Adult Attention Deficit Hyperactivity Disorder and Its Correlates with the Presence and Severity of Early-onset Alcohol Dependence: An Estimate from a Tertiary Care Center
Shankar Kumar, Sneha Venkatakrishna, Sushmitha Kota
Alcohol dependence, Attention deficit hyperactivity disorder, Severe dependence
Citation Information :
Kumar S, Venkatakrishna S, Kota S. Adult Attention Deficit Hyperactivity Disorder and Its Correlates with the Presence and Severity of Early-onset Alcohol Dependence: An Estimate from a Tertiary Care Center. Ind J Priv Psychiatry 2021; 15 (1):23-26.
Background: Alcohol dependence is a highly prevalent condition worldwide. Among those with early-onset substance dependence, studies have found that about 30% have comorbid attention deficit hyperactivity disorder (ADHD). Such patients tend to have severe dependence, poorer outcomes, and failure of classical treatment.
Aim and objective: To study the prevalence of adult ADHD and explore the correlates of ADHD among those with early-onset alcohol dependence.
Materials and methods: Eighty-two adult inpatients with early-onset alcohol dependence were recruited for the study after obtaining informed consent. The World Health Organization (WHO) Adult ADHD Screening Rating Scale (ASRS) was used to screen adult ADHD. Wender Utah Rating Scale (WURS) was used to corroborate childhood ADHD symptoms. Severity of Alcohol Dependence Questionnaire (SAD-Q) was administered to determine the severity of dependence. Cohen\'s Perceived Stress Scale was administered to determine the perceived stress levels in the past 1 month. MINI Plus Neuropsychiatric Interview was administered to rule out mood disorders and antisocial personality disorder (ASPD). Analysis of data was done using t-test, Fisher\'s exact test, Spearman\'s correlations, and multiple logistic regression analysis to determine the odds of having severe dependence.
Results: Twenty-one out of the 82 subjects with early-onset alcohol dependence had adult ADHD (25.6%). The severity of alcohol dependence was significantly greater among those with comorbid ADHD (p <0.001). The odds of having ADHD predicting severe dependence was 8 (p = 0.0004).
Conclusion: The prevalence of adult ADHD in those with early-onset alcohol dependence is high. Adult ADHD is a significant predictor of greater severity of alcohol dependence. There is a need for studies that evaluate therapeutic options that would be effective for the treatment of comorbid ADHD and early-onset alcohol dependence.
Kooij SJ, Bejerot S, Blackwell A, et al. European consensus statement on diagnosis and treatment of adult ADHD: the European Network Adult ADHD. BMC Psychiatry 2010;10:67. DOI: 10.1186/1471-244X-10-67.
Barkley RA, Fischer M, Smallish L, et al. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol 2002;111(2):279–289. DOI: 10.1037/0021-843X.111.2.279.
Biederman J, Petty CR, Clarke A, et al. Predictors of persistent ADHD: an 11-year follow-up study. J Psychiatr Res 2011;45(2):150–155. DOI: 10.1016/j.jpsychires.2010.06.009.
Biederman J, Petty CR, O'Connor KB, et al. Predictors of persistence in girls with attention deficit hyperactivity disorder: results from an 11-year controlled follow-up study. Acta Psychiatr Scand 2012;125(2):147–156. DOI: 10.1111/j.1600-0447.2011.01797.x.
Fayyad J, De Graaf R, Kessler R, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 2007;190:402–409. DOI: 10.1192/bjp.bp.106.034389.
Kessler RC, Adler LA, Barkley R, et al. Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry 2005;57(11):1442–1451. DOI: 10.1016/j.biopsych.2005.04.001.
Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006;163(4): 716–723. DOI: 10.1176/appi.ajp.163.4.716.
Lara C, Fayyad J, De Graaf R, et al. Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry 2009;65(1):46–54. DOI: 10.1016/j.biopsych.2008.10.005.
Mannuzza S, Klein RG, Moulton JL III. Persistence of attention- deficit/hyperactivity disorder into adulthood: what have we learned from the prospective follow-up studies? J Atten Disord 2003;7(2):93–100. DOI: 10.1177/108705470300700203.
Sandra Kooij JJ, Buitelaar JK, van den Oord EJ, et al. Internal and external validity of attention- deficit hyperactivity disorder in a population-based sample of adults. Psychol Med 2005;35(6):817–827. DOI: 10.1017/s003329170400337x.
Polanczyk GV, Salum GA, Sugaya LS, et al. Annual research review: a meta-analysis of the worldwide prevalence of mental disorders in children and adolescents. J Child Psychol Psychiatry 2015;56(3): 345–365. DOI: 10.1111/jcpp.12381.
Biederman J, Wilens TE, Mick E, et al. Does attention-deficit hyperactivity disorder impact the developmental course of drug and alcohol abuse and dependence? Biol Psychiatry 1998;44(4):269–273. DOI: 10.1016/s0006-3223(97)00406-x.
Barkley RA, Fischer M, Smallish L, et al. Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry 2004;45(2):195–121. DOI: 10.1111/j.1469-7610.2004.00214.x.
Fredriksen M, Dahl AA, Martinsen EW, et al. Childhood and persistent ADHD symptoms associated with educational failure and long-term occupational disability in adult ADHD. Atten Defic Hyperact Disord 2014;6(2):87–99. DOI: 10.1007/s12402-014-0126-1.
Sullivan MA, Rudnik-Levin F. Attention deficit/hyperactivity disorder and substance abuse. Diagnostic and therapeutic considerations. Ann N Y Acad Sci 2001;931:251–270. DOI: 10.1111/j.1749-6632.2001.tb05783.x.
Wilens TE. The nature of the relationship between attention- deficit/hyperactivity disorder and substance use. J Clin Psychiatry 2007;68(Suppl. 11):4–8. PMID: 18307375.
Wise BK, Cuffe SP, Fischer T. Dual diagnosis and successful participation of adolescents in substance abuse treatment. J Subst Abuse Treat 2001;21(3):161–165. DOI: 10.1016/s0740-5472(01)00193-3.
Ward MF, Wender PH, Reimherr FW. The Wender Utah Rating Scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry 1993;150(6):885–890. DOI: 10.1176/ajp.150.6.885.
Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav 1983;24(4):385–396. Available from: https://doi.org/10.2307/2136404
Faraone SV, Biederman J. What is the prevalence of adult ADHD? Results of a population screen of 966 adults. J Atten Disord 2005;9(2):384–391. DOI: 10.1177/1087054705281478.
Van de Glind G, van Oortmerssen KV, Carpentier PJ, et al. The international ADHD in substance use disorders prevalence (IASP) study: background, methods and study population. Int J Methods Psychiatr Res 2013;22(3):232–244. DOI: 10.1002/mpr.1397.
Arias AJ, Gelernter J, Chan G, et al. Correlates of co-occurring ADHD in drug-dependent subjects: prevalence and features of substance dependence and psychiatric disorders. Addict Behav 2008;33(9): 1199–1207. DOI: 10.1016/j.addbeh.2008.05.003.
Wilens TE. Impact of ADHD and its treatment on substance abuse in adults. J Clin Psychiatry 2004;65(3):38–45. PMID: 15046534.
Miller M, Hurd Y. Testing the gateway hypothesis. Neuropsychopharmacol 2017;42:985–986. DOI: 10.1038/npp.2016.279.
Kuria MW, Ndetei DM, Obot IS, et al. The association between alcohol dependence and depression before and after treatment for alcohol dependence. ISRN Psychiatry 2012;482802:6 p. DOI: 10.5402/2012/482802.
Barkley RA, Murphy KR. Attention deficit hyperactivity disorder: a clinical workbook. New York: Guilford; 2006.
Daurio AM, Aston SA, Schwandt ML, et al. Impulsive personality traits mediate the relationship between adult attention-deficit/hyperactivity symptoms and alcohol dependence severity. Alcoholism 2018;42(1):173–183. DOI: 10.1111/acer.13538.