ADHD: RISK FOR EARLY DRUG, ALCOHOL ABUSE

Eric Taylor et al. recently reported that hyperactivity is a risk factor for serious adulthood problems, even in the absence of childhood conduct disorder (see related article, Crime Times, Vol. 3, No. 3, Pages 1&2). Now Timothy Wilens and colleagues report that hyperactivity also appears to be a significant risk factor for early onset of substance abuse.

Wilens et al. studied 120 consecutively referred adults diagnosed with childhood-onset attention deficit hyperactivity disorder (ADHD), comparing these subjects to adults with no history of ADHD. Earlier research by Wilens et al., using the same subjects, had revealed that adults with ADHD are more likely to develop substance abuse problems than non-ADHD adults. Data from the new study indicate that, in addition, ADHD substance abusers tend to develop drug or alcohol problems about three years earlier than non-ADHD substance abusers.

Wilens et al. say that because early-onset substance abuse is the hardest to treat, and because the onset of hyperactivity generally precedes the development of drug problems by many years, "our findings highlight the importance of targeting preventive and early intervention strategies at children with ADHD."

Wilens et al. found that conduct disorder was the strongest predictor of early-onset drug abuse in both ADHD and non-ADHD subjects, and that bipolar disorder also was strongly associated with an earlier onset of substance abuse. However, even in the absence of other psychiatric disorders, ADHD was a significant risk factor for early drug and alcohol abuse.

The researchers suggest that individuals with ADHD or other psychiatric disorders "may have less appreciation of the consequences of substance abuse, more difficulty in the cessation of substances, poorer judgment in peer group selection, and more tendency to self- medicate."

"Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders," Timothy E. Wilens, Joseph Biederman, Eric Mick, Stephen V. Faraone, and Thomas Spencer, Journal of Nervous and Mental Disease, Vol. 185, No. 8, August 1997, pp. 475- 482. Address: Timothy E. Wilens, ACC 725, Pediatric Psychopharmacology Clinic, Massachusetts General Hospital, Boston, MA 02114.