A sobering fact: ADHD leads to substance abuse.

t A s h v v T he link between attention-deficit/hyperactivity disorder (ADHD) and alcohol or drug abuse or dependence in adolescents and adults has been an area of increasing clinical, research, and public health interest. ADHD continues to be among the most common neurobehavioral disorders presenting for diagnosis and treatment in children. ADHD occurs in early childhood and affects 6% to 9% of juveniles and 4% to 5% of adults (for review, see Wilens and Spencer). Persistent from childhood into adulthood in approximately half of cases, ADHD is associated with learning disorders, psychiatric comorbidity, and substantial educational, occupational, and interpersonal impairments across the life span. Substance use disorders (SUDs) usually occur in adolescence or early adulthood and affect 15% to 20% of American adults and a less defined but sizable number of juveniles. What has been an intense area of research over the previous decade has been the link between ADHD and SUDs. The thorough and informative meta-analysis by Charach and associates has been very helpful in answering an important question: does ADHD really put you at risk for later SUDs? Understanding this fundamental question is really quite important. Given the catastrophic effects of SUDs on an individual and his or her family, anything we can do as clinicians to ameliorate the risk of developing SUDs is crucial. ADHD uniformly occurs before SUDs. Hence, in the spirit of prevention, by understanding the risk for SUDs, we can educate, monitor, and potentially modify the course of SUDs in youths growing up with ADHD. Clinicians need to start discussing this risk with our patients and their families, beginning in the fifth grade and before the onset of SUDs. Although Charach et al. have shed important light on ADHD risk for SUDs, we can certainly benefit from similar analyses examining the risk for ADHD in substance abusers. Qualitative e