Correlates of co-occurring ADHD in drug-dependent subjects: Prevalence and features of substance dependence and psychiatric disorders

Abstract

We examined the prevalence and course of psychiatric and substance dependence (SD) disorders in subjects with SD and attention deficit hyperactivity disorder (ADHD).Method-We interviewed 1,761 adults with a lifetime diagnosis of cocaine and/or opioid dependence using the Semi-Structured Assessment for Drug Dependence and Alcoholism. Generalized linear regression with generalized estimating equation analysis was used to examine the associations between a lifetime diagnosis of ADHD and indicators of clinical course, and to identify unique correlates of ADHD.Results-Lifetime ADHD prevalence in the SD sample was 5.22% (vs. 0.85% in a group of individuals without SD). ADHD was associated with an earlier age of first substance use, more SD and psychiatric diagnoses, a greater likelihood of attempted suicide, and more hospitalizations. After controlling for conduct disorder and bipolar type I disorder, there were unique effects of ADHD on age of first substance use and number of SD diagnoses.Conclusion-In subjects with cocaine or opioid dependence, ADHD is associated with greater SD and psychiatric comorbidity and a more severe course of illness.

Trastorno por déficit de atención con hiperactividad y dependencia de sustancias depresoras. Una revisión

“…En pacientes en tratamiento por trastornos por uso de sustancias (TUS) se han encontrado mayores prevalencias de TDAH, que habitualmente se sitúan alrededor del 20% en función de las muestras estudiadas y los instrumentos utilizados (Arias et al, 2008;Clure et al, 1999;Daigre et al, 2009;Daigre et al, 2012;Kessler et al, 2006;Perez de Los Cobos et al, 2010;Wilens y Dodson, 2004). En un reciente metanálisis, que incluyó 29 estudios, se ha estimado la prevalencia del TDAH en TUS en un 23.1% (van Emmerik-van Oortmerssen et al, 2011).…”

“…Además, algunos estudios sólo estudian los antecedentes de TDAH en la infancia, sin incluir la sintomatología en la vida adulta (Davids et al, 2005;Modestin, Matutat y Wurmle, 2001). No se conoce una estimación clara de la prevalencia de TDAH en el adulto en dependientes de opiáceos, variando entre 4.5 y 24.9% (Arias et al, 2008;Carpentier, van Gogh, Knapen, Buitelaar y De Jong, 2010;King, Brooner, Kidorf, Stoller y Mirsky, 1999;Kolpe y Carlson, 2007).…”

“…Higher prevalences of ADHD have been found in patients treated for substance use disorders (SUDs), which are usually around 20% depending on the samples studied and the instruments used (Arias et al, 2008;Clure et al, 1999;Daigre et al, 2009;Daigre et al, 2012;Kessler et al, 2006;Perez de Los Cobos et al, 2010;Wilens & Dodson, 2004). In a recent meta-analysis including 29 studies, a prevalence of ADHD in SUD of 23.1% was estimated (van Emmerik-van Oortmerssen et al, 2011).…”

“…Children with an untreated ADHD have greater risk of developing addiction than children without this disorder, usually starting substance abuse early and moving faster from use to abuse and to substance dependence . In addition, an ADHD associated with a substance abuse disorder is associated with a poorer course and a less favorable prognosis of drug abuse (Arias et al, 2008;Brooner, King, Kidorf, Schmidt, & Bigelow, 1997;Charach, Yeung, Climans, & Lillie, 2011;Wilens, Biederman, Mick, Faraone, & Spencer, 1997;. Kollins (2008) proposed in a review that in persons with ADHD, comorbidity with antisocial disorder, oppositional defiant disorder, bipolar disorder, and eating disorder increases the risk of development of a substance use disorder.…”

“…Los niños con un TDAH no tratado tienen más riesgo de desarrollar una adicción que los niños sin este trastorno, tienden a iniciar precozmente el consumo de sustancias y pasan más rápidamente del uso, al abuso y a la dependencia de sustancias . Además, un TDAH asociado a un trastorno por uso de sustancias, se asocia a una peor evolución y a un pronóstico menos favorable de la drogodependencia (Arias et al, 2008;Biederman et al, 1998;Brooner, King, Kidorf, Schmidt y Bigelow, 1997;Charach, Yeung, Climans y Lillie, 2011;Wilens, Biederman, Mick, Faraone y Spencer, 1997;Wilens, Biederman y Mick, 1998). Kollins (2008) en una revisión ha planteado que en personas con un TDAH, la comorbilidad con el trastorno disocial, trastorno oposicionista desafiante, trastorno bipolar y trastorno de la conducta alimentaria aumentan el riesgo del desarrollo de un trastornos por uso de sustancias.…”