Abstract
BackgroundAttention Deficit/Hyperactivity Disorder (ADHD) is associated with an increased risk of co-existing substance abuse. The Swedish legislation on compulsory healthcare can be applied to persons with severe substance abuse who can be treated involuntarily during a period of six months. This context enables a reliable clinical assessment of ADHD in individuals with severe substance use disorder (SUD).MethodsIn the context of compulsory care for individuals with severe SUD, male patients were assessed for ADHD, co-morbid psychiatric symptoms, psychosocial background, treatment history, and cognition. The data from the ADHD/SUD group (n = 60) was compared with data from (1) a group of individuals with severe substance abuse without known ADHD (SUD group, n = 120), as well as (2) a group with ADHD from an outpatient psychiatric clinic (ADHD/Psych group, n = 107).ResultsCompared to the general SUD group in compulsory care, the ADHD/SUD group had already been significantly more often in compulsory care during childhood or adolescence, as well as imprisoned more often as adults. The most common preferred abused substance in the ADHD/SUD group was stimulant drugs, while alcohol and benzodiazepine abuse was more usual in the general SUD group. Compared to the ADHD/Psych group, the ADHD/SUD group reported more ADHD symptoms during childhood and performed poorer on all tests of general intellectual ability and executive functions.ConclusionsThe clinical characteristics of the ADHD/SUD group differed from those of both the SUD group and the ADHD/Psych group in several respects, indicating that ADHD in combination with SUD is a particularly disabling condition. The combination of severe substance abuse, poor general cognitive ability, severe psychosocial problems, including indications of antisocial behaviour, and other co-existing psychiatric conditions should be considered in treatment planning for adults with ADHD and SUD.
Highlights
Attention Deficit/Hyperactivity Disorder (ADHD) is associated with an increased risk of co-existing substance abuse
The flowchart describes the enrolment of participants in the ADHD/substance use disorder (SUD) group from the SiS Institution Hornö
Out of the 413 unique cases during 2004 and 2008, assessments of ADHD were made in 71 patients
Summary
Attention Deficit/Hyperactivity Disorder (ADHD) is associated with an increased risk of co-existing substance abuse. The Swedish legislation on compulsory healthcare can be applied to persons with severe substance abuse who can be treated involuntarily during a period of six months This context enables a reliable clinical assessment of ADHD in individuals with severe substance use disorder (SUD). Eighty % present with at least one additional DSM-IV diagnosis [6,7,8] and co-morbidity as such may increase the risk of substance abuse Psychosocial factors such as failure in school and working life and experiences of alienation among individuals with ADHD may combine to increase the risk of substance abuse. A low dopamine activity in persons with ADHD and the capacity of all addictive substances to increase the release of dopamine has been suggested to be a possible neural link between ADHD and SUD [9,10]
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