A history of attention deficit hyperactivity disorder (ADHD) in adults is significantly associated with younger ages of initiation for illicit substance use and a greater risk of engagement in recent HIV-risk behaviors such as injection drug use and needle sharing, suggests a new article in the journal Addictive Behaviors.

Eugene Dunne, MA, and colleagues at the University of Florida evaluated data on 941 adults ages 18–65 enrolled in the NEURO-HIV Epidemiological Study from 2002–2012 in Baltimore, MD. Inclusion criteria included non-injection or injection drug use in the past six months and participants completed standardized face-to-face interviews that included questionnaires on demographic information, substance abuse, sexual risk behaviors, and self-reported history of ADHD diagnosis.

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About 13% of participants reported a history of ADHD. ADHD history was significantly associated with younger ages of initiation for alcohol, cigarettes, marijuana, nasal cocaine, and injection cocaine. They also reported an earlier initiation age for nasal and injection heroin and injection speedball, although these differences were not significant. These adults were more likely to report recent use of non-injection and injection drugs compared to those without ADHD history. ADHD history was also associated with an increased prevalence of needle sharing among injection drug users.

The authors conclude that these results support an accelerated gateway model for substance use related to ADHD history and increased problem severity in adulthood. Adolescents with ADHD may benefit from targeted prevention efforts to counter the high risk for substance use initiation, while substance abuse treatment facilities should be aware of the potential HIV-risk behaviors among adult illicit drug users with ADHD.

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