Abstract
ADHD is the one of the most prevalent childhood disorders and has been associated with impairments persisting into adulthood. Specifically, childhood ADHD is an independent clinical risk factor for the development of later substance use disorders (SUD). Moreover, adults who meet diagnostic criteria for ADHD have shown high rates of comorbid SUDs. Few studies, however, have reported on the relationship between ADHD subtypes and SUD in adult samples. The purpose of this study was to characterize a clinical sample of adults with ADHD and to identify possible associations between ADHD subtypes, lifetime substance use, and if ADHD subtypes may be preferentially associated with specific substances of abuse. We recruited 413 adult ADHD patients, performed an evaluation of their ADHD and conducted an interview on their use of psychotropic substances. Complete data was obtained for 349 patients. Lifetime substance abuse or dependence was 26% and occasional use was 57% in this sample. The inattentive subtype was significantly less likely to abuse or be dependent on cocaine than the combined subtype. Our findings underscore the high rate of comorbidity between substance use and ADHD in adults. The more frequent abuse/dependence of cocaine by adult patients with hyperactive-impulsive symptoms should be kept in mind when treating this patient group.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a complex neuropsychiatric syndrome that is common in childhood and adolescence, but in adulthood1–4
The most clinically significant result is the finding that the inattentive subtype showed a statistically significantly smaller rate of cocaine abuse/dependence compared to the combined subtype
These results are in line with earlier work by Sobanski et al, who had characterized a sample of 118 adults with attention-deficit/hyperactivity disorder (ADHD) and found that the combined type suffered significantly more from lifetime substance use disorders (SUD) (48.4%) than did patients with a predominantly inattentive type (23.3%
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a complex neuropsychiatric syndrome that is common in childhood and adolescence, but in adulthood. Attention-deficit/hyperactivity disorder (ADHD) is a complex neuropsychiatric syndrome that is common in childhood and adolescence, but in adulthood1–4 It is characterized by symptoms of inattention (distractibility), hyperactivity, and impulsivity, which all contribute to significant psychosocial impairment in affected individuals of all age groups. In 1994, the introduction of the DSM Fourth Edition (IV) marked a diversion from this route by allowing for a diagnosis of ADHD when either hyperactive-impulsive or inattentive behaviors were present, and thereby defined three subtypes of ADHD: a) a predominantly inattentive type, b) a predominantly hyperactiveimpulsive type, and c) a combined type. The clinical response to pharmacologic treatment by subtype or symptom clusters was investigated, as were subtype differences in psychosocial functioning, and the rate of comorbidity in different age groups
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