Studys Show Substance Abuse Use Higher in Teens with Mental Health Issues

Two studies have recently come out showing a higher prevalence of substance abuse and cigarette use amongst adolescents with mental health disorders.

The first study published in the Journal of the American Academy of Child and Adolescent Psychiatry revealed a significantly higher prevalence of substance abuse and cigarette use by adolescents with attention deficit hyperactivity disorder (ADHD) histories than in those without ADHD. Researchers from the University of Pittsburgh School of Medicine and Western Psychiatric Institute and Clinic of UPMC as well as six other health centers across the United States also found that, contrary to previous findings, current medications for ADHD do not counter the risk for substance abuse and substance use disorder (SUD) among teenagers.

This study is the first to examine teenage substance abuse and treatment for ADHD in a large multi-site sample. It also is the first to recognize that increased use of cigarettes in teenagers with ADHD histories commonly occurs with use of other substances such as alcohol and marijuana.

“This study underscores the significance of the substance abuse risk for both boys and girls with childhood ADHD,” said Brooke Molina, Ph.D., professor of psychiatry and psychology at the University of Pittsburgh School of Medicine and lead author of the report. “These findings also are the strongest test to date of the association between medication for ADHD and teenage substance abuse.”

Researchers studied nearly 600 children over an eight-year period from childhood through adolescence to test the hypothesis that children with ADHD have increased risk of substance use and abuse or dependence in adolescence. Molina and colleagues also examined substance abuse patterns, the effects of ADHD medications over time, and the relationship between medication and substance use.

The findings showed:

  • When the adolescents were an average of 15 years old, 35 percent of those with ADHD histories reported using one or more substances, as compared to only 20 percent of teens without ADHD histories.
  • Ten percent of the ADHD group met criteria for a substance abuse or dependence disorder, which means they experienced significant problems from their substance use, as compared to only 3 percent of the non-ADHD group.
  • When the adolescents were an average of 17 years old, marijuana was particularly problematic with 13 percent versus 7 percent of the ADHD and non-ADHD groups, respectively, having marijuana abuse or dependence.
  • Daily cigarette smoking was very high at 17 percent of the ADHD group, a significantly higher rate than national estimates for this age. The smoking rate of non-ADHD teens was only 8 percent.
  • Alcohol use was high in both groups, highlighting its common occurrence for teenagers in general.
  • Substance abuse rates were not different for children who were still being treated with ADHD medication compared to children who were not.

The authors noted the important finding that substance abuse rates were the same in teenagers still taking medication and in those no longer on medication, even after considering multiple factors that might cause teenage medication use. They noted that these results suggest a need to identify alternative approaches to substance abuse prevention and treatment for boys and girls with ADHD.

The second study published in the British Medical Journal highlights the use of alcohol and drugs by mentally ill teens, finding that one in 10 young mentally ill teens frequently use cannabis, drink alcohol, and smoke cigarettes.

Based on the findings, researchers believe that the use of these substances can increase the risk of poor physical and mental health of young teens. They also found that early substance abuse can lead to more frequent abuse of these substances as individuals become older.

In particular, the research project included observations of over 2,000 individuals between 12 and 30 years old. The participants were involved in a national mental health headspace program in Sydney, Australia. The researchers had participants submit information on their weekly use of alcohol, cannabis, and tobacco, with 500 of the participants providing more detailed accounts of their alcohol consumption.

According to the team of investigators, alcohol was consumed at least once a week by one in eight (12 percent) of the teens between 12 to 17 years old, four out of 10 participants (39 percent) between 18 and 19 years of age, and almost half of the individuals who were between 20 and 30 years of age.

Apart from alcohol, about seven percent of the teens stated that they used cannabis at least once a week. Similar use of cannabis was also found among 14 percent of participants between 18 and 19 years of age, and 18 percent of participants between 20 and 30 years of age. The researchers discovered that participants who were in the two younger age groups had a higher likelihood of smoking cannabis every day than drinking alcohol.

Furthermore, almost one in four (23 percent) of teens noted that they smoked cigarettes on a daily basis. A larger percentage of older participants appeared to smoke daily, with one in three (36 percent) of older teens and four out of 10 (41 percent) between ages 20 and 30 years admitting to smoking every day.

At the end of the study, the team of investigators determined that 15 was the average age at which individuals began to engage in drug and alcohol use. The ones who have used any or all three of the substances have a greater likelihood of being older, male, and having suffered from psychotic or bipolar disorders The researchers believe that individuals with mental health issues who use cannabis, smoke cigarettes, or drink alcohol have a higher chance of developing serious health problems and increase their risk of mortality.

The findings from the Australian researchers correlate with a recent study by the U.S. Centers for Disease Control and Prevention (CDC) that found that U.S. adults with mental illness smoke more frequently than individuals who do not suffer from mental illness. The study, conducted collaboratively with the Substance Abuse and Mental Health Services Administration (SAMHSA), found that 36 percent of adults with mental illness smoke compared to 21 percent of individuals who do not have mental illness. Smokers with mental illness also smoke more cigarettes than nonsmokers, approximately 20 more cigarettes in a month or 240 more cigarettes in a year.

ACS’ Director of Outpatient Counseling Services, Connie Mayer, LMFT encounters a significant number of  adolescents who enter the Adolescent Substance Abuse Treatment Program with substance abuse issues and mental health issues. “Lately in assessments, we are seeing kids with mental health issues who start using drugs or alcohol at a very early age – 12 or 13,” said Mayer, “with these clients we have to examine which came first: the substance abuse, or the mental health issue that they are trying to manage with using substances?” She talks more about this  in Teen Talk’s January 24, 2013 blog piece “ACS Meets the Challenge: Treating Co-Occuring Disorders” and how ACS’ Adolescent Substance Abuse Treatment Program has adjusted their treatment methods to treat both mental health and substance abuse issues during the recovery process.

For more information about Adolescent Counseling Services and our Adolescent Substance Abuse Treatment Program go to or contact Connie Mayer at 650-424-0852 ext 104 or

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