Alcohol and drug use disorders in adult attention-deficit/hyperactivity disorder: Prevalence and associations with attention-deficit/hyperactivity disorder symptom severity and emotional dysregulation

Abstract

BACKGROUND High risk of alcohol and drug use disorders in people with attention-deficit/hyperactivity disorder (ADHD) calls for exploratory research of relationships with clinical features of ADHD. AIM To estimate prevalence of alcohol/drug use disorders and associations with ADHD symptom severity and emotional dysregulation, in adults with ADHD. METHODS This observational cross-sectional clinical study consisted of patients admitted to a private psychiatric outpatient clinic in Oslo, Norway (2014-2018). Five-hundred and fifty-eight eligible patients diagnosed with ADHD (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria) agreed to participate. Alcohol and drug use disorders were diagnosed using the Mini International Neuropsychiatric Interview (MINI). Dependence and abuse were merged into “use” disorder as in MINI version 7.0/DSM-5. Questions were related both to lifetime and the past 12-mo. ADHD severity was assessed by the Adult ADHD Self Report Scale (ASRS). Subdivisions of the ASRS questionnaire as inattentive items and hyperactive/impulsivity items were recorded separately. Emotional dysregulation was assessed by the eight-item version of Barkley’s Current Behavior Scale - Self Report. RESULTS The 12-mo prevalence was 5.3% for alcohol use disorder and 13.7% for drug use disorder. The lifetime prevalence was 12.0% for alcohol use disorder and 27.7% for drug use disorder. Men had higher rates of both alcohol use disorder and drug use disorder compared to women. The prevalence of drug use disorder was more than twice that of alcohol use disorder for both sexes. The drugs most participants reported having used were (in descending order): Amphetamine (19.1%), cannabis (17.1%), cocaine or ecstasy (7.4%), benzodiazepines (7.4%), and heroin or other opioids (2.9%). Lifetime drug use disorder was significantly associated with both hyperactivity-impulsivity symptoms and emotional dysregulation symptom severity. Lifetime alcohol use disorder, on the other hand, was not significantly associated with ADHD symptoms or emotional dysregulation when adjusted for gender and age. CONCLUSION Patients with ADHD have a high lifetime prevalence of drug use disorder, which is associated with higher levels of hyperactivity-impulsivity symptoms and emotional dysregulation.

Does Cannabis, Cocaine and Alcohol Use Impact Differently on Adult Attention Deficit/Hyperactivity Disorder Clinical Picture?

“…Attention Deficit Hyperactivity Disorder (ADHD), which was originally identified as a childhood neuropsychiatric illness, is now known to endure into adulthood in about two-thirds of these patients, with adult prevalence rates estimated to be close to the 3–5% range. Even if it has been defined as “a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development” (Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5)) [ 1 ], in adults, ADHD (A-ADHD) reflects a syndrome featuring mood instability, Emotional Dysregulation, impulsiveness and addictive behaviours [ 2 ]. The comorbidity of ADHD and Substance Use Disorders (SUD) has been widely documented and recognized in research studies, and the co-occurrence of the two disorders can be defined as Dual Disorder (DD).…”

“…Furthermore, the ADHD syndrome and SUD are both impacted by dopaminergic dysregulation of the motivational and reward systems that leads directly to executive dysfunctions and impairment in response inhibition. As a result of dopaminergic dysfunction, some ADHD patients might react by using drugs, especially stimulants, in order to self-medicate, so as to cope with inattention and restlessness symptoms according to the concept of “relief craving” [ 2 ]. The “self-medication hypothesis” claims to cover all cases in the same way, but people with ADHD actually rely on a wide variety of illicit substances, among which the best represented are cannabinoids, stimulants and alcohol [ 9 , 10 , 11 , 12 , 13 ].…”

An Exploratory Study of Emotional Dysregulation Dimensions in Youth With Attention Deficit Hyperactivity Disorder and/or Bipolar Spectrum Disorders

“…Symptoms of ED significantly and negatively impact quality of life (11), social functioning (20), acceptability by peers (21), need for interventions (11), and higher rates of persistence of irritability and impulsivity up to adulthood (10). Moreover, ED has been shown to predict risky behaviors in adolescents with ADHD, such as, for instance, substance use and abuse, especially amphetamine and cannabinoids, other addictive behaviors, self-harm, and suicidality (22,23). Finally, ED is a negative predictor of short-term response to methylphenidate monotherapy in drugnaïve youth with ADHD, especially of changes in hyperactiveimpulsive symptoms, and thus should be systematically assessed in ADHD at baseline (24).…”

Prevalence of criminal convictions in Norwegian adult ADHD outpatients and associations with ADHD symptom severity and emotional dysregulation

“…The association between low education and CC is notable since people with ADHD have lower levels of education than the general population [82][83][84]. Additionally, drug use disorder was correlated with CC, which is worth noting since ADHD patients have higher incidences of drug use than the general population [25,60,65,85,86].…”