Abstract
Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development and persistence of substance use disorders (SUD). The prevalence of ADHD in patients with SUD varies across countries and cultures. So far, cross-cultural variance in ADHD prevalence rates among SUD patients was mainly ascribed to methodological differences between studies, leaving the role of societal and cultural practices in the ADHD-SUD link hardly acknowledged. The aim of the present mini review is to address this gap in the literature by providing evidence for the effect of socio-cultural practices on the ADHD-SUD link and suggesting directions for future research. To achieve this goal, we map the influence of socio-cultural factors on the ADHD-SUD link along three lines of research. The first line is concerned with the role of socio-cultural factors in the recognition, diagnosis and treatment of childhood ADHD. The second line of research is concerned with socio-cultural influences on substance use (e.g., religion, ethnic identity, acculturation, and socio-economic status). Finally, we describe potential socio-cultural factors which may operate as mechanisms for reducing or increasing access to substance abuse treatment (e.g., ethnic disparities in health care utilization). Identifying socio-cultural influences on the ADHD-SUD link may provide further insight into the bidirectional association between ADHD and SUD in different contexts and encourage future research in the field.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) are inextricably intertwined
It has been estimated that one quarter of those suffering from SUD have comorbid ADHD [1]
The mechanisms underlying the bidirectional association between ADHD and SUD are not entirely clear [4]
Summary
Attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) are inextricably intertwined. The mechanisms underlying the bidirectional association between ADHD and SUD are not entirely clear [4] Since both ADHD and SUD are known to be familial disorders [heritability estimate of ADHD is approximately 80% [5] and that of SUD is 40–80%, depending on substance [6, 7]], genetic contributions [8] as well as exposure to parental SUD [9] were suggested as possible explanations for their co-morbidity. Based on familial risk analysis of two longitudinal studies of probands aged 6 to 17 years, Yule et al [10] suggested various pathways through which SUD may be transmitted in ADHD families. These include the risk associated with SUD itself, the risk conferred by ADHD, and the risk conferred by
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