13 Feb Doctors Urged to Screen for ADHD in Addicts
ADHD (attention-deficit/hyperactivity) disorder is a childhood behavioral disorder that sometimes produces problems well into adulthood. Current evidence indicates that people affected by ADHD have unusually high risks for developing a substance use disorder; however, the estimates of the overlap between ADHD and substance use disorders vary to an extreme degree. In a multinational study published in January 2014 in the journal Drug and Alcohol Dependence, researchers from the U.S. and nine European countries sought to explain this uncommonly high level of variability.
People affected by attention-deficit/hyperactivity disorder develop one of three basic symptom sets: difficulty controlling impulsive behaviors and unusually active (i.e., hyperactive) body movements and verbal utterances, difficulty staying focused or maintaining attention, or a combination of attention problems and hyperactivity/impulsivity problems. The condition typically appears in early childhood and its symptoms must remain in effect for at least half a year before an official diagnosis can be made. Underlying contributing causes to the onset of ADHD likely include a fairly complex combination of inherited factors and environmental influences.
Substance Use Disorder Basics
Substance use disorder is the general diagnosis that the American Psychiatric Association sets aside for people affected by either a damaging pattern of non-addicted substance use or substance addiction. In any given case, the specific diagnosis of a substance use disorder includes the name of the substance causing problems for an individual (e.g., alcohol use disorder for drinkers and stimulant use disorder for cocaine, amphetamine or methamphetamine users). Doctors also note the severity of a substance use disorder in each affected individual. All diagnoses require the presence of no less than two symptoms drawn from a list of 11 possible symptoms; severe cases of the disorder far exceed this minimum requirement.
Reasons for an Overlap
ADHD and substance use disorder are separate conditions that produce their own unique impairments to well-being. However, according to the authors of a report published in 2010 in Psychiatric Times, they both involve unusual changes in the chemical pathways that help control normal brain function. People affected by both ADHD and substance use disorder experience problems that commonly include a reduced ability to think clearly, a reduced ability to control impulsive actions and a reduced ability to recognize the occurrence of rewarding sensations. Specific substance-related impacts of ADHD include an increased likelihood of using drugs or alcohol at an early age, increased chances of developing intense forms of substance addiction and increased chances of failing to maintain substance abstinence during the course of drug or alcohol treatment.
Explaining the Widely Varying Figures
Depending on the research project under consideration, recent estimates of the degree of overlap between ADHD and some form of substance use disorder have ranged from a low of 2 percent to a high of 83 percent. In the study published in Drug and Alcohol Dependence, researchers from the U.S., Norway, the Netherlands, Sweden, Switzerland, Hungary, Belgium, Spain, Australia and France investigated the reasons for this unusually wide range of outcomes. They made this examination by screening 3,558 adult substance use disorder patients for symptoms of ADHD and conducting additional, highly detailed interviews with 1,276 of these patients. The participants were drawn from all 10 countries represented by the research team. The researchers defined substance use disorder in accordance with a new set of guidelines introduced by the American Psychiatric Association in 2013.
The lowest reported rate for ADHD in people diagnosed with a substance use disorder (7.6 percent) occurred in Hungary; the highest rate (32.6 percent) occurred in Norway. On the low end, these figures were considerably higher than the estimates produced by previous researchers; conversely, on the high end, they were considerably lower than previous estimates. The study’s authors concluded that the main reason for the wide range of prior results was lack of a universal framework for diagnosing substance use disorder. With such a framework in place (in the form of the American Psychiatric Association’s current guidelines), the rate of variation shrank dramatically. Additional secondary explanations for the varying results produced by previous researchers include differences in the forms of substance abuse/addiction common in individual countries, as well as a specific tendency toward overlapping ADHD and substance use disorder in Sweden, Norway and other Nordic countries.
Significance and Considerations
The authors of the study published in Drug and Alcohol Dependence note that, even with the new narrowed estimates, the overlap between ADHD and substance use disorder is clearly apparent. They recommend that doctors screen all substance use disorder patients for ADHD and vigorously pursue treatment for both conditions in all overlapping cases.
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