Margherio Samantha M, Morse Sean, DuPaul George J, Evans Steven W
Department of Psychology, Virginia Polytechnic Institute and State University, United States of America.
Department of Education and Human Services, Lehigh University, United States of America.
J Subst Use Addict Treat. 2025 Jan;168:209523. doi: 10.1016/j.josat.2024.209523. Epub 2024 Oct 2.
Adolescents with attention-deficit/hyperactivity disorder (ADHD) may be at risk for early, escalating patterns of alcohol and substance use via academic, peer, and familial impairment. Existing school-based interventions for youth with ADHD effectively target these risk factors, yet their effects on alcohol and substance use have not been explored. We examined the immediate and long-term alcohol and substance use outcomes of an evidence-based school-based intervention for adolescents with ADHD.
A total of 186 (M = 15, 79% boys, 78% White, 11% Hispanic) adolescents with ADHD were randomized to either a school-based training intervention targeting academic and social skills or a treatment-as-usual control group. A subset of youth was followed into emerging adulthood (5 year follow-up; n = 73). Participants reported on their alcohol and substance use behaviors and problems at post-treatment, 6-month follow-up, and 5-year follow-up.
Two-part hurdle models controlling for prior use and demographics indicated treatment was associated with improvements in substance use outcomes among youth using any substances at 6-month follow-up (β = -0.45). However, among youth reporting any alcohol use at the 5-year follow-up, treatment was associated with worse alcohol use problems relative to the control condition (β = 0.27). Approximately 22% of intervention participants met criteria for risky drinking behavior compared to 5% of participants in the control group.
We found mixed evidence that a school-based intervention associated with positive outcomes on academic, social, and emotional functioning for adolescents with ADHD also prevented adverse alcohol and substance use outcomes. These unexpected results serve as a call for extended follow-up periods to identify the durability of intervention benefits and potential for downstream iatrogenic effects. Additional research is needed to identify school-based intervention strategies that can effectively deter substance use risk among select populations.
患有注意力缺陷多动障碍（ADHD）的青少年可能因学业、同伴和家庭方面的损害而面临早期、不断升级的酒精和物质使用模式的风险。现有的针对患有ADHD的青少年的校内干预措施有效地针对了这些风险因素，但尚未探讨其对酒精和物质使用的影响。我们研究了一项基于证据的针对患有ADHD的青少年的校内干预措施对酒精和物质使用的即时和长期结果。
共有186名（平均年龄15岁，79%为男孩，78%为白人，11%为西班牙裔）患有ADHD的青少年被随机分为接受针对学业和社交技能的校内培训干预组或常规治疗对照组。一部分青少年被追踪至成年早期（5年随访；n = 73）。参与者在治疗后、6个月随访和5年随访时报告了他们的酒精和物质使用行为及问题。
控制先前使用情况和人口统计学因素的两部分障碍模型表明，在6个月随访时，治疗与使用任何物质的青少年的物质使用结果改善相关（β = -0.45）。然而，在5年随访时报告有任何酒精使用的青少年中，与对照组相比，治疗与更严重的酒精使用问题相关（β = 0.27）。干预组约22%的参与者符合危险饮酒行为标准，而对照组为5%。
我们发现证据不一，即一项与患有ADHD的青少年在学业、社交和情感功能方面的积极结果相关的校内干预措施也预防了不良的酒精和物质使用结果。这些意外结果呼吁延长随访期，以确定干预益处的持续性和下游医源性效应的可能性。需要更多研究来确定能够有效降低特定人群物质使用风险的校内干预策略。
