Published online Sep 19, 2020. doi: 10.5498/wjp.v10.i9.202
Peer-review started: June 3, 2020
First decision: June 20, 2020
Revised: July 11, 2020
Accepted: August 15, 2020
Article in press: August 15, 2020
Published online: September 19, 2020
High risk of alcohol and drug use disorders in people with attention-deficit/hyperactivity disorder (ADHD) calls for exploratory research of relationships with clinical features of ADHD.
To estimate prevalence of alcohol/drug use disorders and associations with ADHD symptom severity and emotional dysregulation, in adults with ADHD.
This observational cross-sectional clinical study consisted of patients admitted to a private psychiatric outpatient clinic in Oslo, Norway (2014-2018). Five-hundred and fifty-eight eligible patients diagnosed with ADHD (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria) agreed to participate. Alcohol and drug use disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI). Dependence and abuse were merged into “use” disorder as in MINI version 7.0/DSM-5. Questions were related both to lifetime and the past 12-mo. ADHD severity was assessed by the Adult ADHD Self Report Scale (ASRS). Subdivisions of the ASRS questionnaire as inattentive items and hyperactive/impulsivity items were recorded separately. Emotional dysregulation was assessed by the eight-item version of Barkley’s Current Behavior Scale - Self Report.
The 12-mo prevalence was 5.3% for alcohol use disorder and 13.7% for drug use disorder. The lifetime prevalence was 12.0% for alcohol use disorder and 27.7% for drug use disorder. Men had higher rates of both alcohol use disorder and drug use disorder compared to women. The prevalence of drug use disorder was more than twice that of alcohol use disorder for both sexes. The drugs most participants reported having used were (in descending order): Amphetamine (19.1%), cannabis (17.1%), cocaine or ecstasy (7.4%), benzodiazepines (7.4%), and heroin or other opioids (2.9%). Lifetime drug use disorder was significantly associated with both hyperactivity-impulsivity symptoms and emotional dysregulation symptom severity. Lifetime alcohol use disorder, on the other hand, was not significantly associated with ADHD symptoms or emotional dysregulation when adjusted for gender and age.
Patients with ADHD have a high lifetime prevalence of drug use disorder, which is associated with higher levels of hyperactivity-impulsivity symptoms and emotional dysregulation.
Core Tip: High rates of alcohol and drug use disorders in people with attention-deficit/hyperactivity disorder (ADHD) needs further explanation. In this study of adult ADHD patients in clinical practice, we found a remarkably high incidence of past or current drug use disorder, especially for amphetamine and cannabis. Drug use disorder but not alcohol was associated with clinical features of ADHD, such as hyperactivity-impulsivity symptoms and emotional dysregulation. The findings point to self-medication for ADHD as a plausible explanation and suggest early diagnosis and treatment of ADHD as a preventive strategy against substance abuse.