Schubiner H, Tzelepis A, Milberger S, Lockhart N, Kruger M, Kelley B J, Schoener E P
Department of Internal Medicine, Wayne State University School of Medicine, Detroit, Mich. 48207, USA.
J Clin Psychiatry. 2000 Apr;61(4):244-51. doi: 10.4088/jcp.v61n0402.
This cross-sectional study sought to determine the prevalence of attention-deficit/hyperactivity disorder (ADHD) and conduct disorder among adults admitted to 2 chemical dependency treatment centers. It was hypothesized that ADHD alone or in combination with conduct disorder would be overrepresented in a population of patients with psychoactive substance use disorders.
Two hundred one participants were selected randomly from 2 chemical dependency treatment centers. Standardized clinical interviews were conducted using the Structured Clinical Interview for DSM-IV, the Addiction Severity Index, and DSM-IV criteria for ADHD. Reliabilities for the diagnostic categories were established using the Cohen kappa, and the subgroups of individuals with and without ADHD and conduct disorder were compared.
Forty-eight (24%) of the participants were found to meet DSM-IV criteria for ADHD. The prevalence of ADHD was 28% in men (30/106) and 19% in women (18/95; NS). Seventy-nine participants (39%) met criteria for conduct disorder, and 34 of these individuals also had ADHD. Overall, individuals with ADHD (compared with those without ADHD) were more likely to have had more motor vehicle accidents. Women with ADHD (in comparison with women without ADHD) had a higher number of treatments for alcohol abuse. Individuals with conduct disorder (in comparison with those without conduct disorder) were younger, had a greater number of jobs as adults, and were more likely to repeat a grade in school, have a learning disability, be suspended or expelled from school, have an earlier age at onset of alcohol dependence, and have had a greater number of treatments for drug abuse. They were more likely to have a lifetime history of abuse of and/or dependence on cocaine, stimulants, hallucinogens, and/or cannabis.
A significant overrepresentation of ADHD exists among inpatients with psychoactive substance use disorders. Over two thirds of those with ADHD in this sample also met criteria for conduct disorder. Our sample had a very large overlap between ADHD and conduct disorder, and the major comorbidities identified here were attributable largely to the presence of conduct disorder. Individuals who manifest conduct disorder and/or ADHD represent a significant proportion of those seeking treatment for psychoactive substance use disorders. They appear to have greater comorbidity and may benefit from a treatment approach that addresses these comorbidities specifically through medical and behavioral therapies.
这项横断面研究旨在确定入住两家化学物质依赖治疗中心的成年人中注意力缺陷多动障碍（ADHD）和品行障碍的患病率。研究假设，在患有精神活性物质使用障碍的患者群体中，单独患有ADHD或合并品行障碍的情况会更为常见。
从两家化学物质依赖治疗中心随机选取201名参与者。使用《精神疾病诊断与统计手册》第四版（DSM-IV）的结构化临床访谈、成瘾严重程度指数以及DSM-IV的ADHD标准进行标准化临床访谈。使用科恩kappa系数确定诊断类别的信度，并比较患有和未患有ADHD及品行障碍的个体亚组。
发现48名（24%）参与者符合DSM-IV的ADHD标准。ADHD的患病率在男性中为28%（30/106），在女性中为19%（18/95；无显著差异）。79名参与者（39%）符合品行障碍标准，其中34人同时患有ADHD。总体而言，患有ADHD的个体（与未患有ADHD的个体相比）更有可能发生更多机动车事故。患有ADHD的女性（与未患有ADHD的女性相比）因酒精滥用接受治疗的次数更多。患有品行障碍的个体（与未患有品行障碍的个体相比）更年轻，成年后工作次数更多，更有可能留级、有学习障碍、被学校停学或开除、酒精依赖发病年龄更早，并且因药物滥用接受治疗的次数更多。他们更有可能有可卡因、兴奋剂、致幻剂和/或大麻滥用和/或依赖的终生史。
在患有精神活性物质使用障碍的住院患者中，ADHD的比例显著过高。该样本中超过三分之二患有ADHD的人也符合品行障碍标准。我们的样本中ADHD和品行障碍之间有很大重叠，此处确定的主要共病情况很大程度上归因于品行障碍的存在。表现出品行障碍和/或ADHD的个体占寻求精神活性物质使用障碍治疗者的很大比例。他们似乎有更多共病情况，可能会从一种通过医学和行为疗法专门解决这些共病情况的治疗方法中受益。
