of Telemark, Kragerø, Norway
    Search for articles by this author
Published:December 24, 2015DOI:https://doi.org/10.1016/j.jaac.2015.12.010

      Objective

      To examine gender differences in the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD), and to explore the impact of comorbid psychiatric conditions.

      Method

      This was a cohort study of all children born in Denmark in 1990 to 2003 (n = 729,560). By record linkage across nationwide registers, we merged data on birth characteristics, socioeconomic status, familial psychiatric history, and diagnoses of ADHD (N = 19,645), comorbidities, and SUD. Hazard ratios (HR) with 95% CIs were estimated by Cox regression and adjusted for a range of variables.

      Results

      ADHD increased the risk of alcohol abuse (HRfemales = 1.72 [95% CI = 1.42–2.08], HRmales = 1.57 [1.37–1.79]), cannabis abuse (HRfemales = 2.72 [2.12–3.47], HRmales = 2.24 [1.86–2.70]), and other illicit substance abuse (HRfemales = 2.05 [1.54–2.73], HRmales = 2.42 [1.98–2.96]), compared to individuals without ADHD. In the overall estimates, no gender differences were found. Among individuals with ADHD without comorbidities, females had a higher SUD risk than males, as did females with ADHD and conduct disorder (CD). Comorbid CD, depression, bipolar disorder, and schizophrenia further increased the risk of SUD in ADHD, compared to non-ADHD. Autism spectrum disorder in males with ADHD lowered the SUD risk.

      Conclusion

      ADHD increased the risk of all SUD outcomes. Individuals with ADHD without comorbidities were also at increased risk, and some comorbid disorders further increased the risk. Females and males with ADHD had comparable risks of SUD, although females had higher risk of some SUDs than males. Females with ADHD may be perceived as less impaired than males, but they are at equally increased risk of SUD.

      Key words

      To read this article in full you will need to make a payment

      References

        • Kandel D.B.
        • Johnson J.G.
        • Bird H.R.
        • et al.
        Psychiatric comorbidity among adolescents with substance use disorders: findings from the MECA Study.
        J Am Acad Child Adolesc Psychiatry. 1999; 38: 693-699
        • Regier D.A.
        • Farmer M.E.
        • Rae D.S.
        • et al.
        Comorbidity of mental disorders with alcohol and other drug abuse. Results from the Epidemiologic Catchment Area (ECA) Study.
        JAMA. 1990; 264: 2511-2518
        • Kaye S.
        • Darke S.
        • Torok M.
        Attention deficit hyperactivity disorder (ADHD) among illicit psychostimulant users: a hidden disorder?.
        Addiction. 2013; 108: 923-931
        • van Emmerik-van Oortmerssen K.
        • van de Glind G.
        • van den Brink W.
        • et al.
        Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis.
        Drug Alcohol Depend. 2012; 122: 11-19
        • Wilens T.E.
        • Biederman J.
        • Spencer T.J.
        • Frances R.J.
        Comorbidity of attention-deficit hyperactivity and psychoactive substance use disorders.
        Hosp Community Psychiatry. 1994; 45 (435): 421-423
        • Steinhausen H.C.
        • Bisgaard C.
        Substance use disorders in association with attention-deficit/hyperactivity disorder, co-morbid mental disorders, and medication in a nationwide sample.
        Eur Neuropsychopharmacol. 2014; 24: 232-241
        • Dalsgaard S.
        • Mortensen P.B.
        • Frydenberg M.
        • Thomsen P.H.
        ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood—a naturalistic long-term follow-up study.
        Addict Behav. 2014; 39: 325-328
        • Molina B.S.
        • Flory K.
        • Hinshaw S.P.
        • et al.
        Delinquent behavior and emerging substance use in the MTA at 36 months: prevalence, course, and treatment effects.
        J Am Acad Child Adolesc Psychiatry. 2007; 46: 1028-1040
        • Wilens T.E.
        • Martelon M.
        • Joshi G.
        • et al.
        Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD.
        J Am Acad Child Adolesc Psychiatry. 2011; 50: 543-553
        • Sizoo B.
        • van den Brink W.
        • Gorissen van Eenige M.
        • van der Gaag R.J.
        Personality characteristics of adults with autism spectrum disorders or attention deficit hyperactivity disorder with and without substance use disorders.
        J Nerv Ment Dis. 2009; 197: 450-454
        • Sizoo B.
        • van den Brink W.
        • Koeter M.
        • Gorissen van Eenige M.
        • van Wijngaarden-Cremers P.
        • van der Gaag R.J.
        Treatment seeking adults with autism or ADHD and co-morbid substance use disorder: prevalence, risk factors and functional disability.
        Drug Alcohol Depend. 2010; 107: 44-50
        • Biederman J.
        • Petty C.R.
        • Monuteaux M.C.
        • et al.
        Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder: 11-year follow-up in a longitudinal case-control study.
        Am J Psychiatry. 2010; 167: 409-417
        • Mannuzza S.
        • Klein R.G.
        • Bessler A.
        • Malloy P.
        • LaPadula M.
        Adult psychiatric status of hyperactive boys grown up.
        A J Psychiatry. 1998; 155: 493-498
        • Charach A.
        • Yeung E.
        • Climans T.
        • Lillie E.
        Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses.
        J Am Acad Child Adolesc Psychiatry. 2011; 50: 9-21
        • Lee S.S.
        • Humphreys K.L.
        • Flory K.
        • Liu R.
        • Glass K.
        Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review.
        Clin Psychol Rev. 2011; 31: 328-341
        • Serra-Pinheiro M.A.
        • Coutinho E.S.
        • Souza I.S.
        • et al.
        Is ADHD a risk factor independent of conduct disorder for illicit substance use? A meta-analysis and metaregression investigation.
        J Atten Disord. 2013; 17: 459-469
        • Dalsgaard S.
        • Mortensen P.B.
        • Frydenberg M.
        • Thomsen P.H.
        Conduct problems, gender and adult psychiatric outcome of children with attention-deficit hyperactivity disorder.
        Br J Psychiatry. 2002; 181: 416-421
        • Dalsgaard S.
        • Mortensen P.B.
        • Frydenberg M.
        • Maibing C.M.
        • Nordentoft M.
        • Thomsen P.H.
        Association between attention-deficit hyperactivity disorder in childhood and schizophrenia later in adulthood.
        Eur Psychiatry. 2014; 29: 259-263
        • Dalsgaard S.
        • Østergaard S.D.
        • Leckman J.F.
        • Mortensen P.B.
        • Pedersen M.G.
        Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study.
        Lancet. 2015; 385: 2190-2196
        • Groman S.M.
        • James A.S.
        • Jentsch J.D.
        Poor response inhibition: at the nexus between substance abuse and attention deficit/hyperactivity disorder.
        Neurosci Biobehav Rev. 2009; 33: 690-698
        • Goldstein R.Z.
        • Volkow N.D.
        Dysfunction of the prefrontal cortex in addiction: neuroimaging findings and clinical implications.
        Nat Rev Neurosci. 2011; 12: 652-669
        • Volkow N.D.
        • Wang G.J.
        • Fowler J.S.
        • Tomasi D.
        • Telang F.
        Addiction: beyond dopamine reward circuitry.
        Proc Natl Acad Sci USA. 2011; 108: 15037-15042
        • Luman M.
        • Tripp G.
        • Scheres A.
        Identifying the neurobiology of altered reinforcement sensitivity in ADHD: a review and research agenda.
        Neurosci Biobehav Rev. 2010; 34: 744-754
        • Wilens T.E.
        • Adamson J.
        • Sgambati S.
        • et al.
        Do individuals with ADHD self-medicate with cigarettes and substances of abuse? Results from a controlled family study of ADHD.
        Am J Addict. 2007; 16: 14-21
        • Compton W.M.
        • Thomas Y.F.
        • Stinson F.S.
        • Grant B.F.
        Prevalence, correlates, disability, and comorbidity of DSM-IV drug abuse and dependence in the United States: results from the national epidemiologic survey on alcohol and related conditions.
        Arch Gen Psychiatry. 2007; 64: 566-576
        • Larsson H.
        • Sariaslan A.
        • Langstrom N.
        • D'Onofrio B.
        • Lichtenstein P.
        Family income in early childhood and subsequent attention deficit/hyperactivity disorder: a quasi-experimental study.
        J Child Psychol Psychiatry. 2014; 55: 428-435
        • Dalsgaard S.
        • Nielsen H.S.
        • Simonsen M.
        Consequences of ADHD medication use for children's outcomes.
        J Health Econ. 2014; 37: 137-151
        • Melchior M.
        • Choquet M.
        • Le Strat Y.
        • Hassler C.
        • Gorwood P.
        Parental alcohol dependence, socioeconomic disadvantage and alcohol and cannabis dependence among young adults in the community.
        Eur Psychiatry. 2011; 26: 13-17
        • Yule A.M.
        • Wilens T.E.
        • Martelon M.K.
        • Simon A.
        • Biederman J.
        Does exposure to parental substance use disorders increase substance use disorder risk in offspring? A 5-year follow-up study.
        Am J Addict. 2013; 22: 460-465
        • Linnet K.M.
        • Dalsgaard S.
        • Obel C.
        • et al.
        Maternal lifestyle factors in pregnancy risk of attention deficit hyperactivity disorder and associated behaviors: review of the current evidence.
        Am J Psychiatry. 2003; 160: 1028-1040
        • Sorensen H.J.
        • Manzardo A.M.
        • Knop J.
        • et al.
        The contribution of parental alcohol use disorders and other psychiatric illness to the risk of alcohol use disorders in the offspring.
        Alcohol Clin Exp Res. 2011; 35: 1315-1320
        • Arria A.M.
        • Mericle A.A.
        • Meyers K.
        • Winters K.C.
        Parental substance use impairment, parenting and substance use disorder risk.
        J Substance Abuse Treat. 2012; 43: 114-122
        • Faraone S.
        • Perlis R.
        • Doyle A.
        • et al.
        Molecular genetics of attention-deficit/hyperactivity disorder.
        Biol Psychiatry. 2005; 57: 1313-1323
        • Pedersen C.B.
        The Danish Civil Registration System.
        Scand J Public Health. 2011; 39: 22-25
        • Knudsen L.B.
        • Borlum Kristensen F.
        Monitoring perinatal mortality and perinatal care with a national register: content and usage of the Danish Medical Birth Register.
        Comm Med. 1986; 8: 29-36
        • Petersson F.
        • Baadsgaard M.
        • Thygesen L.C.
        Danish registers on personal labour market affiliation.
        Scand J Public Health. 2011; 39: 95-98
        • Mors O.
        • Perto G.P.
        • Mortensen P.B.
        The Danish Psychiatric Central Research Register.
        Scand J Public Health. 2011; 39: 54-57
        • Lynge E.
        • Sandegaard J.L.
        • Rebolj M.
        The Danish National Patient Register.
        Scand J Public Health. 2011; 39: 30-33
        • World Health Organization
        The ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research.
        World Health Organization, Geneva, Switzerland1993
        • Toftdahl N.G.
        • Nordentoft M.
        • Hjorthoj C.
        Prevalence of substance use disorders in psychiatric patients: a nationwide Danish population-based study.
        Soc. Psychiatry Psychiatr Epidemiol. 2015 August 11; ([epub ahead of print])
        • Knop J.
        • Penick E.C.
        • Nickel E.J.
        • et al.
        Childhood ADHD and conduct disorder as independent predictors of male alcohol dependence at age 40.
        J Stud Alcohol Drug. 2009; 70: 169-177
        • Dalsgaard S.
        • Mortensen P.B.
        • Frydenberg M.
        • Thomsen P.H.
        Long-term criminal outcome of children with attention deficit hyperactivity disorder.
        Crim Behav Ment Health. 2013; 23: 86-98
        • Satterfield J.H.
        • Faller K.J.
        • Crinella F.M.
        • Schell A.M.
        • Swanson J.M.
        • Homer L.D.
        A 30-year prospective follow-up study of hyperactive boys with conduct problems: adult criminality.
        J Am Acad Child Adolesc Psychiatry. 2007; 46: 601-610
        • Larsen T.K.
        • Melle I.
        • Auestad B.
        • et al.
        Substance abuse in first-episode non-affective psychosis.
        Schizophr. Res. 2006; 88: 55-62
        • Wilens T.E.
        • Biederman J.
        • Kwon A.
        • et al.
        Risk of substance use disorders in adolescents with bipolar disorder.
        J Am Acad Child Adolesc Psychiatry. 2004; 43: 1380-1386
        • Thylstrup B.
        • Schroder S.
        • Hesse M.
        Psycho-education for substance use and antisocial personality disorder: a randomized trial.
        BMC Psychiatry. 2015; 15: 283
        • Cantor-Graae E.
        • Nordstrom L.G.
        • McNeil T.F.
        Substance abuse in schizophrenia: a review of the literature and a study of correlates in Sweden.
        Schizophr. Res. 2001; 48: 69-82
        • Rucklidge J.J.
        Gender differences in ADHD: implications for psychosocial treatments.
        Expert Rev Neurotherapeut. 2008; 8: 643-655
        • Quinn P.
        • Wigal S.
        Perceptions of girls and ADHD: results from a national survey.
        MedGenMed. 2004; 6: 2
        • Dalsgaard S.
        • Leckman J.F.
        • Mortensen P.B.
        • Nielsen H.S.
        • Simonsen M.
        Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study.
        Lancet Psychiatry. 2015; 2: 702-709
        • Dalsgaard S.
        • Leckman J.F.
        • Nielsen H.S.
        • Simonsen M.
        Gender and injuries predict stimulant medication use.
        J Child Adolesc Psychopharmacol. 2014; 24: 253-259
        • Groenman A.P.
        • Oosterlaan J.
        • Rommelse N.N.
        • et al.
        Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder.
        Br J Psychiatry. 2013; 203: 112-119
        • Linnet K.M.
        • Wisborg K.
        • Secher N.J.
        • et al.
        Coffee consumption during pregnancy and the risk of hyperkinetic disorder and ADHD: a prospective cohort study.
        Acta Paediatr. 2009; 98: 173-179
        • Dalsgaard S.
        • Hansen N.
        • Mortensen P.B.
        • Damm D.
        • Thomsen P.H.
        Reassessment of ADHD in a historical cohort of children treated with stimulants in the period 1969-1989.
        Eur Child Adolesc Psychiatry. 2001; 10: 230-239
        • Dalsgaard S.
        • Humlum M.K.
        • Nielsen H.S.
        • Simonsen M.
        Relative standards in ADHD diagnoses: the role of specialist behavior.
        Econ Lett. 2012; 117: 663-665
        • Dalsgaard S.
        • Humlum M.K.
        • Nielsen H.S.
        • Simonsen M.
        Common Danish standards in prescribing medication for children and adolescents with ADHD.
        Eur Child Adolesc Psychiatry. 2014; 23: 841-844
        • Dalsgaard S.
        • Nielsen H.S.
        • Simonsen M.
        Five-fold increase in national prevalence rates of attention-deficit/hyperactivity disorder medications for children and adolescents with autism spectrum disorder, attention-deficit/hyperactivity disorder, and other psychiatric disorders: a Danish register-based study.
        J Child Adolesc Psychopharmacol. 2013; 23: 432-439