Attention Deficit/Hyperactivity Disorder and Global Severity Profiles in Treatment-Seeking Patients with Substance Use Disorders

Romain Icick; Franz Moggi; Ortal Slobodin; Geert Dom; Frieda Mathys; Wim van den Brink; Frances R Levin; Matthijs Blankers; Sharlene Kaye; Zsolt Demetrovics; Geurt van de Glind; Maria C Velez-Pastrana; Arnt S A Schellekens; ICASA-group

doi:10.1159/000508546

Attention Deficit/Hyperactivity Disorder and Global Severity Profiles in Treatment-Seeking Patients with Substance Use Disorders

Eur Addict Res. 2020;26(4-5):201-210. doi: 10.1159/000508546. Epub 2020 Jun 22.

Authors

Romain Icick^{1

2

3

4}, Franz Moggi⁵, Ortal Slobodin⁶, Geert Dom⁷, Frieda Mathys⁸, Wim van den Brink⁹, Frances R Levin¹⁰, Matthijs Blankers¹¹, Sharlene Kaye¹², Zsolt Demetrovics¹³, Geurt van de Glind¹⁴, Maria C Velez-Pastrana¹⁵, Arnt S A Schellekens¹⁴; ICASA-group

Affiliations

¹ Integrative Neurobiology of Cholinergic Systems, CNRS UMR 3571, Institut Pasteur, Paris, France, romain.icick@aphp.fr.
² Assistance Publique - Hôpitaux de Paris, University Hospital Saint-Louis - Lariboisière - Fernand Widal, Paris, France, romain.icick@aphp.fr.
³ INSERM UMR-S1144, Paris, France, romain.icick@aphp.fr.
⁴ Paris University, Paris, France, romain.icick@aphp.fr.
⁵ University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
⁶ Department of Education, Ben-Gurion University, Beer-Sheva, Israel.
⁷ Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium.
⁸ Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
⁹ Department of Psychiatry, Amsterdam Institute for Addiction Research - Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
¹⁰ Division on Substance Use Disorders, New York State Psychiatric Institute - Columbia University Medical Center, New York State Psychiatric Institute, New York, New York, USA.
¹¹ Trimbos, Netherlands Institute of Mental Health and Addiction, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹² National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
¹³ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
¹⁴ Psychiater Radboudumc, Donders Centre for Neuroscience, Afdeling Psychiatrie Wetenschappelijk, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, The Netherlands.
¹⁵ PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico.

PMID: 32570249
DOI: 10.1159/000508546

Abstract

Introduction: Comorbid attention deficit/hyperactivity disorder (ADHD) is present in 15-25% of all patients seeking treatment for substance use disorders (SUDs). Some studies suggest that comorbid ADHD increases clinical severity related to SUDs, other psychiatric comorbidities, and social impairment, but could not disentangle their respective influences.

Objectives: To investigate whether comorbid adult ADHD in treatment-seeking SUD patients is associated with more severe clinical profiles in these domains assessed altogether.

Methods: Treatment-seeking SUD patients from 8 countries (N = 1,294: 26% females, mean age 40 years [SD = 11 years]) were assessed for their history of DSM-IV ADHD, SUDs, and other psychiatric conditions and sociodemographic data. SUD patients with and without comorbid ADHD were compared on indicators of severity across 3 domains: addiction (number of SUD criteria and diagnoses), psychopathological complexity (mood disorders, borderline personality disorder, lifetime suicidal thoughts, or behavior), and social status (education level, occupational and marital status, and living arrangements). Regression models were built to account for confounders for each severity indicator.

Results: Adult ADHD was present in 19% of the SUD patients. It was significantly associated with higher SUD severity, more frequent comorbid mood or borderline personality disorder, and less frequent "married" or "divorced" status, as compared with the absence of comorbid ADHD. ADHD comorbidity was independently associated with a higher number of dependence diagnoses (OR = 1.97) and more psychopathology (OR = 1.5), but not marital status.

Conclusions: In treatment-seeking SUD patients, comorbid ADHD is associated with polysubstance dependence, psychopathological complexity, and social risks, which substantiates the clinical relevance of screening, diagnosing, and treating ADHD in patients with SUDs.

Keywords: Addiction; Attention deficit/hyperactivity disorder; Comorbidity; Dual diagnosis; Severity; Substance use disorders.

MeSH terms

Adult
Attention Deficit Disorder with Hyperactivity / epidemiology*
Attention Deficit Disorder with Hyperactivity / physiopathology
Behavior, Addictive*
Comorbidity*
Diagnostic and Statistical Manual of Mental Disorders
Female
Global Health
Humans
Male
Risk Factors
Severity of Illness Index*
Socioeconomic Factors
Substance-Related Disorders / epidemiology*
Substance-Related Disorders / therapy*
Surveys and Questionnaires