Is cigarette smoking a gateway to alcohol and illicit drug use disorders? A study of youths with and without attention deficit hyperactivity disorder.
BACKGROUND
The goal of this study was to assess whether cigarette smoking is a gateway drug for subsequent alcohol and illicit drug abuse and dependence in youth with Attention Deficit Hyperactivity Disorder (ADHD), and to test if this association is stronger in ADHD youth relative to controls.


METHODS
We used data from a case-control family study of female youth with and without ADHD. We studied 97 ADHD and 203 control youth of both sexes, aged at least 12 years. We assessed ADHD, smoking, and substance use status using structured diagnostic interviews. We tested the association between cigarette smoking and subsequent substance use outcomes using Cox proportional hazard regression models.


RESULTS
ADHD youth who smoked cigarettes (n = 15) were significantly more likely to subsequently use alcohol and illicit drugs as well as to develop abuse and dependence compared to ADHD youth who did not smoke (n = 76; p < .05).


CONCLUSIONS
These results extend the gateway hypothesis to an ADHD sample and provide evidence that this effect may be particularly robust in ADHD youth. If replicated in larger, community-based samples, these findings have important public health consequences, and underscore the already pressing need to prevent smoking in ADHD children.
Biederman
Joseph
J
Department of Psychiatry, Harvard Medical School, USA. jbiederman@partners.org
Monuteaux
Michael C
MC
Mick
Eric
E
Wilens
Timothy E
TE
Fontanella
Jessie A
JA
Poetzl
Katrina M
KM
Kirk
Taralee
T
Masse
Joshua
J
Faraone
Stephen V
SV
D000293:Adolescent; D000437:Alcoholism / Q000453:epidemiology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D016022:Case-Control Studies; D002648:Child; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D013287:Illicit Drugs; D016013:Likelihood Functions; D008297:Male; D010552:Personality Assessment; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012306:Risk; D012907:Smoking / Q000453:epidemiology*; D013223:Statistics as Topic; D019966:Substance-Related Disorders / Q000453:epidemiology*
D013287:Illicit Drugs