Behaviors, Not ADHD Diagnosis, Predict Adolescents’ Initial Substance Use

A small NIH-funded study that followed 12-to 14-year olds over four years suggests that specific behaviors can help predict which youth will begin to use tobacco, alcohol, or marijuana. Monique Ernst, M.D., Ph.D., of the NIMH Mood and Anxiety Disorders Program, and colleagues at the National Institute on Drug Abuse reported in the June issue of Pediatrics that aggression in early adolescence predicted initiation of tobacco and marijuana use, while impulsivity predicted initiation of alcohol use. More aggression predicted initiation and use of more substances. However, diagnoses of attention-deficit/hyperactivity disorder (ADHD), with or without conduct disorder, or of ADHD with anxiety and depression did not predict which of the youth would begin to use substances. The distinction may help pediatricians and others to better focus prevention efforts on the adolescents who are most vulnerable to substance use.

Most studies of this age group have focused on substance use, abuse, and dependence already in progress. This study instead examined 78 adolescents before they had used any substances and followed them for four years, providing a window on risk and opportunities for prevention.

Ernst M, Luckenbaugh DA, Moolchan ET, Leff MK, Allen R, Eshel N, London ED, Kimes A. Behavioral predictors of substance-use initiation in adolescents with and without attention-deficit/hyperactivity disorder. Pediatrics. 2006 Jun;117(6):2030-9.