Skip to main content
SpringerLink
Log in

The Relation Between Attention Deficit Hyperactivity Disorder and Substance Abuse: What Role Does Conduct Disorder Play?

  • Published:
Clinical Child and Family Psychology Review Aims and scope Submit manuscript

Abstract

This paper presents a comprehensive review of the literature examining the relation between childhood attention deficit hyperactivity disorder (ADHD) and substance abuse. A number of researchers have statistically controlled for conduct disorder (CD) when examining the ADHD—substance-abuse relation. These studies have generally found that the ADHD—substance-abuse relation disappears when the high overlap between ADHD and CD is taken into account. On this basis, one may conclude that ADHD is unimportant to substance abuse. However, there is some evidence from both empirical studies and related fields that ADHD and CD may interact to afford a higher risk for substance abuse than may either disorder alone. Thus, ADHD appears to be important to substance abuse in that it interacts with CD to increase the risk. This paper calls for more research that directly examines the joint effects of ADHD and CD on risk for substance abuse. There is also a need for more research that examines gender differences, and mechanisms of the relations among ADHD, CD, and substance abuse.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  • Aiken, L. S., & West, S. G. (1991). Multiple regression: Testing and interpreting interactions. Newbury Park, CA: Sage.

    Google Scholar 

  • American Psychiatric Association. (1980). Diagnostic and statistical manual of mental disorders (3rd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders (Rev. 3rd ed.). Washington, DC: Author.

    Google Scholar 

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

    Google Scholar 

  • August, G. J., Realmuto, G. M., MacDonald, A. W., Nugent, S. M., & Crosby, R. (1996). Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behavior. Journal of Abnormal Child Psychology, 24, 571-596.

    Google Scholar 

  • August, G. J., Stewart, M. A., & Holmes, C. S. (1983). A four-year follow-up of hyperactive boys with and without conduct disorder. British Journal of Psychiatry, 143, 192-198.

    Google Scholar 

  • Barkley, R. A. (1998). Attention deficit hyperactivity disorder. In E. J. Mash & R. A. Barkley (Eds.), Treatment of Childhood Disorders(2nd ed., pp. 55-110). New York: The Guilford Press.

    Google Scholar 

  • Barkley, R. A., Fischer, M., Edelbrock, C. S., & Smallish, L. (1990). The adolescent outcome of hyperactive children diagnosed by research criteria. I: An 8-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 546-557.

    Google Scholar 

  • Baumgaertel, A., Wolraich, M. L., & Dietrich, M. (1995). Comparison of diagnostic criteria for attention deficit disorders in a German elementary school sample. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 629-638.

    Google Scholar 

  • Biederman, J., Faraone, S. V., Weber, W., Russell, R., Rater, M., & Park, K. (1997). Correspondence between DSM-III-Rand DSM-IVattention deficit hyperactivity disorder. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1682-1687.

    Google Scholar 

  • Biederman, J., Newcorn, J., & Sprich, S. (1991). Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. American Journal of Psychiatry, 148, 564-577.

    Google Scholar 

  • Biederman, J., Wilens, T., Mick, E., Faraone, S. V., Weber, W., Curtis, S., et al. (1997). Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 21-29.

    Google Scholar 

  • Boyle, M. H., & Offord, D. R. (1991). Psychiatric disorder and substance use in adolescence. The Canadian Journal of Psychiatry, 36, 699-705.

    Google Scholar 

  • Boyle, M. H., Offord, D. R., Racine, Y. A., Szatmari, P., Fleming, J. E., & Links, P. S. (1992). Predicting substance use in late adolescence: Results from the Ontario child health study follow-up. American Journal of Psychiatry, 149, 761-767.

    Google Scholar 

  • Brook, J. S., Cohen, P., Whiteman, M., & Gorden, A. S. (1992). Psychosocial risk factors in the transition from moderate to heavy use or abuse of drugs. In M. D. Glantz & R. W. Pickens (Eds.), Vulnerability to drug abuse(pp. 359-388). Washington, DC: American Psychological Association.

    Google Scholar 

  • Burke, J. D., Loeber, R., & Lahey, B. B. (2001). Which aspects of ADHD are associated with tobacco use in early adolescence? Journal of Child Psychology and Psychiatry, 42, 493-502.

    Google Scholar 

  • Busch, B., Biederman, J., Glassner-Cohen, L., Sayer, J. M., Monuteaux, M. C., Mick, E., et al. (2002). Correlates of ADHD among children in pediatric and psychiatric settings. Psychiatric Services, 53, 1103-1111.

    Google Scholar 

  • Capaldi, D. M., & Stoolmiller, M. (1999). Co-occurrence of conduct problems and depressive symptoms in early adolescent boys. III: Prediction to young-adult adjustment. Development and Psychopathology, 11, 59-84.

    Google Scholar 

  • Chilcoat, H. D., & Breslau, N. (1999). Pathways from ADHD to early drug use. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1347-1354.

    Google Scholar 

  • Clark, D. B., Pollock, N., Bukstein, O. G., Mezzich, A. C., Bromberger, J. T., & Donovan, J. E. (1997). Gender and comorbid psychopathology in adolescents with alcohol dependence. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1195-1203.

    Google Scholar 

  • Claude, D., & Firestone, P. (1995). The development of ADHD boys: A 12-year follow-up. Canadian Journal of Behavioural Science, 27, 226-249.

    Google Scholar 

  • Disney, E. R., Elkins, I. J., McGue, M., & Iacona, W. G. (1999). Effects of ADHD, conduct disorder, and gender on substance use and abuse in adolescence. American Journal of Psychiatry, 156, 1515-1521.

    Google Scholar 

  • Dobkin, P. L., Tremblay, R. E., Masse, L. C., & Vitaro, F. (1995). Individual and peer characteristics in predicting boys' early onset of substance abuse: A seven-year longitudinal study. Child Development, 66, 1198-1214.

    Google Scholar 

  • Donovan, J. E., & Jessor, R. (1985). Structure of problem behavior in adolescence and early adulthood. Journal of Consulting and Clinical Psychology, 53, 890-904.

    Google Scholar 

  • Donovan, J. E., Jessor, R., & Costa, F. M. (1988). Syndrome of problem behavior in adolescence: A replication. Journal of Consulting and Clinical Psychology, 56(5), 762-765.

    Google Scholar 

  • DuPaul, G. J., & Stoner, G. D. (1994). ADHD in the schools: Assessment and intervention strategies. New York: The Guilford Press.

    Google Scholar 

  • Farrington, D. P., Loeber, R., & Van Kammen, W. (1990). Long-term criminal outcomes of hyperactivity-impulsivity-attention deficit and conduct problems in childhood. In L. N. Robins & M. Rutter (Eds.), Straight and devious pathways from childhood to adulthood(pp. 62-81). Cambridge, England: Cambridge University Press.

    Google Scholar 

  • Fergusson, D. M., Lynskey, M. T., & Horwood, L. J. (1993). Conduct problems and attention deficit behaviour in middle childhood and cannabis use by age 15. Australian and New Zealand Journal of Psychiatry, 27, 673-682.

    Google Scholar 

  • Gittelman, R., Mannuzza, S., Shenker, R., & Bonagura, N. (1985). Hyperactive boys almost grown up. Archives of General Psychiatry, 42, 937-947.

    Google Scholar 

  • Greenbaum, P. E., Prange, M. E., Friedman, R. M., & Silver, S. E. (1991). Substance abuse prevalence and comorbidity with other psychiatric disorders among adolescents with severe emotional disturbances. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 575-583.

    Google Scholar 

  • Hartsough, C. S., & Lambert, N. M. (1987). Pattern and progression of drug use among hyperactives and controls: A prospective short-term longitudinal study. Journal of Child Psychology and Psychiatry, 28, 543-553.

    Google Scholar 

  • Hechtman, L., & Weiss, G. (1983). Long-term outcome of hyperactive children. American Journal of Orthopsychiatry, 53, 532-541.

    Google Scholar 

  • Hinshaw, S. P. (1987). On the distinction between attentional deficits/hyperactivity and conduct problems/aggression in child psychopathology. Psychological Bulletin, 101, 443-463.

    Google Scholar 

  • Hinshaw, S. P. (1992). Externalizing behavior problems and academic underachievement in childhood and adolescence: Causal relationships and underlying mechanisms. Psychological Bulletin, 111, 127-155.

    Google Scholar 

  • Horner, B. R., & Scheibe, K. E. (1997). Prevalence and Implications of attention deficit hyperactivity disorder among adolescents in treatment for substance abuse. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 30-36.

    Google Scholar 

  • Jensen, P. S., Martin, D., & Cantwell, D. P. (1997). Comorbidity in ADHD: Implications for research, practice, and DSM-IV. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1065-1079.

    Google Scholar 

  • Jessor, R., & Jessor, S. L. (1977). Problem behavior and psychosocial development: A longitudinal study of youth. New York: Academic Press.

    Google Scholar 

  • Kellam, S. G., Brown, C. H., Rubin, B. R., & Ensminger, M. E. (1983). Paths leading to teenage psychiatric symptoms and substance use: Developmental epidemiological studies in Woodlawn. In S. B. Guze, F. J. Earls, & J. E. Barnett (Eds.), Childhood psychopathology and development(pp. 17-51). New York: Raven Press.

    Google Scholar 

  • Lahey, B. B., Applegate, B., McBurnett, K., Biederman, J., Greenhill, L., Hynd, G. W., et al. (1994). DSM-IVfield trials for attention deficit hyperactivity disorder in children and adolescents. American Journal of Psychiatry, 151, 1673-1685.

    Google Scholar 

  • Lahey, B. B., Loeber, R., Quay, H. C., Applegate, B., Shaffer, D., Waldman, I., et al. (1998). Validity of DSM-IVsubtypes of conduct disorder based on age of onset. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 435-442.

    Google Scholar 

  • Lahey, B. B., Loeber, R., Stouthamer-Loeber, M., Christ, M. A. G., Green, S., Russo, M. F., et al. (1990). Comparison of DSM-IIIand DSM-III-Rdiagnoses for prepubertal children: Changes in prevalence and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 620-626.

    Google Scholar 

  • Lahey, B. B., Piacentini, J. C., McBurnett, K., Stone, P., Hartdagen, S., & Hynd, G. (1987). Psychopathology in the parents of children with conduct disorder and hyperactivity. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 163-170.

    Google Scholar 

  • Lambert, N. M. (1988). Adolescent outcomes for hyperactive children: Perspectives on general and specific patterns of childhood risk for adolescent educational, social, and mental health problems. American Psychologist, 43, 786-799.

    Google Scholar 

  • Landau, S., Milich, R., & Diener, M. B. (1998). Peer relations of children with attention deficit hyperactivity disorder. Reading and Writing Quarterly—Learning Difficulties, 14, 83-105.

    Google Scholar 

  • Levin, E. D., Connors, C. K., Sparrow, E., Hinton, S. C., Erhardt, D., Meck, W. H., et al. (1996). Nicotine effects on adults with attention-deficit/hyperactivity disorder. Psychopharmacology, 123, 55-63.

    Google Scholar 

  • Loeber, R., Brinthaupt, V. P., & Green, S. (1990). Attention deficits, impulsivity, and hyperactivity with or without conduct problems: Relationships to delinquency and unique contextual factors. In R. J. McMahon & R. D. Peters (Eds.), Behavior disorders of adolescence: Research, intervention, and policy in clinical and school settings(pp. 39-61). New York: Plenum Press.

    Google Scholar 

  • Loeber, R., & Dishion, T. J. (1983). Early predictors of male adolescent delinquency: A review. Psychological Bulletin, 94, 68-99.

    Google Scholar 

  • Loeber, R., Stouthamer-Loeber, M., & White, H. R. (1999). Developmental aspects of delinquency and internalizing problems and their association with persistent juvenile substance use between ages 7 and 18. Journal of Clinical Child Psychology, 28, 322-332.

    Google Scholar 

  • Lynam, D. R. (1996). Early identification of chronic offenders: Who is the fledging psychopath? Psychological Bulletin, 120, 209-234.

    Google Scholar 

  • Lynam, D. R. (1998). Early identification of the fledgling psychopath: Locating the psychopathic child in the current nomenclature. Journal of Abnormal Psychology, 107, 566-575.

    Google Scholar 

  • Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & LaPadula, M. (1993). Adult outcome of hyperactive boys: Educational achievement, occupational rank, and psychiatric status. Archives of General Psychiatry, 50, 565-576.

    Google Scholar 

  • Mannuzza, S., Klein, R. G., Bessler, A., Malloy, P., & LaPadula, M. (1998). Adult psychiatric status of hyperactive boys grown up. American Journal of Psychiatry, 155, 493-498.

    Google Scholar 

  • Mannuzza, S., Klein, R. G., Bonagura, N., Malloy, P., Giampino, T. L., & Addalli, K. A. (1991). Hyperactive boys almost grown up. V: Replication of psychiatric status. Archives of General Psychiatry, 48, 77-83.

    Google Scholar 

  • McClelland, G. H., & Judd, C. M. (1993). Statistical difficulties of detecting interactions and moderator effects. Psychological Bulletin, 114, 376-390.

    Google Scholar 

  • Milberger, S., Biederman, J., Faraone, S. V., Chen, L., & Jones, J. (1997). ADHD is associated with early initiation of cigarette smoking in children and adolescents. Journal of American Academy of Child and Adolescent Psychiatry, 36, 37-44.

    Google Scholar 

  • Milich, R., & Landau, S. (1989). The role of social status variables in differentiating subgroups of hyperactive children. In L. M. Bloomingdale and J. Swanson (Eds.), Attention deficit disorders: Vol. 4. Current concepts and emerging trends in attentional and behavioral disorders of childhood(pp. 1-16). New York: Pergamon.

    Google Scholar 

  • Milin, R., Halikas, J. A., Meller, J. E., & Morse, C. (1991). Psychopathology among substance abusing juvenile offenders. Journal of the American Academy of Child and Adolescent Psychiatry, 30, 569-574.

    Google Scholar 

  • Moffitt, T. E., & Henry, B. (1989). Neuropsychological assessment of executive functioning in self-reported delinquency. Development and Psychopathology, 1, 105-118.

    Google Scholar 

  • Molina, B. S. G., Bukstein, O. G., & Lynch, K. G. (2002). Attention-deficit/hyperactivity disorder and conduct disorder symptomatology in adolescents with alcohol use disorder. Psychology of Addictive Behaviors, 16, 161-164.

    Google Scholar 

  • Molina, B. S. G., Smith, B. H., & Pelham, W. E. (1999). Interactive effects of attention deficit hyperactivity disorder and conduct disorder on early adolescent substance use. Psychology of Addictive Behaviors, 13, 348-358.

    Google Scholar 

  • Morgan, A. E., Hynd, G. W., Riccio, C. A., & Hall, J. (1996). Validity of DSM-IVADHD predominately inattentive and combined types: Relationship to previous DSMdiagnoses/subtype differences. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 325-333.

    Google Scholar 

  • Perrin, S., & Last, C. G. (1996). Relationship between ADHD and anxiety in boys: Results from a family study. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 988-996.

    Google Scholar 

  • Pogge, D. L., Stokes, J., & Harvey, P. D. (1992). Psychometric vs. attentional correlates of early onset alcohol and substance abuse. Journal of Abnormal Child Psychology, 20, 151-162.

    Google Scholar 

  • Pulkkinen, L. (1983). Youthful smoking and drinking in a longitudinal perspective. Journal of Youth and Adolescence, 12, 253-283.

    Google Scholar 

  • Riggs, P. D., Mikulich, S. K., Whitmore, E. A., & Crowley, T. J. (1999). Relationship of ADHD, depression, and non-tobacco substance use disorders to nicotine dependence in substance-dependent adolescents. Drug and Alcohol Dependence, 54, 195-205.

    Google Scholar 

  • Sher, K. J., & Trull, T. J. (1994). Personality and disinhibitory psychopathology: Alcoholism and antisocial personality disorder. Journal of Abnormal Psychology, 103, 92-102.

    Google Scholar 

  • Smith, G. M., & Fogg, C. P. (1979). Psychological antecedents of teenage drug use. Research in Community Mental Health, 1, 87-102.

    Google Scholar 

  • Stowell, R. J. A., & Estroff, T. W. (1992). Psychiatric disorders in substance-abusing adolescent inpatients: A pilot study. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1036-1040.

    Google Scholar 

  • Thompson, L. L., Riggs, P. D., Mikulich, S. K., & Crowley, T. J. (1996). Contribution of ADHD symptoms to substance problems and delinquency in conduct-disordered adolescents. Journal of Abnormal Child Psychology, 24, 325-347.

    Google Scholar 

  • Walker, J. L., Lahey, B. B., Hynd, G. W., & Frame, C. L. (1987). Comparison of specific patterns of antisocial behavior in children with conduct disorder with of without coexisting hyperactivity. Journal of Consulting and Clinical Psychology, 55, 910-913.

    Google Scholar 

  • Wallander, J. (1988). The relationship between attention problems in childhood and antisocial behavior eight years later. Journal of Child Psychology and Psychiatry, 29, 53-61.

    Google Scholar 

  • West, D. J., & Farrington, D. P. (1977). The delinquent way of life. London: Heineman.

    Google Scholar 

  • Whitmore, E. A., Mikulich, S. K., Thompson, L. L., Riggs, P. D., Aarons, G. A., & Crowley, T. J. (1997). Influences on adolescent substance dependence: Conduct disorder, depression, attention deficit hyperactivity disorder, and gender. Drug and Alcohol Dependence, 47, 87-97.

    Google Scholar 

  • Windle, M. (1990). A longitudinal study of antisocial behaviors in early adolescence as predictors of late adolescent substance use: Gender and ethic group differences. Journal of Abnormal Psychology, 99, 86-91.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychology, University of Kentucky, Lexington, Kentucky

    Kate Flory & Donald R. Lynam

Authors
  1. Kate Flory
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Donald R. Lynam
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kate Flory.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Flory, K., Lynam, D.R. The Relation Between Attention Deficit Hyperactivity Disorder and Substance Abuse: What Role Does Conduct Disorder Play?. Clin Child Fam Psychol Rev 6, 1–16 (2003). https://doi.org/10.1023/A:1022260221570

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1022260221570

Search

Navigation