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Psychiatric comorbidity in treatment‐seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study
Author(s) -
Emmerikvan Oortmerssen Katelijne,
Glind Geurt,
Koeter Maarten W. J.,
Allsop Steve,
Auriacombe Marc,
Barta Csaba,
Bu Eli Torild H.,
Burren Yuliya,
Carpentier PieterJan,
Carruthers Susan,
Casas Miguel,
Demetrovics Zsolt,
Dom Geert,
Faraone Stephen V.,
Fatseas Melina,
Franck Johan,
Johnson Brian,
KapitányFövény Máté,
Kaye Sharlene,
Konstenius Maija,
Levin Frances R.,
Moggi Franz,
Møller Merete,
RamosQuiroga J. Antoni,
Schillinger Arild,
Skutle Arvid,
Verspreet Sofie,
Brink Wim,
Schoevers Robert A.
Publication year - 2014
Publication title -
addiction
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.424
H-Index - 193
eISSN - 1360-0443
pISSN - 0965-2140
DOI - 10.1111/add.12370
Subject(s) - comorbidity , psychiatry , attention deficit hyperactivity disorder , substance abuse , antisocial personality disorder , odds ratio , conduct disorder , borderline personality disorder , alcohol use disorder , psychology , confidence interval , mini international neuropsychiatric interview , depression (economics) , substance dependence , medicine , poison control , alcohol , anxiety , injury prevention , biochemistry , chemistry , environmental health , economics , macroeconomics
Aims To determine comorbidity patterns in treatment‐seeking substance use disorder ( SUD ) patients with and without adult attention deficit hyperactivity disorder ( ADHD ), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse. Design Data were obtained from the cross‐sectional I nternational ADHD in Substance use disorder Prevalence ( IASP ) study. Setting Forty‐seven centres of SUD treatment in 10 countries. Participants A total of 1205 treatment‐seeking SUD patients. Measurements Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the C onners' A dult ADHD D iagnostic I nterview for DSM‐IV ( CAADID ), the presence of antisocial personality disorder ( ASPD ), major depression ( MD ) and (hypo)manic episode ( HME ) was assessed with the M ini I nternational N europsychiatric I nterview‐ P lus ( MINI P lus), and the presence of borderline personality disorder ( BPD ) was assessed with the Structured Clinical Interview for DSM‐IV Axis II ( SCID II) . Findings The prevalence of DSM‐IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio ( OR) = 2.8, 95% confidence interval ( CI ) = 1.8–4.2], BPD ( OR = 7.0, 95% CI = 3.1–15.6 for alcohol; OR = 3.4, 95% CI = 1.8–6.4 for drugs), MD in patients with alcohol as primary substance of abuse ( OR = 4.1, 95% CI = 2.1–7.8) and HME ( OR = 4.3, 95% CI = 2.1–8.7) were all more prevalent in ADHD + compared with ADHD − patients ( P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype ( P < 0.01), increased HME and ASPD in the hyperactive/impulsive ( P < 0.01) and combined subtypes ( P < 0.001) and increased BPD in all subtypes ( P < 0.001) compared with SUD patients without ADHD . Seventy‐five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD . Conclusions Treatment‐seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders.