Does Combined Stimulant and Psychosocial Treatment in Childhood Attention-Deficit/Hyperactivity Disorder Protect Against Future Substance Use?

Objective: Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for future substance use. Stimulant medication has largely failed to demonstrate protection against future substance use, but no studies have assessed whether combined stimulant and psychosocial treatment reduces future substance use compared with stimulants alone. Method: This retrospective study used data from the Rochester Epidemiology Project, a medical records repository in Olmsted County, Minnesota, to identify 1,541 children ≤7 years old who were prescribed a stimulant for ADHD between 2003 and 2019. Of children, 40% (n = 628) also received psychosocial treatment. Data on substance use after age 10 were gathered from the medical record until 2023, comprising up to 17 years of follow-up. Logistic regression compared substance use outcomes between the 2 treatment groups, and multivariable models identified childhood factors associated with future substance use. Results: Of 1,541 children with ADHD (median age = 6.0 years [interquartile range = 5.0, 7.0]; 1,111 [72%] boys, 1,225 [79%] White), 515 (33%) had documented substance use after age 10. Children who were older at initial treatment, had public insurance, had history of trauma, or had family history of substance use disorder diagnoses were more likely to use substances. Although children who received combined treatment were less likely than children who received stimulants alone to use tobacco/nicotine (21% vs 25%, adjusted odds ratio [aOR] = 0.86, Conclusion: One-third of children with ADHD went on to use substances. Combined stimulant and psychosocial interventions at baseline were associated with lower risk of tobacco/nicotine use, but there was no difference in other substance use.