Is ADHD a Risk Factor Independent of Conduct Disorder for Illicit Substance Use? A Meta-Analysis and Metaregression Investigation

Serra-Pinheiro, Maria Antônia; Coutinho, Evandro Silva Freire; Souza, Isabella S.; Pinna, Camilla Moreira de Sousa; Fortes, Dídia; Araújo, Cátia; Szobot, Cláudia Maciel; Rohde, Luis Augusto; Mattos, Paulo

doi:10.1177/1087054711435362

Cited by 43 publications

(36 citation statements)

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“…Merikangas et al 1998). Attention deficit / hyperactivity disorder (ADHD) is also commonly reported by individuals with SUD (Szobot et al 2007), and some studies have indicated that the link between SUDs and ADHD is usually through conduct disorder or antisocial personality disorder (Disney et al 1999;Elkins et al 2007;Serra-Pinheiro et al 2013).…”

Section: Comorbiditymentioning

confidence: 99%

Behavioural addiction—A rising tide?

Chamberlain

Löchner

Stein

et al. 2016

European Neuropsychopharmacology

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The term 'addiction' was traditionally used in relation to centrally active substances, such as cocaine, alcohol, or nicotine. Addiction is not a unitary construct but rather incorporates a number of features, such as repetitive engagement in behaviours that are rewarding (at least initially), loss of control (spiralling engagement over time), persistence despite untoward functional consequences, and physical dependence (evidenced by withdrawal symptoms when intake of the substance diminishes). It has been suggested that certain psychiatric disorders characterized by maladaptive, repetitive behaviours share parallels with substance addiction and therefore represent 'behavioural addictions'. This perspective has influenced the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which now has a category 'Substance Related and Addictive Disorders', including gambling disorder. Could other disorders characterised by repetitive behaviours, besides gambling disorder, also be considered 'addictions'? Potential examples include kleptomania, compulsive sexual behaviour, 'Internet addiction', trichotillomania (hair pulling disorder), and skin-picking disorder. This paper seeks to define what is meant by 'behavioural addiction', and critically considers the evidence for and against this conceptualisation in respect of the above conditions, from perspectives of aetiology, phenomenology, co-morbidity, neurobiology, and treatment. Research in this area has important implications for future diagnostic classification systems, neurobiological models, and novel treatment directions.

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Section: Comorbiditymentioning

confidence: 99%

Behavioural addiction—A rising tide?

Chamberlain

Löchner

Stein

et al. 2016

European Neuropsychopharmacology

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“…81 However, a meta-analysis of 1,000 individuals found that ADHD alone might not be an independent risk factor for substance use (RR = 1.35 [0.90-2.03]) when CD and ODD are excluded. 82 Panic disorder predicts alcohol use in adolescence and adulthood, while social phobia is associated with alcohol and cannabis. 83,84 Bipolar disorder and depression are important risk factors, and they often precede substance use in childhood and adolescence.…”

Section: Psychiatric Comorbiditiesmentioning

confidence: 99%

Use of psychoactive substances by adolescents: current panorama

Lopes

Nobrega

Prette

et al. 2013

Rev. Bras. Psiquiatr.

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Adolescence is a period of vulnerability to substance use disorders (SUDs). Epidemiological studies indicate that about 23% of Brazilian adolescents use drugs, with alcohol being the most widely consumed substance. The etiology of SUDs is complex, influenced by an interaction of genetic risk, individual development, environmental factors, context of use, and substance used. Clinicians should consider diagnostic criteria and be aware of behavioral changes that may indicate drug use and its consequences in various aspects of adolescent life. Identification and treatment of comorbid conditions is critical to the management of SUDs in this age group. Interventions should restrict access to drugs and facilitate prompt recognition of initial use, preventing progression to serious patterns of abuse or dependence. Intervention should be broad, including academic and occupational activities as well as social relationships and leisure, which are critical to the reestablishment of normal adolescent development.

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“…In this context, there is still no consensus on the question whether the ADHD inattention symptoms or the ADHD hyperactivity/impulsivity symptoms are more predictive of substance problems [7][8][9]. In addition, some studies found a direct association between ADHD and substance abuse [10], while others demonstrated that this relationship disappears when cooccurring conduct disorder (CD) is taken into account [8,11,12]. Flory et al [3] noted that any observed association between ADHD and substance abuse not considering the overlap of ADHD with CD may be spurious.…”

Section: Introductionmentioning

confidence: 99%

“…Yet because the sample consisted of mainly marijuana or marijuana plus cocaine users, the results might not apply to subjects with a different profile of substance abuse or disorders. Furthermore, a meta-analysis and meta-regression investigation concluded that ADHD did not increase the risk of illicit substance use beyond the effects of CD/ODD [11].ADHD can be defined as extreme values along quantitative dimensions of inattention and hyperactivity/impulsivity [8]. Some studies showed that mainly the inattention symptoms are predictive of substance problems [43,9], while other studies demonstrated that the hyperactivity/impulsivity symptoms are most predictive [44,8].…”

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confidence: 99%

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Externalizing disorders and substance use: empirically derived subtypes in a population-based sample of adults

Rodgers

Müller

Rössler

et al. 2014

Soc Psychiatry Psychiatr Epidemiol

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Manuscript to be resubmitted to Social Psychiatry and Psychiatric Epidemiology (SPPE)(Attention-deficit/hyperactivity disorder (ADHD), conduct disorder (CD), and oppositional defiant disorder (ODD) are common externalizing disorders of childhood. The common effects of these disorders on substance abuse need further investigation. The current study investigated the joint clusters of childhood/adolescence ADHD, CD, and ODD, and their influence on substance abuse/dependence in a population-based sample of adults. Methods:The data were drawn from the PsyCoLaus study (n=3720) conducted in Lausanne, Switzerland. The populationbased sample included 238 subjects meeting criteria for ADHD/ODD/CD diagnoses before the age of 15. Latent class analyses (LCA) were performed in order to derive comorbidity subtypes, which were subsequently characterized with respect to psychosocial correlates and substance use. Results:The best fit in LCAs was achieved with three latent classes: an ADHD subtype (35.7%); an externalizing multimorbid subtype (33.6%) involving ODD, ADHD, and CD; and a third subtype with CD (30.7%). The CD subtype showed the highest association with substance use. Apart from this, the externalizing multimorbid subtype was also significantly linked to substance use. The ADHD subtype had only elevated frequencies for alcohol dependence in comparison with subjects that had no history of ADHD, ODD, and CD during childhood or adolescence. Finally, important interactions between subtypes and sex were observed with regard to substance use. Conclusions:This study provides evidence showing that subtyping the externalizing disorders, ADHD, ODD and CD, along their comorbidity patterns leads to important differences regarding substance use. This could have implications for the etiology, prevention, and treatment of substance use disorders. Key words: Attention-deficit/hyperactivity disorder, conduct disorder, oppositional defiant disorder, latent class analysis, epidemiologyExternalizing disorders and substance use Rodgers et al. 3 IntroductionAttention deficit hyperactivity disorder (ADHD) is the most common externalizing disorder of childhood, with prevalence rates between 3 and 7.5%, and, with looser definitions, even up to 17% [1]. Subjects with ADHD frequently remain symptomatic into adulthood. This disorder is associated with adverse long-term functional outcomes, such as poor interpersonal relationships and lower educational qualifications, leading to high economic and social burdens [2]. One of the most controversial issues in the research on ADHD is its relation to comorbid disorders such as substance abuse [3]. A recent meta-analysis demonstrated that childhood ADHD was associated with nicotine use in adolescence and with alcohol and drug use disorders in adulthood [4]. These results were confirmed in a large population-based study [5]. Prevalence rates of substance use disorders were shown to be more than two-fold higher than the 8-15% in the general population [6]. In this context, there is still no consensus on th...

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Is ADHD a Risk Factor Independent of Conduct Disorder for Illicit Substance Use? A Meta-Analysis and Metaregression Investigation

Abstract: The existing data do not indicate that ADHD increases the risk of ISU beyond the effects of CD/ODD. However, the combination of all existing data is limited in power to detect a small increase in chance.

Cited by 43 publications

References 60 publications

Behavioural addiction—A rising tide?

Behavioural addiction—A rising tide?

Use of psychoactive substances by adolescents: current panorama

Externalizing disorders and substance use: empirically derived subtypes in a population-based sample of adults

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