A Prospective Examination of the Association of Stimulant Medication History and Drug Use Outcomes among Community Samples of ADHD Youths

A continuing debate in the child psychopathology literature is the extent to which pharmacotherapy for children with attention-deficit/hyperactivity disorder (ADHD), in particular stimulant treatment, confers a risk of subsequent drug abuse. If stimulant treatment for ADHD contributes to drug abuse, then the risk versus therapeutic benefits of such treatment is greatly affected. We have prospectively followed an ADHD sample (N = 149; 81% males) for approximately 15 years, beginning at childhood (ages 8 to 10 years) and continuing until the sample has reached young adulthood (ages 22 to 24 years). The sample was originally recruited via an epidemiologically derived community procedure, and all youths were diagnosed with ADHD during childhood. We report on the association of childhood psychostimulant medication and subsequent substance use disorders and tobacco use. The substance use outcomes were based on data collected at three time points when the sample was in late adolescence and young adulthood (age range approximately 18 to 22 years old). We did not find evidence to support that childhood treatment with stimulant medication, including the course of stimulant medication, was associated with any change in risk for adolescent or young adulthood substance use disorders and tobacco use. These results from a community-based sample extend the growing body of literature based on clinically derived samples indicating that stimulant treatment does not create a significant risk for subsequent substance use disorders.     

Predicting Students’ Intention to use Stimulants for Academic Performance Enhancement

Background: The non-medical use of stimulants for academic performance enhancement is becoming a more common practice among college and university students. Objective: The objective of this study is to gain a better understanding of students’ intention to use stimulant medication for the purpose of enhancing their academic performance. Based on an extended model of Ajzen's theory of planned behavior, we examined the predictive value of attitude, subjective norm, perceived behavioral control, psychological distress, procrastination, substance use, and alcohol use on students’ intention to use stimulants to improve their academic performance. Methods: The sample consisted of 3,589 Flemish university and college students (mean age: 21.59, SD: 4.09), who participated anonymously in an online survey conducted in March and April 2013. Structural equation modeling was used to investigate the relationships among the study variables. Results: Our results indicate that subjective norm is the strongest predictor of students’ intention to use stimulant medication, followed by attitude and perceived behavioral control. To a lesser extent, procrastinating tendencies, psychological distress, and substance abuse contribute to students’ intention. Conclusions/ Importance: Based on these findings, we provide several recommendations on how to curtail students’ intention to use stimulant medication for the purpose of improving their academic performance. In addition, we urge researchers to identify other psychological variables that might be related to students’ intention.     

Drugs in the Junior High School,Part II

Abstract

The incidence of heroin use among Manhattan arrestees interviewed by the Arrestee Drug Abuse Monitoring (ADAM) program remained around 20% from 1987 through 2001. However, the authors had expected a decline because the heroin injection epidemic peaked back in the 1960s and early 1970s. A detailed analysis found differences across race/ethnicity. Black arrestees born since 1955 (who came of age since the heroin injection epidemic) were much less likely to use heroin than those born between 1945 and 1954 (who came of age during the epidemic). Hispanic arrestees born since 1970 (but not those born between 1955 and 1969) were also less likely to use heroin, suggesting that the decline in heroin use started among Blacks before Hispanics. During the 1990s, sniffing replaced injecting as the predominant mode of heroin consumption for Black and Hispanic arrestees, even among older arrestees. In strong contrast, the prevalence of heroin use among White arrestees did not decline in the 1990s and injection was still their most popular method of consumption. The discussion highlights implications for fu rther research and drug treatment.     

Symptoms of Depression and ADHD in Relation to Stimulant Medication Misuse Among College Students

Background: The misuse of stimulant medications, commonly used for the treatment of attention-deficit/hyperactivity disorder (ADHD), is a concern on college campuses. Objective: This study sought to examine the relations between the misuse of stimulant medications and symptoms of depression and ADHD. Method: Eight hundred and ninety students ages 18–26 from one public university took a web-based survey including rating scales measuring symptoms of depression and ADHD. Results: The prevalence rate of misuse in the past year was 23%. Symptoms of depression were significantly related to misuse; however, once symptoms of ADHD were included in the analysis, depression was no longer a significant predictor. Further, there was not a significant interaction between ADHD and depression, but symptoms of ADHD were significantly related to misuse. Conclusions/Importance: Results suggest that attention difficulties may be one of the most important factors in predicting stimulant medication misuse. Therefore, prevention efforts to reduce the misuse of stimulant medication would be most successful when targeting students with symptoms of inattention.     

Public Policy Statement on the Use of Alcohol and Other Drugs During Pregnancy

No abstract available for this article.     

Preliminary Support for Multidimensional Treatment Foster Care in Reducing Substance Use in Delinquent Boys

This article describes the disparate research findings regarding the effects of stimulant medication in subsequent substance abuse and dependence. A minimum of 4 to 5% of children in the United States will be diagnosed with ADHD; thus it is important for parents to be informed when making decisions about the use of stimulant medication to treat symptoms. Considering the inconsistencies in the literature, it is still difficult to determine the true effects of stimulant medication on drug abuse and dependence in adulthood.     

A Clinician's Guide to Co-occurring ADHD Among Adolescent Substance Users: Comorbidity,Neurodevelopmental Risk,and Evidence-Based Treatment Options

This article introduces neurodevelopmental and clinical considerations for treating adolescents with co-occurring attention deficit hyperactivity disorder (ADHD) and adolescent substance use (ASU) in outpatient settings. We first describe neurobiological impairments common to ADHD and ASU, including comorbidity with conduct disorder, that evoke a profile of multiplicative developmental risk. We then present two evidence-based options for targeting ADHD-related problems during ASU treatment. Medication integration interventions utilize family ADHD psychoeducation to prompt decision making about ADHD medication and integrate medication management into behavioral services. Clinic-based academic training interventions utilize family interventions to improve the home academic environment and boost organization skills. We conclude with recommendations for ADHD assessment and intervention sequencing.     

Substance Use in Undergraduate Students With Histories of Attention-Deficit/Hyperactivity Disorder (ADHD): The Role of Impulsivity

Background: Emerging adulthood (18–25 years old) is regarded as a time of identity exploration that includes a peak in risky behaviors, such as substance use and misuse. Attention-deficit/hyperactivity disorder (ADHD) is also associated with greater levels of risky behaviors, including substance use and misuse; however, there is a lack of research on substance use by emerging adults with ADHD, in particular the potential mechanisms that may facilitate this risk. Objectives: The present study builds on the existing research regarding the association between ADHD and substance use by examining roles of multiple facets of impulsivity in facilitating this association during emerging adulthood. Methods: In a sample of 197 undergraduate students (24 students with an ADHD diagnostic history), we assessed for components of impulsivity (e.g., urgency, sensation-seeking) and rates of alcohol abuse, tobacco use, cannabis use, illicit drug use, and stimulant medication misuse within the past year. Results: Findings indicate that facets of impulsivity, as a whole, explained the association between an ADHD diagnostic history and both illicit drug use and alcohol abuse such that students with ADHD histories tended to report higher levels of impulsivity, which increased risk of alcohol abuse and illicit drug use. Higher levels of specific facets of impulsivity, particularly negative urgency, also facilitated associations between having ADHD and engaging in most forms of substance use tested herein. Conclusions/Importance: Specific facets of impulsivity appear to be important mediators of the association between ADHD and substance use, and should be considered as potential targets of substance use interventions for this population.     

Sociodemographic Characteristics and Drug Abuse Patterns of Treatment-Seeking Illicit Drug Abusers in Finland, 1997–2008: The Huuti Study

The epidemiological part of the Huume tietokanta (HUUTI) consortium research project is the first large-scale longitudinal study of treatment-seeking illicit drug abusers in Finland. The objective of this report was to describe the sociodemographic characteristics and drug abuse patterns of treatment-seeking clients at their first visit. This study analysed baseline data of 4817 clients (3365 men and 1452 women) aged 11–65 years who sought treatment for drug abuse between 1997 and 2008 at Helsinki Deaconess Institute. Data were collected using a structured questionnaire. The majority (56%) of clients were between 15 and 24 years, educated at elementary school level (75%), and unemployed (57%). Opiates (30%) were the primary drugs of abuse. The primary drugs were mostly injected (45%) and were abused daily during the past month (44%). Cannabis was the most common secondary drug of abuse (34%). The secondary drugs were predominantly smoked (39%) or taken orally (38%) and were abused once per week or less frequently during the past month (33%). Age at initiation of illicit drug abuse ranged from 5 to 49 years. Polydrug abuse was common, with a mean consumption of 3.5 concurrent polydrug use, which were combined from 3 or more drug classes. The prevalence of lifetime/ever intravenous drug abuse was 64% and past month intravenous drug abuse was 64%, respectively, and 13% reported sharing injecting equipment during the past month. Early initiation, polydrug abuse, and risky consumption of illicit drugs were major areas of concern among the study population. Injecting drug use could place considerable burden on health services in view of complications and transmission of infectious diseases.     

Negative Reflected Appraisal,Negative Self-Perception,and Drug Use Intentions in a Sample of Suburban High School Students

Drawing on theories of symbolic interaction, some researchers have suggested that negative reflected appraisal imposes a “delinquent” identity on adolescents whom adults and peers perceive as delinquent, creating ego identity discomfort that these adolescents seek to mitigate through association with drug-using peers for whom the delinquent label is evaluated more positively. On the other hand, research on reflected appraisal and delinquency has suggested that negative reflected appraisal is more salient for adolescents who are or desire to be part of high-status peer groups than for adolescents who are uninterested in such peer groups. This article reports results of a secondary analysis of evaluation data from a federally sponsored school-based substance abuse prevention project testing whether reflected appraisal is associated with subsequent intention to use marijuana, whether this association is mediated by negative self-concept, and whether it is moderated by ethnicity and gender. Results indicate that reflected appraisal is associated with marijuana use intentions and that negative self-concept mediates this association. It also indicates that the association between negative reflected appraisal and negative self-concept is weaker for African Americans and males, and that the association between negative reflected appraisal and marijuana use intentions is less salient for Hispanics.