Trimbos-instituut and ICASA Foundation, Utrecht, The Netherlands; Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
Drug Alcohol Depend. 2014 Jan 1;134:158-166. doi: 10.1016/j.drugalcdep.2013.09.026. Epub 2013 Oct 5.
Available studies vary in their estimated prevalence of attention deficit/hyperactivity disorder (ADHD) in substance use disorder (SUD) patients, ranging from 2 to 83%. A better understanding of the possible reasons for this variability and the effect of the change from DSM-IV to DSM-5 is needed.
A two stage international multi-center, cross-sectional study in 10 countries, among patients form inpatient and outpatient addiction treatment centers for alcohol and/or drug use disorder patients. A total of 3558 treatment seeking SUD patients were screened for adult ADHD. A subsample of 1276 subjects, both screen positive and screen negative patients, participated in a structured diagnostic interview.
Prevalence of DSM-IV and DSM-5 adult ADHD varied for DSM-IV from 5.4% (CI 95%: 2.4-8.3) for Hungary to 31.3% (CI 95%:25.2-37.5) for Norway and for DSM-5 from 7.6% (CI 95%: 4.1-11.1) for Hungary to 32.6% (CI 95%: 26.4-38.8) for Norway. Using the same assessment procedures in all countries and centers resulted in substantial reduction of the variability in the prevalence of adult ADHD reported in previous studies among SUD patients (2-83%→5.4-31.3%). The remaining variability was partly explained by primary substance of abuse and by country (Nordic versus non-Nordic countries). Prevalence estimates for DSM-5 were slightly higher than for DSM-IV.
Given the generally high prevalence of adult ADHD, all treatment seeking SUD patients should be screened and, after a confirmed diagnosis, treated for ADHD since the literature indicates poor prognoses of SUD in treatment seeking SUD patients with ADHD.
在物质使用障碍（SUD）患者中，注意力缺陷/多动障碍（ADHD）的患病率在不同研究中有所不同，范围为 2%至 83%。需要更好地了解这种变异性的可能原因，以及从 DSM-IV 到 DSM-5 的变化的影响。
这是一项在 10 个国家的 10 个成瘾治疗中心进行的国际多中心、两阶段、横断面研究，纳入了酒精和/或药物使用障碍患者的住院和门诊治疗寻求者。共有 3558 名 SUD 治疗寻求者接受了成人 ADHD 的筛查。共有 1276 名（包括筛查阳性和筛查阴性患者）受试者参加了一项结构化诊断访谈。
DSM-IV 和 DSM-5 成人 ADHD 的患病率在不同国家之间存在差异，从匈牙利的 5.4%（95%CI：2.4-8.3）到挪威的 31.3%（95%CI：25.2-37.5），从匈牙利的 7.6%（95%CI：4.1-11.1）到挪威的 32.6%（95%CI：26.4-38.8）。在所有国家和中心使用相同的评估程序，大大降低了之前在 SUD 患者中报告的成人 ADHD 患病率的变异性（2%-83%→5.4%-31.3%）。剩余的变异性部分由主要滥用物质和国家（北欧国家与非北欧国家）解释。DSM-5 的患病率估计值略高于 DSM-IV。
鉴于成人 ADHD 的普遍高患病率，所有治疗寻求的 SUD 患者都应进行筛查，在确诊后，应针对 ADHD 进行治疗，因为文献表明，在治疗寻求的 ADHD 合并 SUD 患者中，SUD 的预后较差。
