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
Research background

The co-occurrence of attention-deficit hyperactivity disorder (ADHD) and substance use disorders, such as alcohol use disorder (AUD) and drug use disorder (DUD), has been studied in a variety of clinical and research settings. It is still unclear whether an increased risk of abuse or dependence applies to all forms of substance use to the same extent.

Research motivation

We have yet to fully understand the magnitude and nature of substance use among the adult population with ADHD. By obtaining more knowledge about the prevalence of AUD and DUD in adults with ADHD and the associations with clinical features of ADHD, this information can lead to hypotheses as to why some people with ADHD are at greater risk of developing substance use disorder.

Research objectives

To estimate the prevalence of AUD and DUD in adults with ADHD, and to estimate the associations with ADHD symptom severity and emotional dysregulation.

Research methods

This was an observational cross-sectional clinical study with a study sample consisting of 585 adult ADHD patients, who were admitted to a private psychiatric outpatient clinic over a 5-year period. ADHD was diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition criteria. AUD and DUD were diagnosed using the Mini International Neuropsychiatric Interview. ADHD severity was assessed by the Adult ADHD Self Report Scale. Emotional dysregulation was assessed by the 8-item version of Barkley’s Current Behavior Scale - Self Report.

Research results

The 12-mo prevalences of AUD and DUD were 5.3% and 13.7%, respectively. The lifetime prevalence was 12.0% for AUD and 27.7% for DUD. A history of DUD but not AUD was positively associated with hyperactivity-impulsivity ADHD core symptoms, as well as emotional dysregulation.

Research conclusions

Compared to findings in the normal population, adult ADHD patients had much higher prevalence of past or current DUD but not AUD. DUD was particularly related to amphetamine and cannabis. Associations of DUD with clinical features of ADHD point to self-medication of ADHD as a possible causative factor and suggest early diagnosis and treatment of ADHD as a preventive strategy against substance abuse.

Research perspectives

Future research should be supplemented by longitudinal studies of children and adolescents with ADHD to investigate who develops substance use disorders. The effect of early ADHD treatment on substance abuse can be investigated by intervention studies.