Cigarette smoking as a risk factor for other substance misuse: 10-year study of individuals with and without attention-deficit hyperactivity disorder
Joseph Biederman, Carter R. Petty, Paul Hammerness, Holly Batchelder, Stephen V. Faraone
  • Declaration of interest

    J.B. is currently receiving research support from: Elminda, Janssen, McNeil and Shire. He has received: honoraria from the Massachusetts General Hospital (MGH) Psychiatry Academy for a tuition-funded continuing medical education (CME) course on ADHD; departmental royalties from a copyrighted rating scale used for ADHD diagnoses, paid to the Department of Psychiatry at MGH by Eli Lilly, Shire and AstraZeneca; a speaker’s fee for a talk given at Fundación Dr. Manuel Camelo A.C. in Monterrey, Mexico; honoraria for consultations for Shionogi Pharma and Cipher Pharmaceuticals, paid to the Department of Psychiatry at the MGH; research support, consultation fees, or speaker’s fees for/from: Abbott, Alza, AstraZeneca, Boston University, Bristol-Myers Squibb, Celltech, Cephalon, Eli Lilly and Co., Esai, Fundacion Areces (Spain), Forest, GlaxoSmithKline, Gliatech, Hastings Center, Janssen, McNeil, Medice Pharmaceuticals (Germany), Merck, MMC Pediatric, NARSAD, NIDA, New River, NICHD, NIMH, Novartis, Noven, Neurosearch, Organon, Otsuka, Pfizer, Pharmacia, Phase V Communications, Physicians Academy, The Prechter Foundation, Quantia Communications, Reed Exhibitions, Shire, the Spanish Child Psychiatry Association, The Stanley Foundation, UCB Pharma, Veritas, and Wyeth. In the past 12 months, P.H. has participated in CME activities/writing supported by Shire Pharmaceuticals and, as an investigator/principal investigator, in research funded by: Cephalon, Forest, GlaxoSmithKline, Johnson & Johnson, McNeil, Novartis, Ortho-McNeil Janssen, Shire, Takeda Pharmaceuticals and Elminda. P.H. has also received honoraria from commercial entities supporting the MGH Psychiatry Academy ( In the past year, S.V.F. received consulting income and research support from Shire, Otsuka and Alcobra and research support from the National Institutes of Health. He has also received consulting fees or was on advisory boards or participated in CME programmes sponsored by: Shire, McNeil, Janssen, Novartis, Pfizer and Eli Lilly.



We previously documented that cigarette smoking is a risk factor for subsequent alcohol and drug misuse and dependence in adolescent girls with attention-deficit hyperactivity disorder (ADHD).


To revisit this hypothesis with a large longitudinal sample of both genders followed up for 10 years into young adulthood.


We used data from two identically designed, longitudinal, case–control family studies of boys and girls with and without ADHD ascertained from psychiatric and paediatric sources. We studied 165 individuals with ADHD and 374 controls followed up longitudinally and masked for 10 years. We assessed ADHD, smoking and substance use status using structured diagnostic interviews. We tested the association between cigarette smoking and subsequent substance use outcomes using Cox proportional hazard regression models.


Youth with ADHD who smoked cigarettes (n = 27) were significantly more likely to subsequently develop drug misuse and dependence compared with youth with ADHD who did not smoke (n = 138, P<0.05).


These results confirm that cigarette smoking increases the risk for subsequent drug and alcohol use disorders among individuals with ADHD. These findings have important public health implications, and underscore the already pressing need to prevent smoking in children with ADHD.