Abstract
BackgroundAdult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada.MethodsData were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n = 5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use.ResultsAfter controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use.ConclusionsADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner.
Highlights
Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females
One found a positive association of inattentive symptoms with alcohol use and cannabis misuse that was independent of comorbid internalizing and externalizing psychopathology [5], while the other linked inattentive and hyperactive symptoms to greater cannabis use after controlling for conduct disorder and antisocial personality disorder [6]. While these studies describe an important connection between ADHD symptom domains and potentially hazardous substance use, results were likely influenced by self-selection bias and sampling of higher functioning populations [5, 6]
Hyperactive symptoms were positively associated with problematic alcohol use and impulsive symptomatology predicted alcohol misuse in men
Summary
Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. One found a positive association of inattentive symptoms with alcohol use and cannabis misuse that was independent of comorbid internalizing and externalizing psychopathology [5], while the other linked inattentive and hyperactive symptoms to greater cannabis use after controlling for conduct disorder and antisocial personality disorder [6]. While these studies describe an important connection between ADHD symptom domains and potentially hazardous substance use, results were likely influenced by self-selection bias and sampling of higher functioning populations [5, 6]
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