When ADHD and substance use disorders intersect: relationship and treatment implications.

Pediatric Psychopharmacology Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Current Psychiatry Reports (Impact Factor: 3.05). 11/2007; 9(5):408-14. DOI: 10.1007/s11920-007-0053-3
Source: PubMed

ABSTRACT There has been increasing interest in the overlap between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs). In this report, we describe the developmental relationship between ADHD and SUDs. ADHD alone and in combination with co-occurring psychopathology is a risk factor for the development of SUDs in adulthood. Conversely, approximately one fifth of adults with SUDs have ADHD. Pharmacotherapeutic treatment of ADHD in children reduces the risk for later cigarette smoking and SUDs in adulthood. In contrast, medication treatment alone of adults with ADHD and current SUD is inadequate for both ADHD and SUD. Stimulant diversion continues to be of concern, particularly in older adolescents and young adults.

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    ABSTRACT: 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.
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    ABSTRACT: The use of central stimulant medication in adults with attention deficit hyperactivity disorder (ADHD) who receive opioid maintenance treatment remains controversial and empirical evidence is limited. Because of the abuse potential of stimulant drugs, Norway has restrictions on prescribing central stimulants to individuals who have substance use disorders or who are on opioid maintenance treatment. In this naturalistic study, we describe experiences from a program through which central stimulant medication was administered to patients with ADHD receiving opioid maintenance treatment.
    Journal of Dual Diagnosis 02/2014; 10(1):32-8. DOI:10.1080/15504263.2013.867657 · 0.80 Impact Factor
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    ABSTRACT: Objective: Attention-deficit/hyperactivity disorder (ADHD) is a common mental disorder in adults that was under-diagnosed until recently. Due to probable consequences of ADHD such as occupational and educational dysfunctions and substance use, this disorder is becoming more and more of a concern. This study aimed to investigate ADHD symptoms among students of Zahedan University of medical sciences, Iran. Methods: This cross-sectional study was performed in Zahedan University of Medical Sciences from 2008 to 2009. Our sample included 1500 individuals who were chosen using simple sampling method. Considering the goal of the investigation, two questionnaires were distributed among students including demographic information form and the Conners' Adult ADHD Rating Scales–Self Report (Screening Version, CAARS-S:SV). Data analysis was done using descriptive and analytical statistics in SPSS software. Results: Out of 1500 questionnaires distributed among students, 913 were completed. 589 students (64.5%) were female and 324 (35.5%) were male. The Mean age of participants was 21.7 ± 3.2 years. ADHD symptoms were defined based on the Conner’s adult test. Based on CAARS-S: SV, inattention/memory, hyperactivity/restlessness, impulsiveness/emotional lability, and problems with self-concept subscale symptoms were found in 107 (11.7%), 109 (12%), 121 (13.2%), and 30 (3.3%) respondents, respectively. These findings were significantly higher than average. Conclusions: According to our results, it seems that the prevalence of ADHD is high among students. Thus, more screening is required in this population in order to diagnose and treat the disorder earlier and prevent its consequences, such as substance abuse. Declaration of interest: None.
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