Observational Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatr. Sep 19, 2020; 10(9): 202-211
Published online Sep 19, 2020. doi: 10.5498/wjp.v10.i9.202
Alcohol and drug use disorders in adult attention-deficit/hyperactivity disorder: Prevalence and associations with attention-deficit/hyperactivity disorder symptom severity and emotional dysregulation
Espen Anker, Jan Haavik, Trond Heir
Espen Anker, Oslo ADHD clinic, Oslo 0366, Norway
Jan Haavik, Department of Biomedicine, University of Bergen, Bergen 5007, Norway
Jan Haavik, Division of Psychiatry, Haukeland University Hospital, Bergen 5021, Norway
Trond Heir, Institute of Clinical Medicine, University of Oslo, Oslo 0316, Norway
Author contributions: Anker E and Heir T designed the study; Anker E collected and analyzed the data; Anker E, Haavik J, and Heir T actively participated in the writing of the manuscript; all authors approved the final draft.
Supported by NevSom University of Oslo, No. 51379.
Institutional review board statement: The study was reviewed and approved by (Regionale Komiteer for Medisinsk og Helsefaglig Forskningsetikk). Norwegian Regional committees for medical and health research ethics.
Informed consent statement: All study participants gave written informed consent to participate in the study.
Conflict-of-interest statement: Espen Anker has received speaker honoraria from Shire; Jan Haavik has received speaker honoraria from Lilly, Shire, HB Pharma, Medice and Biocodex; Trond Heir reports having no competing interests.
Data sharing statement: Data are from a private psychiatric outward in Oslo. Public availability would compromise privacy of the respondents. According to the approval from the Norwegian Regional committees for medical and health research ethics, the data is to be stored properly and in line with the Norwegian Law of privacy protection. However, anonymized data is freely available to interested researchers upon request, pending ethical approval from the ethics committee. Interested researchers can contact project leader Espen Anker (espen.anker@online.no) with requests for the data.
STROBE statement: The authors have read the STROBE Statement – checklist of items, and the manuscript was prepared and revised according to the STROBE Statement – checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Espen Anker, MD, Oslo ADHD Clinic, Kirkeveien 64B, Oslo 0366, Norway. espen.anker@online.no
Received: June 3, 2020
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.

Keywords: Attention-deficit/hyperactivity disorder, Adult ADHD Self Report Scale, Emotional dysregulation, Substance use disorder, Alcohol use disorder, Drug use disorder

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.