Psychiatric comorbidity in treatment‐seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study

Abstract

Aims To determine comorbidity patterns in treatment-seeking substance use disorder (SUD) patients with and without adult attention deficit hyperactivity disorder (ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. Design Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence (IASP) study. Setting Forty-seven centres of SUD treatment in 10 countries. Participants A total of 1205 treatment-seeking SUD patients. Measurements Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners’ Adult ADHD Diagnostic Interview for DSM-IV (CAADID), the presence of antisocial personality disorder (ASPD), major depression (MD) and (hypo)manic episode (HME) was assessed with the Mini International Neuropsychiatric Interview-Plus (MINI Plus), and the presence of borderline personality disorder (BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II (SCID II). Findings The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio (OR) = 2.8, 95% confidence interval (CI) = 1.8–4.2], BPD (OR = 7.0, 95% CI = 3.1–15.6 for alcohol; OR = 3.4, 95% CI = 1.8–6.4 for drugs), MD in patients with alcohol as primary substance of abuse (OR = 4.1, 95% CI = 2.1–7.8) and HME (OR = 4.3, 95% CI = 2.1–8.7) were all more prevalent in ADHD+ compared with ADHD− patients (P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype (P < 0.01), increased HME and ASPD in the hyperactive/impulsive (P < 0.01) and combined subtypes (P < 0.001) and increased BPD in all subtypes (P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD. Conclusions Treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders.

The pathway to substance misuse for young people with ADHD and conduct disorder

“…without it I felt hopeless about the future (depression), to help me cope with stress (stress/anxiety). Both depression and anxiety are two of the most frequent correlates with ADHD generally (Biederman et al, 2006;van Emmerik-van Oortmerssen et al, 2014) and in prison (Gonzalez, Velez-Pastrana, Ruiz Varcarcel, Levin, & Albizu-Garcia, 2015). In this context, further research should examine how much variance is explained by comorbid disorders, using a structured approach and longitudinal-experimental designs that allow for testing moderators and mediators.…”

“…Meanwhile, the comorbidity hypothesis states that substance misuse is better explained by coexisting disorders with SUD (i.e., dual diagnoses), such as conduct disorder in youths, and personality traits, anxiety or mood disorders. A meta-analysis documented the extent of additional comorbidity present in patients with coexisting ADHD/SUD (van Emmerik-van Oortmerssen et al, 2014), lending some support to this view.…”

“…A lifetime prevalence of 23% was recently reported based on international samples of treatment-seeking adults with SUD (van Emmerik-van Oortmerssen et al, 2014).…”

“…The estimated pooled prevalence of ADHD in prison ranges between 26-30% (Young, Moss, Sedgwick, Fridman, & Hodgkins, 2014), which substantially contrasts with prevalence estimates in the general population at about 2.8-5.3% (Polanczyk, de Lima, Horta, Biederman, & Rohde, 2007;Simon, Czobor, Balint, Meszaros, & Bitter, 2009). This dual-diagnosis has critical implications for intervention and policy, because ADHD is associated with further comorbidity (van Emmerik-van Oortmerssen et al, 2014), and moderates drug treatment outcomes with overall poorer prognosis (Levin et al, 2004).…”

A Study of Prevalence and Other Characteristics of Adult Adhd in Substance Use Disorder Patients: A Cross Sectional Study

“…This prevalence rate was comparable to the result of the recent meta-analysis by Van Emmerik-Van Oortmersser et al 2013 (Based on 12 studies in adult treatment seeking SUD patients). 23 which reported the pooled Adult ADHD prevalence rate at 23.3%. The results are also comparable to another study conducted in Egypt by A. Abdelkarim et al 2013.…”