Association of attention-deficit/hyperactivity disorder and conduct disorder with early tobacco and alcohol use

• Data are from a young adolescent sample representative of the U.S. population.
• We relate attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) diagnoses and symptoms with substance use.
• Adolescents with comorbid ADHD + CD are more likely to use tobacco and alcohol.
• Each inattention symptom increased the odds of tobacco and alcohol use by 8–10%.
• Each conduct disorder symptom increased the odds of tobacco use by 31%.

BackgroundThe association of attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) with tobacco and alcohol use has not been assessed in a young adolescent sample representative of the U.S. population.MethodsData are from the 2000–2004 National Health and Nutrition Examination Survey, a cross-sectional sample representative of the U.S. population. Participants were age 12–15 years (N = 2517). Exposure variables included diagnosis of ADHD and CD, and counts of ADHD and CD symptoms based on caregiver responses to the Diagnostic Interview Schedule for Children. Primary outcomes were adolescent-report of any use of tobacco or alcohol and age of initiating use. Multivariate logistic regression and Cox proportional hazard models were conducted.ResultsAdolescents with ADHD + CD diagnoses had a 3- to 5-fold increased likelihood of using tobacco and alcohol and initiated use at a younger age compared to those with neither disorder. Having ADHD alone was associated with an increased likelihood of tobacco use but not alcohol use. Hyperactive-impulsive symptom counts were not independently associated with any outcome, while every one symptom increase in inattention increased the likelihood of tobacco and alcohol use by 8–10%. Although participants with a diagnosis of CD alone (compared to those without ADHD or CD) did not have a higher likelihood of tobacco or alcohol use, for every one symptom increase in CD symptoms the odds of tobacco use increased by 31%.ConclusionsADHD and CD diagnoses and symptomatology are linked to higher risk for a range of tobacco and alcohol use outcomes among young adolescents in the U.S.