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Am J Psychiatry 1995; 152:1652-1658
Copyright © 1995 by American Psychiatric Association
Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity
J Biederman, T Wilens, E Mick, S Milberger, TJ Spencer and SV Faraone
Pediatric Psychopharmacology Unit, Massachusetts General Hospital, Boston 02114, USA.
OBJECTIVE: The authors evaluated the association between attention deficit
hyperactivity disorder (ADHD) and psychoactive substance use disorders in
adults with ADHD, attending to comorbidity with mood, anxiety, and
antisocial disorders. It was hypothesized that psychiatric comorbidity
would be a risk factor for psychoactive substance use disorders. METHOD:
Findings for 120 referred adults with a clinical diagnosis of
childhood-onset ADHD were compared with those for non-ADHD adult comparison
subjects (N = 268). All childhood and adult diagnoses were obtained by
structured psychiatric interviews for DSM-III-R. RESULTS: There was a
significantly higher lifetime risk for psychoactive substance use disorders
in the ADHD adults than in the comparison subjects (52% versus 27%).
Although the two groups did not differ in the rate of alcohol use
disorders, the ADHD adults had significantly higher rates of drug and drug
plus alcohol use disorders than the comparison subjects. ADHD significantly
increased the risk for substance use disorders independently of psychiatric
comorbidity. Antisocial disorders significantly increased the risk for
substance use disorders independently of ADHD status. Mood and anxiety
disorders increased the risk for substance use disorders in both the ADHD
and comparison subjects, but more demonstrably in the comparison subjects.
CONCLUSIONS: Although psychiatric comorbidity increased the risk for
psychoactive substance use disorders in adults with ADHD, by itself ADHD
was a significant risk factor for substance use disorders. More information
is needed to further delineate risk and protective factors mediating the
development of substance use disorders in persons with ADHD.
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