Preparation for Child Psych PRITE and Boards
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ADHD is a common childhood diagnosis, with as many as 1 in 10 US children receiving the diagnosis by age 18. The article addresses the following two issues:

  • Risk of developing substance use in youth with current ADHD diagnosis and treatment. Parents often have a concern about treatment with stimulants, since these drugs are the first-line therapy for ADHD and are also considered drugs of abuse.
  • Considerations in evaluation and treatment of youth with concurrent ADHD and substance use.

Future risk of substance use

  • There is consistent evidence that children with ADHD are at higher risk for developing substance use disorders (SUD). (1) This had been attributed in part to core and associated symptoms of ADHD, such as impulsive behaviors, poor distress tolerance, school truancy due to difficulty with attention.
    • in the meta-analysis, childhood ADHD was associated with alcohol use disorder by young adulthood (Odds Ratio = 1.35) and with nicotine use by middle adolescence (OR = 2.36). (1)
  • Recent studies have demonstrated that treatment of ADHD with stimulants does not increase risk of SUD, particularly when treatment is started in before age 10 (2); another study found that starting stimulant at a young age actually decreased risk of SUD (3).
  • Non-stimulant ADHD treatment was actually found to increase risk of SUD, compared to youth who began stimulant treatment early (<10 y.o.) and stayed on it for > 6 years. (2)

Co-occurring ADHD and substance use

  • In the absence of specific guidelines, ADHD symptoms should generally be evaluated after 1 month of abstinence from substances (4).
  • Pharmacological treatment of ADHD is less effective during an active substance use disorder, and SUD should be treated first.
  • Non-stimulant medication is considered the first-line treatment in patients ADHD and current or recent SUD.


1. 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.

2. McCabe, SE Age of Onset, Duration, and Type of Medication Therapy for Attention-Deficit/Hyperactivity Disorder and Substance Use During Adolescence: A Multi-Cohort National Study. J Am Acad Child Adolesc Psychiatry 2016;55(6):479–486

3. Dalsgaard S, Mortensen PB, Frydenberg M, Thomsen PH. ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood—a naturalistic long-term follow-up study. Addict Behav. 2014;39: 325-328.

4. Youth Substance Abuse and Co-Occurring Disorders. Yifrah Kaminer. APA Publishing 2015. ISBN-13:9781585624973