title: Adolescent substance use in the multimodal treatment study of attention-deficit/hyperactivity disorder (ADHD) (MTA) as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication.
abstract: OBJECTIVE
  To determine long-term effects on substance use and substance use disorder (SUD), up to 8 years after childhood enrollment, of the randomly assigned 14-month treatments in the multisite Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder (MTA; n = 436); to test whether medication at follow-up, cumulative psychostimulant treatment over time, or both relate to substance use/SUD; and to compare substance use/SUD in the ADHD sample to the non-ADHD childhood classmate comparison group (n = 261).
  
  
  METHODS
  Mixed-effects regression models with planned contrasts were used for all tests except the important cumulative stimulant treatment question, for which propensity score matching analysis was used.
  
  
  RESULTS
  The originally randomized treatment groups did not differ significantly on substance use/SUD by the 8-year follow-up or earlier (mean age = 17 years). Neither medication at follow-up (mostly stimulants) nor cumulative stimulant treatment was associated with adolescent substance use/SUD. Substance use at all time points, including use of two or more substances and SUD, were each greater in the ADHD than in the non-ADHD samples, regardless of sex.
  
  
  CONCLUSIONS
  Medication for ADHD did not protect from, or contribute to, visible risk of substance use or SUD by adolescence, whether analyzed as randomized treatment assignment in childhood, as medication at follow-up, or as cumulative stimulant treatment over an 8-year follow-up from childhood. These results suggest the need to identify alternative or adjunctive adolescent-focused approaches to substance abuse prevention and treatment for boys and girls with ADHD, especially given their increased risk for use and abuse of multiple substances that is not improved with stimulant medication. Clinical trial registration information-Multimodal Treatment Study of Children With Attention Deficit and Hyperactivity Disorder (MTA); http://clinical trials.gov/; NCT00000388.
authors: Department of Psychiatry, University of Pittsburgh, School of Medicine, Pittsburgh, PA 15213, USA. molinab@upmc.edu
authors: Brooke S G
authors: BS
authors: Molina
authors: Stephen P
authors: SP
authors: Hinshaw
authors: L
authors: L
authors: Eugene Arnold
authors: James M
authors: JM
authors: Swanson
authors: William E
authors: WE
authors: Pelham
authors: Lily
authors: L
authors: Hechtman
authors: Betsy
authors: B
authors: Hoza
authors: Jeffery N
authors: JN
authors: Epstein
authors: Timothy
authors: T
authors: Wigal
authors: Howard B
authors: HB
authors: Abikoff
authors: Laurence L
authors: LL
authors: Greenhill
authors: Peter S
authors: PS
authors: Jensen
authors: Karen C
authors: KC
authors: Wells
authors: Benedetto
authors: B
authors: Vitiello
authors: Robert D
authors: RD
authors: Gibbons
authors: Andrea
authors: A
authors: Howard
authors: Patricia R
authors: PR
authors: Houck
authors: Kwan
authors: K
authors: Hur
authors: Bo
authors: B
authors: Lu
authors: Sue
authors: S
authors: Marcus
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy / Q000453:epidemiology / Q000628:therapy*; D001521:Behavior Therapy; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D003131:Combined Modality Therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D011569:Psychiatric Status Rating Scales; D012044:Regression Analysis; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants