Department of Psychology, University "Vita-Salute San Raffaele", Milan, Italy.
Unit of Clinical Psychology and Psychotherapy, San Raffaele-Turro Hospital, Milan, Italy.
Subst Use Misuse. 2022;57(12):1837-1853. doi: 10.1080/10826084.2022.2120358. Epub 2022 Sep 12.
The link between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) has been largely demonstrated. Some scholars have hypothesized that self-regulation mechanisms might play a key role in explaining this association. The current study tested the hypothesis that retrospective childhood ADHD symptoms might lead to more severe SUDs and this association should be mediated by current self-ratings of behavioral disinhibition, inattention, and emotional dysregulation among 204 treatment-seeking adults (male: 67.3%; female: 32.7%) with a primary diagnosis of alcohol use disorder and other SUDs. The mediational model was estimated through self-report measures of childhood ADHD symptoms (independent variable; WURS), current self-regulation mechanisms (mediators)-behavioral disinhibition (BIS-11 motor subscale), difficulties with attention regulation (MAAS) and emotion regulation (DERS)-and severity of SUDs (dependent variable; SPQ alcohol, illicit and prescribed drugs). The analysis showed that alterations in the self-regulation system fully mediated the association between the severity of childhood ADHD symptoms and SUDs in adulthood. Behavioral disinhibition and difficulties in attention regulation were the most representative alterations in self-regulation processes that explained this association. These findings suggest it is useful to implement several therapeutic approaches (e.g. behavioral, mindfulness-based, and pharmacological) to increase the self-regulation abilities of children and adolescents with ADHD in order to reduce the probability of SUD onset in adulthood. However, future longitudinal neuroimaging and neuropsychological studies are needed to further support the role of self-regulation mechanisms in explaining the prospective association between childhood ADHD symptoms and SUDs in adulthood.
注意力缺陷多动障碍（ADHD）与物质使用障碍（SUD）之间的联系已得到广泛证实。一些学者假设自我调节机制可能在解释这种关联方面发挥关键作用。本研究检验了以下假设：回顾性儿童期 ADHD 症状可能导致更严重的 SUD，而这种关联应该通过 204 名寻求治疗的患有酒精使用障碍和其他 SUD 的成年人（男性：67.3%；女性：32.7%）当前的行为抑制、注意力不集中和情绪调节自我评估来介导，这些成年人的主要诊断为酒精使用障碍和其他 SUD。通过儿童期 ADHD 症状的自我报告测量（自变量；WURS）、当前自我调节机制（中介变量）-行为抑制（BIS-11 运动子量表）、注意力调节困难（MAAS）和情绪调节（DERS）以及 SUD 的严重程度（因变量；SPQ 酒精、非法和处方药物）来估计中介模型。分析表明，自我调节系统的改变完全介导了儿童期 ADHD 症状严重程度与成年后 SUD 之间的关联。行为抑制和注意力调节困难是自我调节过程中最具代表性的改变，这些改变解释了这种关联。这些发现表明，实施几种治疗方法（例如行为、基于正念的和药物治疗）以提高 ADHD 儿童和青少年的自我调节能力，从而降低成年后患 SUD 的可能性是有用的。然而，需要进一步进行前瞻性神经影像学和神经心理学研究，以进一步支持自我调节机制在解释儿童期 ADHD 症状与成年后 SUD 之间的前瞻性关联中的作用。
