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Multicenter Study
. 2014 Feb;109(2):262-72.
doi: 10.1111/add.12370. Epub 2013 Nov 20.

Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study

Katelijne van Emmerik-van Oortmerssen  1 , Geurt van de Glind, Maarten W J Koeter, Steve Allsop, Marc Auriacombe, Csaba Barta, Eli Torild H Bu, Yuliya Burren, Pieter-Jan Carpentier, Susan Carruthers, Miguel Casas, Zsolt Demetrovics, Geert Dom, Stephen V Faraone, Melina Fatseas, Johan Franck, Brian Johnson, Máté Kapitány-Fövény, Sharlene Kaye, Maija Konstenius, Frances R Levin, Franz Moggi, Merete Møller, J Antoni Ramos-Quiroga, Arild Schillinger, Arvid Skutle, Sofie Verspreet; IASP research group; Wim van den Brink, Robert A Schoevers
Collaborators, Affiliations
Multicenter Study

Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study

Katelijne van Emmerik-van Oortmerssen et al. Addiction. 2014 Feb.

Abstract

Aims: To determine comorbidity patterns in treatment-seeking substance use disorder (SUD) patients with and without adult attention deficit hyperactivity disorder (ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse.

Design: Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence (IASP) study.

Setting: Forty-seven centres of SUD treatment in 10 countries.

Participants: A total of 1205 treatment-seeking SUD patients.

Measurements: Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID), the presence of antisocial personality disorder (ASPD), major depression (MD) and (hypo)manic episode (HME) was assessed with the Mini International Neuropsychiatric Interview-Plus (MINI Plus), and the presence of borderline personality disorder (BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II (SCID II).

Findings: The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio (OR) = 2.8, 95% confidence interval (CI) = 1.8-4.2], BPD (OR = 7.0, 95% CI = 3.1-15.6 for alcohol; OR = 3.4, 95% CI = 1.8-6.4 for drugs), MD in patients with alcohol as primary substance of abuse (OR = 4.1, 95% CI = 2.1-7.8) and HME (OR = 4.3, 95% CI = 2.1-8.7) were all more prevalent in ADHD(+) compared with ADHD(-) patients (P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype (P < 0.01), increased HME and ASPD in the hyperactive/impulsive (P < 0.01) and combined subtypes (P < 0.001) and increased BPD in all subtypes (P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD.

Conclusions: Treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders.

Keywords: ADHD; antisocial personality disorder; bipolar disorder; borderline personality disorder; comorbidity; depression; substance use disorder.

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Conflict of interest statement

Declaration of interests

For coordination of the IASP study, as described in the Acknowledgement section of this paper, grants were received from pharmaceutical companies (Shire, Eli Lilly & Company, Jansen Cilag), from participating institutes and from three non-profit organizations: the Waterloo Foundation, the Noaber Foundation and the Augeo Foundation. The funding companies, institutes and foundations did not and will not have influence on any aspect of the study, including research questions, data sampling, data management, data analyses and publishing results. From September 2010, the IASP study functions independently from pharmaceutical companies. On one occasion, G. van de Glind was consultant for Shire, for which he refused payment. In 2013 he received an unrestricted travel grant from Neurotech and he is a member (unpaid) of the advisory board of Neurotech. In 2011 P.-J. Carpentier received a fee for speaking at a conference organized by Eli Lilly. F. R. Levin reports study medication provided by US World Meds and is a consultant to GW Pharmaceuticals. The ICASA Foundation has reimbursed her for airfare and hotel to attend the Annual Meeting as a speaker. S. Kaye reports receiving unrestricted travel grants for participation in the World ADHD Federation conference in Berlin (2011) from Shire, Janssen and Eli Lilly. In the past year, S. V. Faraone received consulting income and/or research support from Shire, Akili Interactive Labs, VAYA Pharma, SynapDx and Alcobra and research support from the National Institutes of Health (NIH). His institution is seeking a patent for the use of sodium–hydrogen exchange inhibitors in the treatment of ADHD. In previous years, he received consulting fees or was on Advisory Boards or participated in continuing medical education programmes sponsored by Shire, Alcobra, Otsuka, McNeil, Janssen, Novartis, Pfizer and Eli Lilly. He receives royalties from books published by Guilford Press: Straight Talk about Your Child’s Mental Health and Oxford University Press: Schizophrenia: The Facts. J. A. Ramos-Quiroga was on the speakers’ bureau and/or acted as consultant for Eli-Lilly, Janssen-Cilag, Novartis, Shire and Rubió in the last 3 years. He also received travel awards (air tickets + hotel) for taking part in psychiatric meetings from Janssen-Cilag, Shire and Eli-Lilly. The ADHD programme chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last 3 years: Eli-Lilly, Janssen-Cilag, Shire and Rubió. M. Casas was on the speakers’ bureau and/or acted as consultant for Eli-Lilly, Janssen-Cilag and Shire in the last 3 years. He also received travel awards (air tickets + hotel) for taking part in psychiatric meetings from Janssen-Cilag, Shire and Eli-Lilly. Z. Demetrovics received reimbursement for participating at a symposium organized by Lundbeck (2011). G. Dom acted as a paid consultant for Lundbeck and received speakers fee and reimbursement for symposium attendance from GSK, Janssen Pharmaceuticals, Astra-Zeneca and Eli Lilly. F. Moggi received a speaker’s fee from Novartis and from Eli Lilly. M. Auriacombe and his institution report unrestricted grants and advisory board activities from RBK Pharmaceutical, Mundipharma and D&A Pharma. J. Franck declares that his research group received an unrestricted research grant from Jansen-Cilag in 2007. The grant was received and administered by his university (Karolinska Institutet). L. Degenhardt is supported by an Australian National Health and Medical Research Council (NHMRC) Principal Research Fellowship. The National Drug and Alcohol Research Centre at the University of NSW is supported by funding from the Australian Government under the Substance Misuse Prevention and Service Improvements Grants Fund. W. van den Brink has received a fee from Eli Lilly for organizing a symposium on the role of impulsivity in psychiatric disorders and a speaker’s fee from Eli Lilly for a presentation on the relationship between ADHD and addiction. Apart from the funding resources mentioned in the Acknowledgement section and the declarations of interest reported above, the above-mentioned authors and the other authors declare no other conflicts of interest.

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