Differential implications of persistent, remitted, and late-onset ADHD symptoms for substance abuse in women and men: A twin study from ages 11 to 24. (1st July 2020)

• Record Type: Journal Article
• Authors: Elkins, Irene J.; Saunders, Gretchen R.B.; Malone, Stephen M.; Wilson, Sylia; McGue, Matt; Iacono, William G.
• Is Part Of: Drug and alcohol dependence. Volume 212(2020)
• Publication Date: 2020-07-01
• Subjects: Attention deficit hyperactivity disorder -- Gender differences -- Tobacco -- Alcohol -- Marijuana -- Longitudinal -- Discordant twin design; Drug abuse -- Periodicals; Alcoholism -- Periodicals; 616.86
• DOI: 10.1016/j.drugalcdep.2020.107947
• Languages: English
• ISSNs: 0376-8716

Abstract

Highlights: Persistent and late-onset ADHD symptoms are associated with adult substance problems. Remitted ADHD is associated with less risk, except for alcohol problems in women. Presence of adult ADHD increases risk for substance problems in women more than men. Women with more late-adolescent ADHD than co-twins have more adult tobacco problems. ADHD appears to influence substance problems, while the reverse remains unclear. Abstract: Background: Persistence and emergence of ADHD in adulthood are associated with substance problems. We investigate differential implications of ADHD course for tobacco, alcohol, or marijuana problems by sex, then whether substance misuse results from ADHD or contributes to it, through a twin differences design. Methods: A population-based cohort of 998 twins (61 % monozygotic; 52 % female), born in Minnesota from 1988 to 1994, was prospectively assessed from ages 11–24. Childhood ADHD was oversampled. At age 24, 255 had a history of childhood-onset ADHD (160 persistent, 95 remitted); 93 had late-onset ADHD symptoms identified in late-adolescence/adulthood. Persistent, remitted, and late-onset groups were compared to those without ADHD (N = 459) on childhood characteristics and age-24 substance problems. Results: Persistent and late-onset groups differed in childhood; twin concordances suggested greater genetic etiology for persistent ADHD. As adolescents, however, both groups were high in conduct problems; by adulthood, they were comparably high in substance problems. In particular, women whose ADHD persisted were 5 times more likely to develop tobacco use disorder than women without ADHD. Remitted ADHD was associated with less-increased risk, except for alcohol problems among women. Consistent with possible causality, monozygotic female twins with more age-17 ADHD symptoms than co-twins had more age-24 tobacco symptoms; a similar association was found for alcohol. Conclusions: Presence or emergence of ADHD in early adulthood increases substance problems to a greater degree for women than men. While effects of substances on later ADHD were not statistically significant, detection was limited by the relative rarity of late-adolescent substance symptoms.