The relevance of ADHD in substance use disorders

67 Pages·2011·4.45 MB·English

The relevance of ADHD
in substance use disorders (SUD)
Pieter-Jan Carpentier, psychiatrist
Reinier van Arkel Groep, ‘s-Hertogenbosch
Novadic-Kentron, Netwerk voor Verslavingszorg
THE NETHERLANDS
2
God
invented
alcohol
to prevent
the Irish
from ruling
the world
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adult ADHD
NL 1.0 – 2.5
: % (N= 1800)
USA 4.4
: % (N= 3200)
(Nat. Comorbidity
Survey Replication)
worldwide 3.4
: % (N =11422)
1.2 - 7.3
( %)
Kooij e.a. Psychol Med. 2005; 35: 817-27.
Kessler e.a. Am J Psychiatry. 2006 Apr;163(4):716-23
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Fayyad e.a. Br J Psychiatry. 2007; 190: 402-9
Comorbidity in adults with ADHD
± 80 % of patients at least 1
± 50 % at least 2
comorbid psychiatric disorder(s):
- mood disorders: mood swings
depression
bipolar disorder
- anxiety disorders
- personality disorders
Substance Use Disorders
-
McGough Am J Psychiatry 2005; 162: 1621-7
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substance use disorders (SUD)
loss of control
main characteristic:
DSM-IV-TR : diagnostic and statistical manual of mental disorders
abuse: persistent use in spite of serious negative consequences
dependence: even more serious abuse, complicated by
• tolerance
• withdrawal symptomatology
craving
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Prevalence of Adult ADHD in Substance Abusers
Seeking Treatment *
Author, Year Population ADHD
*Based on DSM-IV Criteria
Levin, 1998 281 Cocaine Abusers 10-15%
Clure, 1999 136 Cocaine and/or Alcohol Abusers 15%
King, 1999 125 Methadone Patients 17%
Schubiner, 2000 201 Substance Abusers 24%
* Based on DSM-IV Criteria
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Prevalence
ADHD in SUD
Prevalence of ADHD in substance-abusing patients:
A meta-analysis and meta-regression analysis. Study name Ervaetent LloSiwmtaeittris ticUslp ifmoperi tre achZ -sVtaulduyep-Value Event rate and 95% CI
CGalarrlakn edt eatl al 00,,221816 00,,125166 00,,238608 --64,,973638 00,,000000
Katelijne van Emmerik - van Oortmerssen GHJaroeivnllceahn eisllt eeattl aall 000,,,123341060 000,,,122110080 000,,,124574267 --21-032,,,186386598 000,,,000000008
LdMaeot liMimnialei ore te ta lal 000,,,421084060 000,,,320247142 000,,,432835536 ---284,,,327015876 000,,,000200100
Geurt van de Glind NSSSStuuzooobbvwbrriaaonemmtsll eaaeetnntt iiaaaaallmml eettaall AB 00000,,,,,334013948800300 00000,,,,,223014825136413 00000,,,,,455123062715934 -----31095,,,,,288942786997816 00000,,,,,003000670011400
TTCaimarrtrseo rle l ete tat alall B 000,,,123938980 000,,,113464352 000,,,234732010 ---645,,,898382200 000,,,000000000
Wim van den Brink CDlauirger ee te ta lal 00,,210500 00,,102969 00,,320220 --47,,926203 00,,000000
FJKoainhlcga kne nte tae lat lal 000,,,210199309 000,,,110737100 000,,,221663287 -1--961,,,643866920 000,,,000000000
Filip Smit LMOehovldmiense eiteitnr aeeltt aall A 000,,,211310100 000,,,100567620 000,,,311284871 -1--416,,,085357054 000,,,000000000
ORSchohlumunbseiianever riel leet t a ealt l Bal 000,,,253444019 000,,,142819667 000,,,364060415 --605,,,961743090 000,,,050020020
Cleo L. Crunelle TWZaieondogod ne eits ta ealtl al 0000,,,,133204331601 0000,,,,021169899114 0000,,,,145240276532 --11--0401,,,,269761739720 0000,,,,000000080004
-1,00 -0,50 0,00 0,50 1,00
Robert A. Schoevers
Meta Analysis 0%-50%
29 studies, including 6689 subjects (4054 adolescents and 2635 adults)
Overall prevalence ADHD in SUD = 23.1% (95% C.I: 19.4% – 27.2%)
Meta-regression analysis:
- lower prevalence of ADHD in primary cocaine dependent subjects
- higher prevalence of ADHD in studies with DICA or SADS-L
- no effect of age, gender, setting, time-frame, abstinence duration
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ADHD & SUD : prevalence
bidirectional overrepresentation of ADHD and SUD
among subjects with these disorders
ADHD prevalence clearly increased among SUD patients
clinical impression: ADHD prevalence even more increased
among SUD populations with
more severe / more chronic disorders (e.g. inpatient populations)
adults with ADHD + SUD are at risk for
other psychiatric comorbidities and
a longer course of SUD
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ADHD & SUD : selection of substances
substances used: EEEEVVVVEEEERRRRYYYYTTTTHHHHIIIINNNNGGGG !!!!
NO CLEAR SELECTION
not only psycho-stimulant drugs:
amfetamines / cocaine
paradoxical effect of stimulant drugs :
(some, not all) users become relaxed and more focused
also sedating substances:
alcohol / heroine / soft drugs
Clure e.a. Am J Drug Alcohol Abuse. 1999; 25: 441-8
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Biederman e.a. Am J Psychiatry 1995; 152: 1652-8