ArticleAddiction biology2021
Investigating causality between liability to ADHD and substance use, and liability to substance use and ADHD risk, using Mendelian randomization.
Article in Addiction biology, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 3 of them syntheses that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
53 citing papers in PubMed, 3 syntheses or guidelines pooled it, 99 citations in OpenAlex.
- Prenatal smoking, alcohol and caffeine exposure and offspring externalizing disorders: a systematic review and meta-analysis.Addiction (Abingdon, England) · 2022Pooled it
- Genetic basis of cannabis use: a systematic review.BMC medical genomics · 2021Pooled it
- Using Mendelian randomization analysis to better understand the relationship between mental health and substance use: a systematic review.Psychological medicine · 2021Pooled it
- Attention-Deficit/Hyperactivity Disorder Treatment Patterns and Association With Clinical Outcomes in Adolescents and Young Adults with Co-Occurring Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder: A Retrospective Analysis.Journal of the American Academy of Child and Adolescent Psychiatry · 2026Article
- Early-life tobacco exposure elevating childhood attention-deficit hyperactivity disorder risk: a two-sample Mendelian randomisation analysis.European archives of psychiatry and clinical neuroscience · 2026Article
- Shared genetic architecture and neurobiological pathways of problematic alcohol use and anxiety disorders.Neuropsychopharmacology : official publication of the American College of Neuropsychopharmacology · 2026Article
- A comprehensive overview of the biological foundations of ADHD.Bioscience reports · 2026Review
- Causal inference in psychiatric research: how to critically evaluate and interpret mendelian randomization studies.Molecular psychiatry · 2026Review
- Cardiovascular Medicine Use Among Adults With ADHD: A Nationwide Study in Australia.Journal of attention disorders · 2026Article
- The Evolving ADHD Phenotype in the Externalizing Context.The American journal of psychiatry · 2026Review
- Association Between Cannabis Use and Neuropsychiatric Disorders: A Two-sample Mendelian Randomization Study.Alpha psychiatry · 2025Article
- Comparing Obstetrical Outcomes Between Attention Deficit Hyperactivity Disorder and Attention Deficit Disorder: A Population-Based Studys.Journal of clinical medicine · 2025Article
- Association between ADHD symptoms, physical effort discounting, and unhealthy lifestyles in adults.Scientific reports · 2025Article
- Bayesian causal graphical model for joint Mendelian randomization analysis of multiple exposures and outcomes.American journal of human genetics · 2025Article
- Polygenic overlap of substance use behaviors and disorders with externalizing and internalizing problems independent of genetic correlations.Psychological medicine · 2025Article
- Article
- Mediating pathways between attention deficit hyperactivity disorder and type 2 diabetes mellitus: evidence from a two-step and multivariable Mendelian randomization study.Epidemiology and psychiatric sciences · 2024Article
- Article
- Patient, supporter and primary healthcare professional perspectives on health risks in over 16s with attention deficit hyperactivity disorder (ADHD) in England: a national survey study.BMC health services research · 2024Article
- Executive Function as an Underlying Mechanism of Alcohol Use, Aggression, and ADHD.medRxiv : the preprint server for health sciences · 2024Article
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 3 countries.
Funding
Abstract
Attention-deficit hyperactivity disorder (ADHD) has consistently been associated with substance use, but the nature of this association is not fully understood. To inform intervention development and public health messages, a vital question is whether there are causal pathways from ADHD to substance use and/or vice versa. We applied bidirectional Mendelian randomization, using summary-level data from the largest available genome-wide association studies (GWAS) on ADHD, smoking (initiation, cigarettes per day, cessation, and a compound measure of lifetime smoking), alcohol use (drinks per week, alcohol problems, and alcohol dependence), cannabis use (initiation), and coffee consumption (cups per day). Genetic variants robustly associated with the "exposure" were selected as instruments and identified in the "outcome" GWAS. Effect estimates from individual genetic variants were combined with inverse-variance weighted regression and five sensitivity analyses (weighted median, weighted mode, MR-Egger, generalized summary data-based MR, and Steiger filtering). We found evidence that liability to ADHD increases likelihood of smoking initiation and heaviness of smoking among smokers, decreases likelihood of smoking cessation, and increases likelihood of cannabis initiation. There was weak evidence that liability to ADHD increases alcohol dependence risk but not drinks per week or alcohol problems. In the other direction, there was weak evidence that smoking initiation increases ADHD risk, but follow-up analyses suggested a high probability of horizontal pleiotropy. There was no clear evidence of causal pathways between ADHD and coffee consumption. Our findings corroborate epidemiological evidence, suggesting causal pathways from liability to ADHD to smoking, cannabis use, and, tentatively, alcohol dependence. Further work is needed to explore the exact mechanisms mediating these causal effects.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.