Correlates and Treatment Outcome of Risky Sexual Behaviour in Young Males with ADHD and Comorbid Alcohol Use Disorder: A Prospective Study

Abstract

Background: Attention-deficit/hyperactivity disorder (ADHD) is associated with risky sexual behavior (RSB). Alcohol use and high perceived stress in young adulthood contributes to this association. Previous studies have not found methylphenidate to reduce RSB in ADHD, as the population had comorbidities such as mood disorders and antisocial personality disorder. We aimed to study (a) the association of RSB with ADHD and severity of alcohol use among adolescents and young adult males with ADHD who had comorbid alcohol use disorder and (b) the effect of treatment of ADHD using methylphenidate on RSB in this population at 3-and 6-month follow-ups. Methodology: The study had 31 participants who were selected by screening for RSBs using the sexual behavior section of the HIV Risk-taking Behavior Scale (HRBS) manual among a cohort of individuals with ADHD and early onset alcohol use. These individuals were also administered WHO ADHD self-report scale (ASRS), alcohol-use disorders identification test (AUDIT), perceived stress scale (PSS), and HRBS-sexual behavior section. They were then treated with methylphenidate and these assessments were repeated at 3 and 6 months. Results: Those having ADHD with RSB had higher total ADHD score (P = .007) and inattention score (p = .0001) than those without RSB. There was a significant correlation between the ADHD total score with alcohol-use severity (r = 0.47), with RSB (r = 0.34), and ADHD hyperactivity scores with alcohol-use severity (r = 0.49) and with RSB (r = 0.34). There was also a significant reduction of ADHD total, inattention and hyperactivity scores, alcohol-use severity scores, RSB and perceived stress scores with use of methylphenidate at 3-and 6-month follow-ups. Multiple logistic regression predicted reduction in ADHD total scores to reduce RSB (odds ratio [OR] = 1.26, P = .01). Conclusion: RSB was associated with severity of ADHD and alcohol use. Methylphenidate not only reduced ADHD severity but also alcohol-use severity and RSB, whose reduction was predicted by reduction in ADHD severity.

Exploring Online Sexual Abuse and Risky Sexual Behaviors: A Comparative Analysis of Adolescents with ADHD and Healthy Controls

“…Online sexual victimization and receiving sexual content messages (passive sexting) were signi cantly higher in non-users of ADHD medication and users of short-acting methylphenidate. Studies have shown that methylphenidate treatment in patients diagnosed with ADHD is successful in treating risky behaviors and risky sexual behaviors (39,40). In the literature, it is mentioned that methylphenidate treatment reduces risky sexual behaviors, but there is no speci c study addressing online sexual victimization, which is a form of sexual exploitation that does not involve physical contact (41).…”

Functional Impairments Associated With ADHD in Adulthood and the Impact of Pharmacological Treatment

“…ADHD scores (particularly the hyperactivity/impulsivity subscale) were significantly correlated with RSB (Spearmen’s ρ = 0.34, p < .05), and RSB was significantly reduced at both 3 months ( p = .02) and 6 months ( p = .004) relative to baseline. Further, ADHD total scores significantly predicted the reduction in RSB (odds ratio = 1.26, p = .01), but not in alcohol-use severity or in perceived stress ( Kumar et al, 2019 ), suggesting the improvement was unique to RSBs.…”

“…Two recent studies have examined this issue among the broader pool of adolescents and young adults. A 2019 study examined RSB in young men ( N = 31, ages 15–25 years) with diagnosed ADHD and comorbid alcohol use disorder after 6-month, open-label treatment with methylphenidate ( Kumar et al, 2019 ). ADHD scores (particularly the hyperactivity/impulsivity subscale) were significantly correlated with RSB (Spearmen’s ρ = 0.34, p < .05), and RSB was significantly reduced at both 3 months ( p = .02) and 6 months ( p = .004) relative to baseline.…”