Childhood Psychiatric Disorders as Risk Factor for Subsequent Substance Abuse: A Meta-Analysis


To assess the prospective risk of developing substance-related disorders after childhood mental health disorders (i.e., attention-deficit/hyperactivity disorder [ADHD], oppositional defiant disorder [ODD] or conduct disorder [CD], anxiety disorder, and depression) using meta-analysis.

PubMed, Embase, and PsycInfo were searched for relevant longitudinal studies that described childhood (<18 years old) ADHD, ODD or CD, anxiety, or depression in relation to later alcohol-, nicotine-, or drug-related disorders or substance use disorders (SUDs) published in peer-reviewed journals in the English language from 1986 to May 2016. Two researchers conducted all review stages. Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed.

Thirty-seven studies including more than 762,187 participants were identified for quantitative analyses. These studies included 22,029 participants with ADHD, 434 participants with ODD or CD, 1,433 participants with anxiety disorder, and 2,451 participants with depression. Ninety-seven effects sizes were extracted for analyses. Meta-analysis showed a significantly increased risk for addiction in ADHD (n = 23, odds ratio [OR] 2.27, 95% CI 1.98–3.67; OR alcohol 2.15, 95% CI 1.56–2.97; OR drugs 1.52, 95% CI 1.52–5.27; OR nicotine 2.52, 95% CI 2.01–3.15; OR SUDs 2.61, 95% CI 1.77–3.84), ODD or CD (n = 8, OR 3.18, 95% CI 1.97–5.80; OR alcohol 1.73, 95% CI 1.51–2.00; OR drugs 4.24, 95% CI; OR nicotine 4.22, 95% CI 3.21–5.55; OR SUDs 4.86, 95% CI 3.09–7.56), and depression (n = 13, OR 2.03, 95% CI 1.47–2.81; OR alcohol 1.10, 95% CI 1.02–1.19; OR nicotine 2.56, 95% CI 1.89–3.48; OR SUDs 2.20, 95% CI 1.41–3.43), but not for anxiety disorders (n = 15, OR 1.34, 95% CI 0.90–1.55, not significant).

Childhood ADHD, ODD, CD, and depression increase the risk of developing substance-related disorders. Anxiety disorders do not seem to increase the risk for future substance-related disorders, although the findings are highly heterogeneous. These findings emphasize the need for early detection and intervention to prevent debilitating substance-related disorders in later life.

In Journal of the American Academy of child and adolescent psychiatry