Substance Use Disorder in Adult-Attention Deficit Hyperactive Disorder Patients: Patterns of Use and Related Clinical Features.

Vincenza Spera,Giulio Perugi,Alessandro Pallucchini,Marco Carli,Icro Maremmani,Angelo G I Maremmani,Marco Maiello

doi:10.3390/ijerph17103509

Abstract

Background: While a large amount of medical literature has explored the association between Attention Deficit/Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUDs), less attention has been dedicated to the typologies of SUD and their relationships with ADHD-specific symptomatology and general psychopathology in dual disorder patients. Methods: We selected 72 patients (aged 18–65) with a concomitant SUD out of 120 adults with ADHD (A-ADHD). Assessment instruments included the Diagnostic Interview for ADHD in adults (DIVA 2.0), Conner’s Adult ADHD Rating Scales–Observer (CAARS-O:S): Short Version, the Structured Clinical Interview for Axis I and II Disorders (SCID-I), the Barratt Impulsiveness Scale (BIS-11), the Brief Psychiatric rating scale (BPRS), the Reactivity Intensity Polarity Stability Questionnaire (RIPoSt-40), the World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the Morningness-Eveningness Questionnaire (MEQ). A factorial analysis was performed to group our patients by clusters in different typologies of substance use and correlations between SUDs, as made evident by their typological and diagnostic features; in addition, specific ADHD symptoms, severity of general psychopathology and patients’ functionality were assessed. Results: Two patterns of substance use were identified: the first (type 1) characterized by stimulants/alcohol and the second (type 2) by the use of cannabinoids (THC). Type 1 users were significantly younger and had more legal problems. The two patterns were similar in terms of ADHD-specific symptomatology and its severity at treatment entry. No differences were found regarding the other scales assessed, except for lower scores at MEQ in type 1 users. Conclusions: At treatment entry, the presence of different comorbid SUD clusters do not affect ADHD-specific symptomatology or severity.

Highlights

Attention Deficit Hyperactive Disorder (ADHD) and Substance Use Disorder (SUD) are two disorders that are mutually interconnected, as demonstrated by many studies in the literature.About 15% of young adults with Attention Deficit/Hyperactivity Disorder (ADHD) (A-ADHD) have a comorbid SUD [1]
No differences were found between the two patterns of substance use regarding functional impairment as measured by means of the total WHODAS 2.0 score. In this cross-sectional study we found two distinct patterns of substance use, the first distinguished by the use of both stimulants and alcohol, and the second by the use of the use of cannabinoids (THC) among adults with ADHD (A-ADHD) patients
Patients belonging to this pattern were, significantly younger when they attracted our attention by comparison with THC users—a difference that could reasonably be attributed to a higher severity of substance addiction, together with its poly-use consequences

Summary

Introduction

Attention Deficit Hyperactive Disorder (ADHD) and Substance Use Disorder (SUD) are two disorders that are mutually interconnected, as demonstrated by many studies in the literature.About 15% of young adults with ADHD (A-ADHD) have a comorbid SUD [1]. SUD is more severe in patients affected by ADHD; the comorbidity between SUD and ADHD is associated with an earlier age at onset of substance use, a higher likelihood of use of a variety of substances and higher rates of polysubstance use [3]. While a large amount of medical literature has explored the association between Attention Deficit/Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUDs), less attention has been dedicated to the typologies of SUD and their relationships with ADHD-specific symptomatology and general psychopathology in dual disorder patients. A factorial analysis was performed to group our patients by clusters in different typologies of substance use and correlations between SUDs, as made evident by their typological and diagnostic features; in addition, specific ADHD symptoms, severity of general psychopathology and patients’ functionality were assessed. Conclusions: At treatment entry, the presence of different comorbid SUD clusters do not affect ADHD-specific symptomatology or severity

Methods

Results

Discussion

Conclusion