BACKGROUND Persistence and emergence of ADHD in adulthood are associated with substance problems. We investigate differential implications of ADHD course for tobacco, alcohol, or marijuana problems by sex, then whether substance misuse results from ADHD or contributes to it, through a twin differences design. METHODS A population-based cohort of 998 twins (61 % monozygotic; 52 % female), born in Minnesota from 1988 to 1994, was prospectively assessed from ages 11-24. Childhood ADHD was oversampled. At age 24, 255 had a history of childhood-onset ADHD (160 persistent, 95 remitted); 93 had late-onset ADHD symptoms identified in late-adolescence/adulthood. Persistent, remitted, and late-onset groups were compared to those without ADHD (N = 459) on childhood characteristics and age-24 substance problems. RESULTS Persistent and late-onset groups differed in childhood; twin concordances suggested greater genetic etiology for persistent ADHD. As adolescents, however, both groups were high in conduct problems; by adulthood, they were comparably high in substance problems. In particular, women whose ADHD persisted were 5 times more likely to develop tobacco use disorder than women without ADHD. Remitted ADHD was associated with less-increased risk, except for alcohol problems among women. Consistent with possible causality, monozygotic female twins with more age-17 ADHD symptoms than co-twins had more age-24 tobacco symptoms; a similar association was found for alcohol. CONCLUSIONS Presence or emergence of ADHD in early adulthood increases substance problems to a greater degree for women than men. While effects of substances on later ADHD were not statistically significant, detection was limited by the relative rarity of late-adolescent substance symptoms.

中文翻译：

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持续，缓解和迟发性ADHD症状对男女滥用药物的不同影响：一项针对11至24岁的双胞胎研究。

背景技术成人多动症的持续存在和出现与物质问题有关。我们通过性别差异调查了ADHD课程对烟草，酒精或大麻问题的不同影响，然后通过双差异设计研究了药物滥用是由ADHD导致还是由ADHD造成。方法前瞻性评估了1988年至1994年在明尼苏达州出生的998例双胞胎（单卵菌为61％；女性为52％）的队列研究结果。儿童多动症被过度抽样。在24岁时，有255名有儿童多动症的病史（160例持续性，95例已缓解）；93例在青春晚期/成人期出现迟发性ADHD症状。坚持组，缓解组和迟发组与无ADHD组（N = 459）进行了儿童期特征和24岁以下物质问题的比较。结果在儿童期，持久性和迟发性人群有所不同。双胞胎的一致性提示持续性多动症有更多的遗传病因。但是，作为青少年，这两个群体的品行问题都很高。从成年开始，他们的物质问题就比较高。尤其是，ADHD持续存在的女性患烟草使用障碍的可能性是没有ADHD的女性的5倍。除妇女饮酒问题外，多动症的缓解与风险降低有关。与可能的因果关系一致，与同卵双胞胎相比，具有17岁以上ADHD症状的单卵双胞胎女性具有更多的24岁以下烟草症状。发现与酒精有相似的关联。结论成年早期多动症的存在或出现使女性的物质问题比男性更严重。