Everyday difficulties in a person with a methamphetamine-use history cannot automatically be attributed to that exposure. Childhood-onset conditions may contribute to both the history and later functioning. A 2013 study examined ADHD as one such factor.
A 755-person retrospective study
Obermeit and colleagues examined 400 participants with methamphetamine-use disorders within 18 months of evaluation and 355 comparison participants without that history. Participants came from methamphetamine and HIV research cohorts recruited primarily through local HIV and drug-treatment clinics.
ADHD diagnoses were established through a structured interview using DSM-IV criteria, including childhood symptoms between ages six and ten. Current ADHD required full criteria within the preceding year; lifetime ADHD referred to criteria met at any time.
Participants were required to have negative urine toxicology for illicit substances other than marijuana on the testing day. That screening criterion does not establish a uniform duration of methamphetamine abstinence or a concentration associated with functioning.
What did the prevalence comparison show?
Lifetime ADHD occurred in approximately 20.8% of the methamphetamine group and 6.2% of comparison participants. Adjustment for selected background differences still showed an association between methamphetamine-group status and ADHD.
The pattern differed by subtype. Combined and hyperactive subtypes were more frequent in the methamphetamine group, while the inattentive subtype comparison was not significant. Persistence of childhood combined-type ADHD into adulthood also differed; persistence comparisons for the other subtypes did not.
These are sample-specific prevalence findings, not estimates for every person who has used methamphetamine. Recruitment through clinical and research cohorts limits generalization.
Which everyday outcomes were associated with ADHD?
Within the methamphetamine group, lifetime ADHD remained associated with more cognitive symptoms, greater dependence in instrumental daily activities and unemployment in adjusted models. The models considered education and reading ability, age, depression, neurocognitive impairment and other substance-use histories.
Daily functioning was assessed predominantly through self-report. Employment included full- or part-time work; it should not be recast as an exclusively full-time employment outcome. The study’s statistical use of “predictor” refers to regression association, not a prospectively validated prediction of future disability.
What does the study leave unresolved?
Retrospective diagnosis and self-report can introduce recall or reporting bias. The analysis did not determine whether ADHD increased susceptibility to methamphetamine-use problems, whether use influenced persistence of childhood symptoms, or whether shared factors contributed to both.
It did not demonstrate that methamphetamine caused ADHD. Nor did it test whether treating ADHD would improve the reported functional outcomes. Those are separate causal and intervention questions.
For an expert reviewing an individual matter, the study supports examining developmental history alongside exposure history, objective testing and functional records. A positive drug result cannot establish the source of a longstanding organizational difficulty, and an ADHD diagnosis cannot itself resolve legal capacity, credibility or driving impairment.
Historical primary source
Obermeit LC, Cattie JE, Bolden KA, et al. Attention-Deficit/Hyperactivity Disorder Among Chronic Methamphetamine Users: Frequency, Persistence, and Adverse Effects on Everyday Functioning. Addictive Behaviors. 2013;38(12):2874–2878. doi:10.1016/j.addbeh.2013.08.010.
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