National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom,
Centre for Psychiatry, Imperial College London, London, United Kingdom,
Eur Addict Res. 2020;26(4-5):211-222. doi: 10.1159/000508653. Epub 2020 Jun 26.
This study addressed the age of onset of conduct disorder (CD) and oppositional defiant disorder (ODD) in treatment-seeking substance use disorder (SUD) patients with and without adult attention-deficit/hyperactivity disorder (ADHD) and its association with early onset of SUD.
We examined data from the 2nd International ADHD in Substance Use Disorders Prevalence Study, including 400 adults in SUD treatment from Puerto Rico, Hungary, and Australia. ADHD, SUD, and CD/ODD were assessed with the Conners Adult ADHD Diagnostic Interview for DSM-IV, the MINI International Neuropsychiatric Interview, and the K-SADS, respectively. Cox regression analyses modeled time to emergence of CD/ODD separately for SUD patients with and without adult ADHD. Linear regression models examined associations between age of onset of SUD and presence of ADHD and adjusted for sex, age, and country. To assess the mediating role of CD/ODD on the association of ADHD with onset of SUD, adjusted regression models were estimated.
Treatment-seeking SUD patients with ADHD presented an earlier onset of CD/ODD compared with those without ADHD. CD/ODD symptom loads were higher among the SUD and ADHD group. Age of first substance use and SUD were significantly earlier in SUD patients with ADHD, and these findings remained significant after adjustment for demographics and coexisting CD/ODD.
ADHD is associated with earlier onset of SUD as well as with an earlier onset of more frequent and more severe disruptive behavioral disorders. These findings may inform preventive interventions to mitigate adverse consequences of ADHD.
本研究探讨了在寻求治疗的物质使用障碍（SUD）患者中，伴有和不伴有成人注意缺陷多动障碍（ADHD）的品行障碍（CD）和对立违抗性障碍（ODD）的发病年龄，以及其与 SUD 早期发病的关系。
我们检查了来自第 2 届国际物质使用障碍中 ADHD 患病率研究的数据，包括来自波多黎各、匈牙利和澳大利亚的 400 名 SUD 治疗中的成年人。ADHD、SUD 和 CD/ODD 分别采用 DSM-IV 成人 ADHD 诊断访谈、MINI 国际神经精神访谈和 K-SADS 进行评估。Cox 回归分析分别为伴有和不伴有成人 ADHD 的 SUD 患者建立 CD/ODD 发病时间模型。线性回归模型检查了 SUD 发病年龄与 ADHD 存在之间的关联，并对性别、年龄和国家进行了调整。为了评估 CD/ODD 在 ADHD 与 SUD 发病关联中的中介作用，估计了调整后的回归模型。
与不伴有 ADHD 的 SUD 患者相比，伴有 ADHD 的 SUD 患者的 CD/ODD 发病年龄更早。在 SUD 和 ADHD 组中，CD/ODD 症状负荷更高。伴有 ADHD 的 SUD 患者的首次物质使用和 SUD 年龄明显更早，且这些发现在调整人口统计学和共存的 CD/ODD 后仍然显著。
ADHD 与 SUD 的更早发病以及更频繁和更严重的破坏性行为障碍的更早发病有关。这些发现可能为减轻 ADHD 的不良后果提供预防干预信息。
