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3 June 2017

Weisner TS et al. J Atten Disord 2017; Epub ahead of print

Implementation of qualitative interviews may lead to improved resilience models in drug prevention and treatment programmes for young adults (YAs) with ADHD with substance use (SU) disorders. An understanding of the reasons why YAs start, persist or cease SU may be captured during the course of a qualitative interview. This report described the design, sample and methods for a qualitative interview study of a subsample of YAs participating in the 14- and 16- year follow-up of the Multimodal Treatment Study of ADHD (MTA).

A total of 183 participants* from the ADHD group (n=125; mean age, 24.40 years) and local normative comparison group (LNCG) (n=58; mean age, 23.74 years) were recruited from the longitudinal follow-up of the MTA study. Of these, 58 were identified as persistent substance users. An adapted version of the Substance Use Questionnaire was completed.§ Estimated daily stimulant doses (in mg equivalents of methylphenidate), number of treatment days between assessments and cumulative dose were determined using the Services for Children and Adolescents-Parent Interview and the Health Information Questionnaire self-report.

A qualitative interview based on the Ecocultural Family Interview was developed to enable participants to “tell their story” using a semi-structured script. From the interview transcripts, excerpts were indexed and coded (on a scale of 0 = unimportant to 8 = very important) to 16 topics selected by the researchers.

Of the 183 YAs participating in the study, 180 provided at least one SU-related excerpt. From the interview excerpts, a total of 9 SU topics were identified and 7 were extensively discussed. Of these coded topics, seeing others “going down the wrong path” was found to significantly influence YAs’ decisions to cease SU (ADHD participants, n=65 [52%]; LNCG participants, n=35 [60%]; p=0.006). A review of these excerpts highlighted that some YAs:

  • Believed that their ADHD medication didn’t influence their SU, but that observing peers experiencing difficulties, personal choice and other turning points in their lives influenced SU.
  • Felt that it was the stigma of an ADHD diagnosis, rather than ADHD medication itself, that influenced their SU.
  • Believed that there was a connection between taking medication and having ADHD but that it does not lead to SU, whereas others argued that taking ADHD medication discouraged them from SU.
  • Believed that the connection between ADHD and SU lay in influencing which drugs to take, not whether they developed SU.
  • Considered ADHD medication as a risk factor in SU, and suggested that it could be used as an excuse for SU.
  • Felt that they were less likely to require medication or SU if they found employment compatible with their ADHD symptoms.

The authors concluded that the qualitative interview captured the perspectives of YAs regarding SU, and that the reasons for starting, persisting or ceasing SU were similar among participants with or without ADHD. However, perceived associations between ADHD, medication and SU varied widely among the YAs.

Read more about qualitative interviews and substance use in ADHD here

 

*Participants were recruited from four of the original seven MTA sites: University of California, Irvine, n=53; Duke University Medical Center, n=52; University of California, Berkeley, n=52; Montreal Childrens’ Hospital, n=26
The MTA study randomly assigned children with ADHD to one of the following four treatment groups and assessed them up to 16 years following randomisation: 1) pharmacological treatment only; 2) behavioural treatment only; 3) combined treatment; or 4) community-treated comparison
The nine coded SU topics were: 1) relationship between emotional functioning and SU initiation or maintenance; 2) extent to which negative experience impacted SU; 3) YA’s opportunities for SU; 4) extent of connection made between ADHD drugs and use of other substances (e.g. substituted for ADHD drugs; led to other use; led to abstention; dual use); 5) extent to which people in his or her family influenced/impacted use/non-use; 6) extent to which YA perceives SU as a negative experience; 7) extent to which seeing others go “down the wrong path” influenced decisions about SU; 8) extent to which SU has a positive impact in other ways; 9) extent to which SU has a positive impact on ADHD symptoms
§Responses to the frequency items in the Substance Use Questionnaire were rated from 1 = never to 9 = more than twice per week

Weisner TS, Murray DW, Jensen PS, et al. Follow-up of young adults with ADHD in the MTA: design and methods for qualitative interviews. J Atten Disord 2017; Epub ahead of print.

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