The effect of attention-deficit hyperactivity disorder (ADHD) compared to psychiatric comorbidity, familiality, and adversity, as risk factors for psychoactive substance use disorder (PSUD) was evaluated at the Department of Psychiatry, Massachusetts General Hospital, Boston, MA. Using baseline and 4-year follow-up data from 140 ADHD and 120 normal control subjects, the rates of alcohol or drug abuse or dependence (PSUD) were 15%, with no differences between groups. Conduct and bipolar disorders were predictive of PSUD, but these associations were independent of ADHD. Oppositional defiant disorder, uncomplicated by conduct disorder, did not predict PSUD. Family history of substance dependence and antisocial disorders was associated with PSUD in controls but less so in ADHD probands. Family history of ADHD was not associated with risk of PSUD. 
COMMENT. Adolescents with or without ADHD have a similar risk of psychoactive substance use disorders (PSUD), with a frequency of 15%. However, children with ADHD may be at higher risk for early-onset addictions than controls. PSUD in adolescents is associated with a history of conduct and bipolar disorders, but not oppositional defiant disorder, major depression, or anxiety disorders. The risk of PSUD is increased in adults with ADHD, and a sharp increase in PSUD may be expected in adolescent ADHD subjects as they become adults.
Comorbid ADHD and substance abuse. Comorbidity of ADHD among adolescents in treatment for substance abuse is reported from the National Center for Post Traumatic Stress Disorder, Veteran’s Affairs Medical Center, West Haven, CT . Attempts to self-medicate symptoms of ADHD may underlie substance use and abuse, especially in previously untreated adolescents. Prescribed medical treatment for ADHD may decrease drug craving in adults with ADHD and improve functioning.
ADHD and cigarette smoking. ADHD, particularly when associated with conduct disorders, is a significant risk factor for early cigarette smoking in children and adolescents in a study at the Massachusetts General Hospital, Boston.