Carroll K M, Rounsaville B J
Department of Psychiatry, Yale University, New Haven, CT.
Compr Psychiatry. 1993 Mar-Apr;34(2):75-82. doi: 10.1016/0010-440x(93)90050-e.
Thirty-five percent of 298 treatment-seeking cocaine abusers met DSM-III-R criteria for childhood attention deficit hyperactivity disorder (ADHD). Subjects with childhood ADHD were likely to be male (78%), meet Research Diagnostic Criteria (RDC) for conduct disorder (93%) and antisocial personality disorder (47%), and report a history of conduct disorder in first-degree relatives. With respect to those without the disorder and regardless of co-occurrence with sociopathy, cocaine abusers with childhood ADHD were younger at presentation for treatment and reported more severe substance use, earlier onset of cocaine abuse, more frequent and intense cocaine use, intranasal rather than freebase or intravenous use of cocaine, higher rates of alcoholism, and more previous treatment. This pattern of cocaine use is consistent with clinical descriptions of self-medication of residual symptoms of ADHD in cocaine abusers. Data from this study suggest that there may be more cocaine abusers with a history of ADHD than previously recognized in clinical samples of cocaine users, and that these individuals may differ in clinically meaningful ways from those without childhood ADHD. Moreover, the poorer outcome of subjects with ADHD in this sample underlines the importance of identifying and treating residual symptoms of ADHD in cocaine abusers.
在298名寻求治疗的可卡因滥用者中，35%符合《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）中儿童注意力缺陷多动障碍（ADHD）的标准。患有儿童期ADHD的受试者很可能为男性（78%），符合品行障碍的研究诊断标准（RDC）（93%）和反社会人格障碍的标准（47%），并且报告有一级亲属患品行障碍的病史。对于那些没有该障碍的人，无论是否同时患有反社会型人格障碍，患有儿童期ADHD的可卡因滥用者在开始接受治疗时年龄更小，报告的物质使用情况更严重，可卡因滥用的起始时间更早，可卡因使用更频繁、程度更强烈，使用可卡因的方式为鼻内用药而非快克或静脉注射，酗酒率更高，且之前接受治疗的次数更多。这种可卡因使用模式与可卡因滥用者对ADHD残留症状进行自我药物治疗的临床描述一致。本研究的数据表明，有ADHD病史的可卡因滥用者可能比之前在可卡因使用者的临床样本中所认识到的更多，而且这些个体在临床上可能与没有儿童期ADHD的个体存在有意义的差异。此外，该样本中患有ADHD的受试者预后较差，这凸显了识别和治疗可卡因滥用者ADHD残留症状的重要性。
