The role of conduct disorder in the association between ADHD and alcohol use (disorder). Results from the Netherlands Mental Health Survey and Incidence Study-2

Netherlands Institute of Mental Health and Addiction, P.O. Box 725, 3500 AS Utrecht, The Netherlands.
Drug and alcohol dependence (Impact Factor: 3.42). 11/2011; 123(1-3):115-21. DOI: 10.1016/j.drugalcdep.2011.10.030
Source: PubMed


Much is unclear about the association between attention-deficit/hyperactivity disorder (ADHD) and alcohol use (disorder). Research on this subject is hindered by the role of conduct disorder (CD). We investigate whether (1) childhood ADHD is associated with higher prevalence and earlier onset of alcohol initiation, regular alcohol use and alcohol use disorder (AUD) (2) CD mediates or modifies this association.
Data were derived from the baseline assessment of the Netherlands Mental Health Survey and Incidence Study-2, a general population study. ADHD and CD were assessed among respondents aged 18-44 (n=3309). ADHD, CD, and alcohol use (disorder) were assessed using the Composite International Diagnostic Interview 3.0.
Lifetime prevalence was 2.9% for ADHD, 5.6% for CD, 94.3% for alcohol initiation, 85.7% for regular alcohol use and 19.0% for AUD; mean ages of onset were 6.7, 11.5, 14.8, 16.7 and 19.2 years, respectively. After correction for gender and age, ADHD was associated with a higher prevalence of all three stages of alcohol use, but not with earlier onset of these stages. The association between ADHD and prevalence of AUD was fully explained by a mediating role of CD. CD did not modify the associations between ADHD and prevalence and onset of alcohol use (disorder).
The mediating role of CD in the association between ADHD and AUD suggests a developmental pathway from ADHD to CD and subsequent AUD. Early interventions in children with ADHD may prevent CD and subsequent onset of AUD.

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Available from: Ron de Graaf, Sep 04, 2015
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    • "Thus, whilst the continuity hypothesis assumes a direct link between behavioural disorders and criminal offending, the life course perspective expects social contextual factors to mediate this association. Prior research provides sufficient evidence for us to consider three life course processes because childhood behavioural disorders have been shown to predict adolescent involvement in drug and alcohol use (Tuithof et al., 2012), educational problems (Fergusson et al., 1993; Rodriguez et al., 2007) and peer marginalisation (Mrug et al., 2012). Each of these adolescent outcomes has been implicated as a robust precursor of criminal activity (Maguin and Loeber, 1996; Haynie, 2002; Felson et al., 2008). "
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    ABSTRACT: Background Although a pathway from childhood behavioural disorders to criminal offending is well established, the aetiological processes remain poorly understood. Also, it is not clear if attention deficit hyperactivity disorder (ADHD) is predictive of crime in the absence of comorbid disruptive behaviour disorder (DBD).HypothesisWe examined two research questions: (1) Does ADHD have a unique effect on the risk of criminal offending, independently of DBD? (2) Is the effect of childhood behavioural disorders on criminal offending direct or mediated by adolescent processes related to school experience, substance misuse and peers?Method Structural equation modelling, with latent variables, was applied to longitudinally collected data on 4644 men from the 1986 Northern Finland Birth Cohort Study.ResultsBoth ADHD and DBD separately predicted felony conviction risk. Most of these effects were mediated by adolescent alcohol use and low academic performance. The effect of DBD was stronger and included a direct pathway to criminal offending.Conclusion Findings were more consistent with the life course mediation hypothesis of pathways into crime than the behavioural continuity path, in that the effects of each disorder category were mediated by heavy drinking and educational failure. Preventing these adolescent risk outcomes may be an effective approach to closing pathways to criminal behaviour amongst behaviourally disordered children. However, as there was some evidence of a direct pathway from DBD, effective treatments targeting this disorder are also expected to reduce criminal offending. Copyright © 2014 John Wiley & Sons, Ltd.
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    • "In one study, up to 36% of patients with BPAD had a positive family history of alcohol dependence among first-degree relatives [Mantere et al., 2012]. There is also a strong relationship between adolescent attention deficit hyperactivity disorder (ADHD) and adult alcohol dependence [Edwards and Kendler, 2012] with at least 30% of subjects with ADHD reported to develop an alcohol use disorder [Wilens et al., 2011; Tuithof et al., 2012]. "
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    ABSTRACT: Single nucleotide polymorphisms (SNPs) in the tachykinin receptor 1 gene (TACR1) are nominally associated with bipolar affective disorder (BPAD) in a genome-wide association study and in several case-control samples of BPAD, alcohol dependence syndrome (ADS) and attention-deficit hyperactivity disorder (ADHD). Eighteen TACR1 SNPs were associated with BPAD in a sample (506 subjects) from University College London (UCL1), the most significant being rs3771829, previously associated with ADHD. To further elucidate the role of TACR1 in affective disorders, rs3771829 was genotyped in a second BPAD sample of 593 subjects (UCL2), in 997 subjects with ADS, and a subsample of 143 individuals diagnosed with BPAD and comorbid alcohol dependence (BPALC). rs3771829 was associated with BPAD (UCL1 and UCL2 combined: P = 2.0 × 10−3), ADS (P = 2.0 × 10−3) and BPALC (P = 6.0 × 10−4) compared with controls screened for the absence of mental illness and alcohol dependence. DNA sequencing in selected cases of BPAD and ADHD who had inherited TACR1-susceptibility haplotypes identified 19 SNPs in the promoter region, 5′ UTR, exons, intron/exon junctions and 3′ UTR of TACR1 that could increase vulnerability to BPAD, ADS, ADHD, and BPALC. Alternative splicing of TACR1 excludes intron 4 and exon 5, giving rise to two variants of the neurokinin 1 receptor (NK1R) that differ in binding affinity of substance P by 10-fold. A mutation in intron four, rs1106854, was associated with BPAD, although a regulatory role for rs1106854 is unclear. The association with TACR1 and BPAD, ADS, and ADHD suggests a shared molecular pathophysiology between these affective disorders. © 2014 The Authors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics Published by Wiley Periodicals.
    Full-text · Article · Jun 2014 · American Journal of Medical Genetics Part B Neuropsychiatric Genetics
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    • "Longitudinal studies have shown that individuals who are diagnosed with attention deficit hyperactivity disorder (ADHD) in childhood have an increased risk for problematic alcohol use in adolescence (Friedrichs et al. 2012) and adulthood (Knop et al. 2009). Crosssectional studies in adults also report a positive association between ADHD symptoms and alcohol dependence (Kessler et al. 2006; Friedrichs et al. 2012; Tuithof et al. 2012). These findings may represent the presence of a common underlying process influencing the risk of both ADHD and alcohol dependence, possibly related to neurobehavioural deficiencies in behavioural disinhibition and reward sensitivity (Volkow et al. 2009). "
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