Attention-deficit/hyperactivity disorder (ADHD) in adults: Specific clinical and therapeutic issues

Attention-deficit/hyperactivity disorder (ADHD) was initially considered as a childhood psychiatric disorder. However, longitudinal observations have revealed that ADHD symptoms may persist in adulthood among approximately 50% of the patients . Adult ADHD is associated with impaired social outcome and frequent comorbidities such as mood disorders, personality disorders, and substance use disorders [2,3]. Correctly identifying and treating ADHD can significantly improve the global functioning and cognition of adult subjects, and reduce the intensity and frequency of the comorbid states [2,3]. Nonetheless, the clinical features of adult ADHD are clearly different from the youth form [1,2], and ADHD symptoms are easily mixed up in adults with symptoms of the comorbid conditions [2,3]. These clinical intricacies can make the diagnosis of ADHD difficult in adults. Moreover, the management of methylphenidate in adult subjects is also associated with specific risks and pitfalls, such as abuse and tampering behaviors, and additional safety risks . Put together, it appears crucial to identify and treat ADHD in adults, but the clinical and therapeutic complexities of adult ADHD require improved expertise and caution from adult psychiatrists and addiction specialists. In this thematic session of the 2015 French Psychiatry Congress, three French leading experts of adult ADHD will address the aforementioned clinical and therapeutic issues of the adulthood form of this disorder. David Da Fonseca, professor of child psychiatry in Marseille, will disentangle the clinical features of adult ADHD from the typical symptoms observed in the youth form. Mélina FATSEAS, associate professor of psychiatry and addiction medicine in Bordeaux, will specifically focus on the many and complex relationships observed between adult ADHD and substance use disorders. Last, Nicolas Simon, professor of addiction medicine and psychopharmacology in Marseille, will synthesize what are the very risks and issues with prescribing methylphenidate in adults.

Download Full-text

Treating adult ADHD and comorbid substance-related disorders

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.930 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S54-S54

Author(s):

J.A. Ramos-Quiroga

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Attention Deficit ◽

Adult Adhd ◽

Stimulant Medication ◽

Behavioral Therapy ◽

Neurodevelopmental Disorder ◽

Hyperactivity Disorder ◽

Competing Interest

Attention-deficit/hyperactivity disorder (ADHD) is a complex, and multifactorial and chronic neurodevelopmental disorder. Comorbid psychiatric disorders are highly prevalent in individuals with a diagnosis of ADHD. There is a solid overlap between ADHD and substance use disorders (SUD). Prevalence of SUD is high among patients with ADHD, so that SUD are approximately double as common among individuals with ADHD than in general population, and individuals with SUD have much higher rates than expected of a comorbid ADHD. Studies shown that treatment during childhood of attention-deficit/hyperactivity disorder with stimulant medication neither protects nor increases the risk of later substance use disorders. Nevertheless, recent studies found that patients with ADHD and SUD can reduce ADHD symptoms and SUD with stimulants and cognitive-behavioral therapy. Treatment of ADHD in patients with SUD requires a comprehensive diagnostic assessment. It is recommendable to stabilize the addiction prior to treating the ADHD. In this talk, the recent literature for the treatment of adults with co-occurring ADHD and SUD will be reviewed.Disclosure of interestThe author has not supplied his declaration of competing interest.

Download Full-text

ADHD with comorbid substance use disorder: review of treatment

Advances in Psychiatric Treatment ◽

10.1192/apt.bp.111.009340 ◽

2012 ◽

Vol 18 (6) ◽

pp. 436-446 ◽

Cited By ~ 8

Author(s):

Rakesh Magon ◽

Ulrich Müller

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Substance Use Disorder ◽

Attention Deficit ◽

Adult Adhd ◽

Treatment Algorithm ◽

Hyperactivity Disorder ◽

The Relationship ◽

Illicit Substances

SummarySubstance use disorders are a frequent comorbidity in adult attention-deficit hyperactivity disorder (ADHD). This review discusses the relationship between adult ADHD and substance use disorder, including use of licit and illicit substances such as nicotine, alcohol, cocaine and cannabis. We discuss treatment studies in this area and provide a treatment algorithm to guide clinicians in the management of adult ADHD comorbid with different forms and severities of substance use disorder.

Download Full-text

Adult attention-deficit/hyperactivity disorder and its association with substance use and substance use disorders in young men

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796015000360 ◽

2015 ◽

Vol 25 (3) ◽

pp. 255-266 ◽

Cited By ~ 22

Author(s):

N. Estévez ◽

M. Dey ◽

D. Eich-Höchli ◽

S. Foster ◽

G. Gmel ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Attention Deficit ◽

Illicit Drugs ◽

Adult Adhd ◽

Young Men ◽

Use Patterns ◽

Hyperactivity Disorder ◽

Co Morbidity

Background.Functional and mental health impairments that adults with attention-deficit/hyperactivity disorder (ADHD) experience may be exacerbated by regular substance use and co-morbidity with substance use disorders (SUD). This may be especially true during young adulthood, which represents a critical stage of life associated with increased substance use and associated problems. However, previous studies investigating the association between ADHD and substance use and SUD have demonstrated inconsistent results, probably due to methodological limitations (e.g., small and non-representative samples). Thus, the relationship of ADHD with substance use and related disorders remains unclear. The aim of the present study was to examine the association between ADHD and both the use of licit and illicit substances and the presence of SUD in a large, representative sample of young men.Method.The sample included 5677 Swiss men (mean age 20 ± 1.23 years) who participated in the Cohort Study on Substance Use Risk Factors (C-SURF). ADHD was assessed using the adult ADHD Self Report Screener (ASRS). The association between ADHD and substance use and SUD was assessed for alcohol, nicotine, cannabis and other illicit drugs, while controlling for socio-demographic variables and co-morbid psychiatric disorders (i.e., major depression (MD) and anti-social personality disorder (ASPD)).Results.Men with ADHD were more likely to report having used nicotine, cannabis and other illicit drugs at some time in their life, but not alcohol. ADHD was positively associated with early initiation of alcohol, nicotine and cannabis use, the risky use of these substances, and the presence of alcohol use disorders, and nicotine and cannabis dependence. Additionally, our analyses revealed that these patterns are also highly associated with ASPD. After adjusting for this disorder, the association between ADHD and licit and illicit substance use and the presence of SUDs was reduced, but remained significant.Conclusions.Our findings suggest that adult ADHD is significantly associated with a propensity to experiment with licit and illicit substances, especially at earlier ages, to exhibit risky substance use patterns, and to subsequently develop SUDs. Preventive strategies that include early intervention and addressing co-morbidity with ASPD may be crucial to reducing substance use and the development of pathological substance use patterns in young men affected by ADHD and, thus, helping to prevent further illness burden later in life.

Download Full-text

Attention-deficit hyperactivity disorder (ADHD) in adults attending addiction treatment in Ireland: preliminary international ADHD in substance-use disorders prevalence study (IASP) results

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2013.8 ◽

2013 ◽

Vol 30 (3) ◽

pp. 171-177 ◽

Cited By ~ 1

Author(s):

M. C. Van Hout ◽

M. Foley

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Attention Deficit ◽

Addiction Treatment ◽

Adult Adhd ◽

Treatment Pathways ◽

Hyperactivity Disorder ◽

Co Morbidity ◽

New Treatment

ObjectivesAttention-deficit hyperactivity disorder (ADHD) is a neuro-behavioural disorder characterised by early onset of persistent inattention–disorganisation and hyperactivity–impulsivity. Symptoms causing significant impairment in psychosocial function commence in childhood and heighten the risk for early substance experimentation and potential development of substance-use disorders (SUD). The research aimed to estimate the occurrence of adult attention-deficit hyperactivity disorder (ADHD) in new treatment cases of adults attending addiction treatment services.MethodsThe Adult ADHD Symptoms Rating Scale (ASRS) self-administered questionnaire was administered on entry and 2 weeks later for first admissions to inpatient and outpatient addiction treatment settings The ASRS is a validated and reliable 18-item self-report scale derived from the DSM-IV-TR diagnostic criteria for ADHD, comprising nine items on inattention and nine items on hyperactivity/impulsivity.ResultsA total of 47 new treatment cases took part in the study. The occurrence of ADHD among SUDs in this sample was 13% (n = 6). Four of the participants were being treated for Problem Poly Substance use, whereas two participants were being treated for Problem Drug use. None of the participants screening positive for ADHD were being treated for Problem Alcohol use. Of the positively screened cases, all were male, predominantly single and unemployed.ConclusionsThe ASRS screening instrument may be a useful tool to detect ADHD co-morbidity in SUD treatment-seeking cases. More research is needed to appropriately develop the SUD treatment pathways for adolescent and adult ADHD sufferers in Ireland.

Download Full-text

Childhood risk factors for substance use disorders in attention deficit hyperactivity disorder subjects

European Psychiatry ◽

10.1016/s0924-9338(11)71800-4 ◽

2011 ◽

Vol 26 (S2) ◽

pp. 89-89 ◽

Cited By ~ 1

Author(s):

M. Nogueira ◽

R. Bosch ◽

G. Palomar ◽

M. Corrales ◽

N. Gómez ◽

...

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Attention Deficit ◽

Childhood Maltreatment ◽

Adhd Symptoms ◽

Assessment Protocol ◽

Childhood Adhd ◽

Hyperactivity Disorder ◽

Oppositional Defiant

IntroductionCo-morbidity between Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD) is considered to be about 25–50% in adults. Several studies show vulnerability factors to later SUD to be associated with childhood ADHD features, such as conduct problems, untreated ADHD and maltreatment.ObjectivesTo define childhood ADHD associated factors that predispose to SUD.Specifically, comorbidity with oppositional defiant disorder (ODD) and conduct disorder (CD), temperamental traits, academic failure, familial SUD history, childhood maltreatment and subtype, severity and age of treatment of ADHD symptoms.MethodsA comparative study was carried out in a sample of ADHD adults from the Department of Psychiatry H.U. Vall d’Hebron. Both groups, ADHD and ADHD+SUD subjects underwent the following assessment protocol: Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID-I & II), Wender Utath Rating Scale (WURS), SCID-I, SCID-II and K-SDAS.ResultsThe total sample (n = 305) consisted of 201 men (66%) with age between 18–61 years. Two groups were compared: 162 ADHD subjects and 143 ADHD+SUD subjects. The ADHD+SUD group had significantly higher rates of comorbidity with ODD and CD, temperamental traits (obstinacy, bad temper, impulsive behavior), maladaptive behaviors at school, familial SUD history, childhood maltreatment, and major severity of the childhood ADHD symptoms. Neither ADHD subtype nor the non-treatment of ADHD during childhood were associated with later SUD.ConclusionsAn important percentage of ADHD children develop a SUD during their lifespan. This study shows that there are childhood factors that are strongly associated with SUD in ADHD subjects.

Download Full-text