(PS1-D87) Can Social Engagement Predict Substance Use Outcomes in Adolescents with ADHD?

Adolescents with attention deficit/hyperactivity disorder (ADHD) have a higher risk of early substance use and substance use disorders (SUDs) (Biederman et al., 1997; Kousha et al., 2011). Determining predictors of substance use in those with ADHD can highlight who is most at risk and improve prevention efforts. Low social engagement as a predictor of poor substance use outcomes requires further study (Greene et al., 1999; Molina et al., 2014). Adolescence is a key prevention period because substance use initiation typically occurs at this age (Wilens, 2021). Remediation of social impairments may be one method of prevention in adolescents with ADHD; however, the precise domains of social impairment that are implicated remain unclear. It is not clear what type of treatments would be most effective, but a few potential options include medication, high intensity behavioral treatment that focuses on social impairment, or skills-based behavior therapy that focuses on improving ADHD symptom management. This study investigates the relationship between social engagement and substance use in adolescents with ADHD. Using 4-year follow up data from a large RCT of behavioral treatments for adolescent ADHD (Sibley et al., 2018, Sibley et al., 2020), 218 students with ADHD entering sixth and ninth grade were recruited. Participants were randomly assigned to attend either a high intensity or a low intensity summer treatment program. The current study utilizes data from the baseline and 4-year follow up assessments. Using this previously collected data, we selected social impairment, close friendships, interactive activity involvement, and treatment group as independent variables of interest and alcohol and/or marijuana initiation as the dependent variable. The covariates were presence of ODD or CD, medication status, and parent education level. Binary logistic regression models were used to analyze predictors of long-term substance use outcomes in the ninth-grade cohort. All of the measures for social engagement were insignificant, suggesting there is no relationship between social engagement and substance use outcomes for this sample. Surprisingly, the participants in the high-intensity treatment group were more likely to initiate substance use. Parent education level of bachelor’s degree or more was also associated with increased risk for substance use initiation in adolescence. We will discuss possible interpretations of the results and implications for the prevention of substance use in adolescents with ADHD.