An observational study of the characteristics of different substance-use disorder subtypes combined with adult attention deficit hyperactivity disorder

Abstract

Aim The aim of this study was to examine the characteristics and intensity of the association between various subtypes of substance-use disorders (SUD) with adult attention deficit hyperactivity disorder (ADHD) and compare this with the progression of substance use in those without ADHD. Participants and methods The study was conducted at the Psychiatric Department, Mansoura University Hospital. Both inpatients and outpatients who screened positive for any one of the substances such as alcohol, opioids, amphetamine, or cannabis were approached to enter the study. Out of these, patients who gave informed consent, satisfied the inclusion and exclusion criteria, and met the DSM-IV-TR diagnosis for SUD for dependence or abuse entered the study and completed the patient intake form. A total of 100 such consecutive patients were screened for symptoms of adult ADHD by administering the first six questions of part A of the Arabic version of the adult ADHD self-report scale-VI.I (ASRS-VI.I) symptom checklist. Only the first six questions that are found to be the most predictive of symptoms were included for screening. Patients who answered positive for four or more questions were further interviewed using the Diagnostic Interview of Adult ADHD to make a diagnosis of adult ADHD in these patients. A total of 97 patients completed all parts of study questionnaire. The patients were divided and grouped depending on the type of substance abused, alcohol, opioid, cannabis, amphetamine, or polysubstance, and whether or not they had comorbid adult ADHD. The results obtained were statistically analyzed using SPSS software. Results The prevalence and course of SUD combined with adult ADHD differed depending on the primary substance of abuse. Cannabis and alcohol users had a higher percentage of adult ADHD (36.4 and 33.3%, respectively) compared with other drug users. Cannabis had the earliest age of onset of SUD at 15 years of age. Cannabis and amphetamine had a prolonged duration of abuse: 14.87 and 14.7 years, respectively. Similarly, they had a greater number of hospitalizations (3.82 and 3.88 times, respectively) and an increased duration of stay in the hospital (166.67 and 110 days, respectively) as compared with other drugs. Polysubstance, cannabis, and amphetamine abusers had more relapses: 3.27, 3.36, and 3.38 times, respectively. Conclusion The percentage of ADHD differs among different subgroups of SUD depending on the primary substance of abuse. Cannabis and amphetamine have a higher comorbidity, an earlier age of onset, and a more protracted course of SUD in ADHD patients compared with other drugs.