Epidemiology,Biostatistics and Prevention Institute,Zurich,Switzerland.
Psychiatric University Hospital Zurich,Zurich,Switzerland.
Epidemiol Psychiatr Sci. 2016 Jun;25(3):255-66. doi: 10.1017/S2045796015000360. Epub 2015 May 20.
Functional and mental health impairments that adults with attention-deficit/hyperactivity disorder (ADHD) experience may be exacerbated by regular substance use and co-morbidity with substance use disorders (SUD). This may be especially true during young adulthood, which represents a critical stage of life associated with increased substance use and associated problems. However, previous studies investigating the association between ADHD and substance use and SUD have demonstrated inconsistent results, probably due to methodological limitations (e.g., small and non-representative samples). Thus, the relationship of ADHD with substance use and related disorders remains unclear. The aim of the present study was to examine the association between ADHD and both the use of licit and illicit substances and the presence of SUD in a large, representative sample of young men.
The sample included 5677 Swiss men (mean age 20 ± 1.23 years) who participated in the Cohort Study on Substance Use Risk Factors (C-SURF). ADHD was assessed using the adult ADHD Self Report Screener (ASRS). The association between ADHD and substance use and SUD was assessed for alcohol, nicotine, cannabis and other illicit drugs, while controlling for socio-demographic variables and co-morbid psychiatric disorders (i.e., major depression (MD) and anti-social personality disorder (ASPD)).
Men with ADHD were more likely to report having used nicotine, cannabis and other illicit drugs at some time in their life, but not alcohol. ADHD was positively associated with early initiation of alcohol, nicotine and cannabis use, the risky use of these substances, and the presence of alcohol use disorders, and nicotine and cannabis dependence. Additionally, our analyses revealed that these patterns are also highly associated with ASPD. After adjusting for this disorder, the association between ADHD and licit and illicit substance use and the presence of SUDs was reduced, but remained significant.
Our findings suggest that adult ADHD is significantly associated with a propensity to experiment with licit and illicit substances, especially at earlier ages, to exhibit risky substance use patterns, and to subsequently develop SUDs. Preventive strategies that include early intervention and addressing co-morbidity with ASPD may be crucial to reducing substance use and the development of pathological substance use patterns in young men affected by ADHD and, thus, helping to prevent further illness burden later in life.
患有注意力缺陷多动障碍（ADHD）的成年人的功能和心理健康障碍可能会因经常使用物质和物质使用障碍（SUD）共病而加重。这在青年时期可能尤其如此，青年时期是生命的一个关键阶段，与物质使用增加和相关问题有关。然而，先前研究 ADHD 与物质使用和 SUD 之间的关联的研究结果不一致，可能是由于方法学上的限制（例如，样本小且非代表性）。因此，ADHD 与物质使用和相关障碍之间的关系仍不清楚。本研究的目的是在一个大型代表性的青年男性样本中检查 ADHD 与合法和非法物质使用以及 SUD 之间的关系。
该样本包括 5677 名瑞士男性（平均年龄 20 ± 1.23 岁），他们参加了物质使用风险因素队列研究（C-SURF）。使用成人 ADHD 自我报告筛查器（ASRS）评估 ADHD。在控制社会人口统计学变量和共病精神障碍（即重度抑郁症（MD）和反社会人格障碍（ASPD））的情况下，评估 ADHD 与物质使用和 SUD 之间的关系，包括酒精、尼古丁、大麻和其他非法药物。
患有 ADHD 的男性更有可能报告在他们的一生中某个时候使用过尼古丁、大麻和其他非法药物，但没有使用过酒精。ADHD 与酒精、尼古丁和大麻的早期使用、这些物质的危险使用以及酒精使用障碍和尼古丁和大麻依赖的存在呈正相关。此外，我们的分析还表明，这些模式也与 ASPD 高度相关。在调整了这种障碍后，ADHD 与合法和非法物质使用以及 SUD 的存在之间的关联仍然显著。
我们的研究结果表明，成人 ADHD 与尝试使用合法和非法物质的倾向显著相关，尤其是在年龄较小的时候，与危险的物质使用模式有关，并随后发展为 SUD。预防策略包括早期干预和解决与 ASPD 的共病，可能对于减少 ADHD 患者的物质使用和病理性物质使用模式的发展至关重要，从而有助于减轻生命后期的进一步疾病负担。
