Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use – a clinical study

ADHD is the one of the most prevalent childhood disorders and has been associated with impairments persisting into adulthood. Specifically, childhood ADHD is an independent clinical risk factor for the development of later substance use disorders (SUD). Moreover, adults who meet diagnostic criteria for ADHD have shown high rates of comorbid SUDs. Few studies, however, have reported on the relationship between ADHD subtypes and SUD in adult samples. The purpose of this study was to characterize a clinical sample of adults with ADHD and to identify possible associations between ADHD subtypes, lifetime substance use, and if ADHD subtypes may be preferentially associated with specific substances of abuse. We recruited 413 adult ADHD patients, performed an evaluation of their ADHD and conducted an interview on their use of psychotropic substances. Complete data was obtained for 349 patients. Lifetime substance abuse or dependence was 26% and occasional use was 57% in this sample. The inattentive subtype was significantly less likely to abuse or be dependent on cocaine than the combined subtype. Our findings underscore the high rate of comorbidity between substance use and ADHD in adults. The more frequent abuse/dependence of cocaine by adult patients with hyperactive-impulsive symptoms should be kept in mind when treating this patient group.

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Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use – a clinical study.

F1000Research ◽

10.12688/f1000research.6780.1 ◽

2015 ◽

Vol 4 ◽

pp. 407 ◽

Cited By ~ 2

Author(s):

Michael Liebrenz ◽

Alex Gamma ◽

Iliyan Ivanov ◽

Anna Buadze ◽

Dominique Eich

Keyword(s):

Substance Use ◽

Adult Adhd ◽

Clinical Sample ◽

High Rate ◽

Clinical Risk Factor ◽

Adhd Subtypes ◽

Childhood Disorders ◽

Psychotropic Substances ◽

Hyperactivity Disorder ◽

The One

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Adult ADHD subtypes, autistic traits, and substance use

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2014.02.143 ◽

2014 ◽

Vol 140 ◽

pp. e44-e45

Author(s):

Duneesha De Alwis ◽

A. Todorov ◽

Arpana Agrawal ◽

A. Reiersen

Keyword(s):

Substance Use ◽

Adult Adhd ◽

Autistic Traits ◽

Adhd Subtypes

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

European Psychiatry ◽

10.1016/j.eurpsy.2015.09.083 ◽

2015 ◽

Vol 30 (S2) ◽

pp. S27-S28

Author(s):

B. Rolland ◽

D. Da Fonseca ◽

M. Fatseas ◽

N. Simon

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Clinical Features ◽

Attention Deficit ◽

Adult Adhd ◽

Adhd Symptoms ◽

Addiction Medicine ◽

Global Functioning ◽

Hyperactivity Disorder

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.

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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.

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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.

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Neuropsychological Functioning and Psychosocial Outcome in Adults with Attention-Deficit/ Hyperactivity Disorder

Zeitschrift für Neuropsychologie ◽

10.1024/1016-264x/a000129 ◽

2015 ◽

Vol 26 (1) ◽

pp. 17-26 ◽

Cited By ~ 4

Author(s):

Esther Sobanski ◽

Alexandra Sirtl ◽

Barbara Alm ◽

Oliver Hennig ◽

Tobias Banaschewski

Keyword(s):

Psychosocial Functioning ◽

Neuropsychological Tests ◽

Adult Adhd ◽

Clinical Sample ◽

Neuropsychological Functioning ◽

Neuropsychological Impairment ◽

Adhd Symptoms ◽

Global Assessment Of Functioning ◽

Psychosocial Impairment ◽

Hyperactivity Disorder

This study explores the association of neuropsychological functioning with ADHD-symptoms and psychosocial functioning in a clinical sample of 131 adults with ADHD. Neuropsychological functioning was assessed with the computerized Test Battery of Attentional Performance (TAP). Overall psychosocial impairment was assessed with the Global Assessment of Functioning Scale (GAF). Neuropsychological performance was impaired in 39.6 % of the ADHD-patients meeting a predefined impairment criterion of a perfomance reduction of 1.5 standard deviations below normative controls in ≥ 2 TAP-subtests; 28.4 % of the patients showed regular performance in all neuropsychological tests. Severity of neuropsychological impairment was inversely correlated to severity of psychosocial impairment (GAF score; = -.24, p < .001) but not to childhood or adult ADHD symptoms. Overall severity of neuropsychological impairment explained 10 % (p < .05) of variance of psychosocial impairment.

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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.

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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.

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A risk calculator to predict adult attention-deficit/hyperactivity disorder: generation and external validation in three birth cohorts and one clinical sample

Epidemiology and Psychiatric Sciences ◽

10.1017/s2045796019000283 ◽

2019 ◽

Vol 29 ◽

Cited By ~ 2

Author(s):

A. Caye ◽

J. Agnew-Blais ◽

L. Arseneault ◽

H. Gonçalves ◽

C. Kieling ◽

...

Keyword(s):

Birth Cohort ◽

Regression Models ◽

Adult Adhd ◽

Clinical Sample ◽

Test Sample ◽

Population Based ◽

Learning Approaches ◽

Risk Calculator ◽

Logistic Regression Models ◽

Hyperactivity Disorder

Abstract Aim Few personalised medicine investigations have been conducted for mental health. We aimed to generate and validate a risk tool that predicts adult attention-deficit/hyperactivity disorder (ADHD). Methods Using logistic regression models, we generated a risk tool in a representative population cohort (ALSPAC – UK, 5113 participants, followed from birth to age 17) using childhood clinical and sociodemographic data with internal validation. Predictors included sex, socioeconomic status, single-parent family, ADHD symptoms, comorbid disruptive disorders, childhood maltreatment, ADHD symptoms, depressive symptoms, mother's depression and intelligence quotient. The outcome was defined as a categorical diagnosis of ADHD in young adulthood without requiring age at onset criteria. We also tested Machine Learning approaches for developing the risk models: Random Forest, Stochastic Gradient Boosting and Artificial Neural Network. The risk tool was externally validated in the E-Risk cohort (UK, 2040 participants, birth to age 18), the 1993 Pelotas Birth Cohort (Brazil, 3911 participants, birth to age 18) and the MTA clinical sample (USA, 476 children with ADHD and 241 controls followed for 16 years from a minimum of 8 and a maximum of 26 years old). Results The overall prevalence of adult ADHD ranged from 8.1 to 12% in the population-based samples, and was 28.6% in the clinical sample. The internal performance of the model in the generating sample was good, with an area under the curve (AUC) for predicting adult ADHD of 0.82 (95% confidence interval (CI) 0.79–0.83). Calibration plots showed good agreement between predicted and observed event frequencies from 0 to 60% probability. In the UK birth cohort test sample, the AUC was 0.75 (95% CI 0.71–0.78). In the Brazilian birth cohort test sample, the AUC was significantly lower –0.57 (95% CI 0.54–0.60). In the clinical trial test sample, the AUC was 0.76 (95% CI 0.73–0.80). The risk model did not predict adult anxiety or major depressive disorder. Machine Learning approaches did not outperform logistic regression models. An open-source and free risk calculator was generated for clinical use and is available online at https://ufrgs.br/prodah/adhd-calculator/. Conclusions The risk tool based on childhood characteristics specifically predicts adult ADHD in European and North-American population-based and clinical samples with comparable discrimination to commonly used clinical tools in internal medicine and higher than most previous attempts for mental and neurological disorders. However, its use in middle-income settings requires caution.

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The impact of attention deficit hyperactivity disorder (ADHD) in adulthood: a qualitative study

Irish Journal of Psychological Medicine ◽

10.1017/ipm.2017.21 ◽

2017 ◽

Vol 35 (3) ◽

pp. 173-179

Author(s):

C. Watters ◽

D. Adamis ◽

F. McNicholas ◽

B. Gavin

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Attention Deficit ◽

Adult Adhd ◽

Clinical Sample ◽

Phenomenological Approach ◽

Individual Treatment ◽

Negative Effects ◽

Hyperactivity Disorder ◽

Qualitative Approaches ◽

The Impact

ObjectivesThere is limited evidence of the unmet needs and experiences of adults with attention deficit hyperactivity disorder (ADHD). Previous research in this area is predominantly quantitative by nature, few studies employing qualitative approaches. This study seeks to provide a deeper insight into the lived experiences of adults with ADHD within Western Ireland.MethodsA qualitative design, consisting of semi-structured face-to-face interviews with a clinical sample in the Sligo/Leitrim area. Participants were eligible for this study if they screened positive for symptoms of ADHD, and diagnosed with ADHD with the Conners’ Adult ADHD Diagnostic Interview for DSM-IV. In total, 11 participants completed this research. The interviews were open ended and exploratory, adopting a phenomenological approach.ResultsThematic analysis was used to explore three main themes; The Burden of symptoms of ADHD, Perceived Positive and Negative Effects of ADHD and Challenge of Accessing Services, each with several subthemes.ConclusionThis research highlights the experiences of adults with ADHD. It is important for practitioners to be aware of the perceived positive and negative effects of the disorder, and how it can impact on their patient’s lives. In addition, becoming aware of the stigma associated with ADHD can help clinicians improve upon individual treatment plans to meet their patient’s needs. It is important to note that this sample experienced co-morbid diagnoses and so this may limit the interpretation of the findings. Further research in this area could explore patient’s attitudes towards receiving a formal diagnosis of ADHD.

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