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1. Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study

Author

Emmerik-van Oortmerssen, K. van, Glind, G. van de, Koeter, M.W., Allsop, S., Auriacombe, M., Barta, C., Bu, E.T., Burren, Y., Carpentier, P.J.B.R., Carruthers, S., Casas, M., Demetrovics, Z., Dom, G., Faraone, S.V., Fatseas, M., Franck, J., Johnson, B., Kapitany-Foveny, M., Kaye, S., Konstenius, M., Levin, F.R., Moggi, F., Moller, M., Ramos-Quiroga, J.A., Schillinger, A., Skutle, A., Verspreet, S., Brink, W. van den, Schoevers, R.A., and Gaag, R.J. van der

Subjects
Neurodevelopmental disorders Donders Center for Medical Neuroscience [Radboudumc 7], mental disorders, Other Research Donders Center for Medical Neuroscience [Radboudumc 0], behavioral disciplines and activities
Abstract

Item does not contain fulltext 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 International 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 Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID), the presence of antisocial personality disorder (ASPD), major depression (MD) and (hypo)manic episode (HME) was assessed with the Mini International Neuropsychiatric Interview-Plus (MINI Plus), 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.

Published
2014

2. Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria

Author

Glind, G. van de, Konstenius, M., Koeter, M.W., Emmerik-van Oortmerssen, K. van, Carpentier, P.J.B.R., Kaye, S., Degenhardt, L., Skutle, A., Franck, J., Bu, E.T., Moggi, F., Dom, G., Verspreet, S., Demetrovics, Z., Kapitany-Foveny, M., Fatseas, M., Auriacombe, M., Schillinger, A., Moller, M., Johnson, B., Faraone, S.V., Ramos-Quiroga, J.A., Casas, M., Allsop, S., Carruthers, S., Schoevers, R.A., Wallhed, S., Barta, C., Alleman, P., Levin, F.R., Brink, W. van den, Gaag, R.J. van der, et al., Glind, G. van de, Konstenius, M., Koeter, M.W., Emmerik-van Oortmerssen, K. van, Carpentier, P.J.B.R., Kaye, S., Degenhardt, L., Skutle, A., Franck, J., Bu, E.T., Moggi, F., Dom, G., Verspreet, S., Demetrovics, Z., Kapitany-Foveny, M., Fatseas, M., Auriacombe, M., Schillinger, A., Moller, M., Johnson, B., Faraone, S.V., Ramos-Quiroga, J.A., Casas, M., Allsop, S., Carruthers, S., Schoevers, R.A., Wallhed, S., Barta, C., Alleman, P., Levin, F.R., Brink, W. van den, Gaag, R.J. van der, and et al.

Abstract

Contains fulltext : 137177.pdf (publisher's version ) (Open Access), BACKGROUND: Available studies vary in their estimated prevalence of attention deficit/hyperactivity disorder (ADHD) in substance use disorder (SUD) patients, ranging from 2 to 83%. A better understanding of the possible reasons for this variability and the effect of the change from DSM-IV to DSM-5 is needed. METHODS: A two stage international multi-center, cross-sectional study in 10 countries, among patients form inpatient and outpatient addiction treatment centers for alcohol and/or drug use disorder patients. A total of 3558 treatment seeking SUD patients were screened for adult ADHD. A subsample of 1276 subjects, both screen positive and screen negative patients, participated in a structured diagnostic interview. RESULTS: Prevalence of DSM-IV and DSM-5 adult ADHD varied for DSM-IV from 5.4% (CI 95%: 2.4-8.3) for Hungary to 31.3% (CI 95%:25.2-37.5) for Norway and for DSM-5 from 7.6% (CI 95%: 4.1-11.1) for Hungary to 32.6% (CI 95%: 26.4-38.8) for Norway. Using the same assessment procedures in all countries and centers resulted in substantial reduction of the variability in the prevalence of adult ADHD reported in previous studies among SUD patients (2-83%-->5.4-31.3%). The remaining variability was partly explained by primary substance of abuse and by country (Nordic versus non-Nordic countries). Prevalence estimates for DSM-5 were slightly higher than for DSM-IV. CONCLUSIONS: Given the generally high prevalence of adult ADHD, all treatment seeking SUD patients should be screened and, after a confirmed diagnosis, treated for ADHD since the literature indicates poor prognoses of SUD in treatment seeking SUD patients with ADHD.

Published
2014

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