ADHD a Risk Factor for Alcoholism

March 27, 2007 – Its really no surprise for those in the field, working with ADHD children and teens, but two new studies show that children with ADHD are more likely than other children to abuse alcohol in their teen years, and maybe beyond.

In one study, researchers found that 15- to 17-years olds with childhood ADHD reported being drunk an average of about 15 times during the previous year, compared to about 2 times for adolescents without ADHD.

Fourteen percent of the ADHD group was classified as alcohol abusers or alcohol dependent, but none of the youths in the non-ADHD group were. Before age 15, kids with ADHD didn't abuse alcohol any more than did other kids. The study looked at 364 children with ADHD -- attention deficit hyperactivity disorder -- enrolled in the Pittsburgh ADHD Longitudinal Study.

Psychologist Brooke S.G. Molina, PhD, and colleagues interviewed the kids and their parents at the beginning of the study and again, eight years later, during adolescence (ages 11 to 17) or young adulthood (ages 18-25). They also interviewed 120 adolescents and 120 young adults never diagnosed with ADHD.

"Children with ADHD are believed to be at risk for alcoholism because of their impulsivity and distractibility, as well as other problems that often accompany ADHD such as school failure and behavior problems," said Brooke Molina of the University of Pittsburgh, corresponding author for both studies. "We found that children with ADHD are more likely to report heavy drinking in their teen years, and more problems from drinking, than non-ADHD teens... In the United States, 5% of teens have this problem. We found that in their late teen years, 14% of children with ADHD had these drinking problems."

When they reached young adulthood, the ADHD group did not, on average, drink more alcohol than did other young adults. But that is probably because so many young adults in America drink heavily when they go off to college, or get out on their own, that Even so, some of the ADHD group -- those with persistent ADHD problems -- seemed to be drinking even more than other young adults did.

Does ADHD Treatment Cut Alcoholism Risk?

Adolescent medicine specialist Cheryl Kodjo, MD, treats ADHD teens at the University of Rochester Medical Center in New York, where she is assistant professor of pediatrics. Kodjo says kids with undiagnosed, untreated ADHD certainly are at increased risk of drug and alcohol abuse.

"These kids don't fit in well with their peers and are not doing well in school," Kodjo tells WebMD. "They recognize they are not like other kids and may self-medicate with substances."

Kodjo says the crucial question is whether treating childhood ADHD cuts kids' risk of later alcohol and drug abuse.

"People who have ADHD have more of a tendency to be impulsive. If they are treated, theoretically the medications should control that, giving them a chance to think things through and be more organized," Kodjo tells WebMD. "The kids I work with who have ADHD have done pretty well as teens."

Molina says it's difficult to separate out the effects of ADHD treatment. That's because treatments vary, as does the severity of a child's ADHD. Some studies show that early ADHD treatment protects kids from later substance abuse -- but some don't, she says.

The Pittsburgh ADHD Longitudinal Study group is looking at the issue and expects to report new findings this summer, Molina says.

Meanwhile, Molina advises parents to remain involved as their ADHD kids reach adolescence.

"What we now know is that two-thirds of kids with ADHD will still have ADHD in adolescence -- and even more of them may be suffering academically," she says. "Parents and teachers cannot back off because academic performance does play a role in risk for alcohol abuse. So one thing must be to keep them on a good track in school."

"When ADHD teens complain that they need more independence, the message to give them is yes, you do need to learn to become independent -- and we will manage that change with you," she says. "It is important for parents, pediatricians, and teachers to monitor not only ADHD symptoms but how well a child is doing in school and how well a child is doing socially."

Researchers added that parental alcoholism and family stress add to the alcoholism risk for children with ADHD.

"One of the reasons that children with ADHD might be at risk for alcohol problems is that alcoholism and ADHD tend to run together in families," said Molina. "We found that parental alcoholism predicted heavy problem drinking among the teenagers, that the association was partly explained by higher rates of stress in these families, and these connections were stronger when the adolescent had ADHD in childhood. So, the bottom line is that when the child has ADHD and the parent has suffered from alcoholism, either currently or in the past, the child will have an increased risk for alcohol problems himself or herself."

SOURCES: Molina, B.S.G. Alcoholism: Clinical and Experimental Research, April 2007; vol 31, manuscript received ahead of print. Marshal, M.P. Alcoholism: Clinical and Experimental Research, April 2007; vol 31, manuscript received ahead of print. Brooke Molina, PhD, associate professor of psychiatry and psychology, University of Pittsburgh. Cheryl Kodjo, MD, assistant professor of pediatrics and adolescent medicine specialist, Golisano Children’s Hospital at Strong, University of Rochester Medical Center, Rochester, N.Y.

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