ECPN Student Poster Contestant: Predictors of the Initiation of Substance Use Among Adolescents with ADHD

Introduction: Evidence suggests an association between ADHD and increased alcohol use during adolescence (Molina & Pelham, 2003). Impulsivity and attention problems have been found to be associated with initiating substance use (Ernst et al., 2006). To date, few have examined variables associated with the initiation of substance use among adolescents with ADHD. The purpose of this study is to generate hypotheses about adolescent characteristics associated with initiation of alcohol or drug use in a sample of high school students with ADHD.

Method: In the context of an intervention study, high school teens with ADHD (N=291) and their parents completed the Emotion Regulation Index for Children and Adolescents (ERICA), Barratt Impulsiveness Scale-11 (BIS), Adolescent Academic Problems Checklist (AAPC), and Substance Abuse Subtle Screening Inventory, Adolescent, (SASSI-A2) at baseline (time 1), end of treatment (time 2; 9 months later), and six month follow-up (time 3). Adolescents’ SASSI scores were coded categorically by use or no use at times 1, 2 and 3. Among the sample of 121 adolescents who reported no substance use at time 1, logistic regression was used to examine the extent to which baseline measures (ERICA, BIS, AAPC) predicted alcohol and drug use at times 2 and 3. For substance use at times 2 and 3 the percentage of the sample who reported any use ranged from 8.26% to 9.92%.

Results: For alcohol use at time 2, results suggest AAPC Academic Problems (OR =1.31), AAPC Behavior Problems (OR=1.32), and BIS Cognitive Complexity (OR=1.39) were the strongest predictors. At time 3, BIS Cognitive Instability (OR=1.29), BIS Cognitive Complexity (OR=1.38), and AAPC Academic Problems (OR=1.27) predicted alcohol use. For drug use at time 2, results suggest ERICA total score (OR=1.40) and BIS Cognitive Complexity (OR=1.36) were the strongest predictors. At time 3, results suggest AAPC Behavior Problems (OR = 2.20), AAPC Academic Problems (OR=1.80), ERICA emotional control (OR=1.76), and ERICA Emotional Self-Awareness (OR=2.19) were the strongest predictors of drug use.

Conclusion: These findings suggest adolescent characteristics related to emotion regulation, impulsivity, and academic problems may be predictors of initiation of substance use among teens with ADHD (OR range: 1.32-2.20). Although sample size limits our confidence in the findings, these results provide a valuable contribution to the literature, as all participants reported no use at baseline. In addition, it is reasonable to expect that other variables, such as parent monitoring and treatment may predict the initiation of substance use. However, these findings focus on adolescent characteristics that may lead to initial use as well as implications for the role of treatment and prevention.