Influence of attention deficit hyperactivity disorder and conduct disorder on opioid dependence severity and psychiatric comorbidity in chronic methadone-maintained patients.
BACKGROUND
Persistent attention deficit hyperactivity disorder (ADHD) and a history of conduct disorder (CD) are highly prevalent among patients with substance use disorders (SUD). We examined the influence of both diagnoses on problem severity, psychiatric comorbidity, and quality of life in methadone-maintained patients.


METHODS
193 patients in long-term methadone maintenance treatment (MMT) were assessed for ADHD through a semi-structured interview. Psychiatric disorders and SUD were assessed with the MINI, the CIDI-SAM, and the SIDP-IV.


RESULTS
Childhood ADHD was diagnosed in 68 (35.2%) patients; 48 (24.9%) had persisting ADHD; a CD history was present in 116 (60.1%). Patients with adult ADHD had significantly higher problem severity scores, lower quality of life scores, more comorbid SUD and more psychiatric comorbidity. Although both ADHD and CD contributed to problem severity, addictive pathology and psychopathology, ADHD was found to substantially increase the risk of psychiatric comorbidity, independent of CD.


CONCLUSIONS
ADHD in MMT patients is characterised by greater addiction severity and more comorbid psychopathology, only partly explained by the influence of a coexisting CD. The presence of ADHD in a substantial minority of patients accentuates the need for early detection and treatment of this complicating disorder.
Carpentier
P J
PJ
Novadic-Kentron, Network for Addiction Treatment Services, Vught, The Netherlands. pjcarpentier@planet.nl
van Gogh
M T
MT
Knapen
L J M
LJ
Buitelaar
J K
JK
De Jong
C A J
CA
D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology* / Q000523:psychology; D015897:Comorbidity; D019955:Conduct Disorder / Q000150:complications / Q000523:psychology*; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000453:epidemiology* / Q000523:psychology; D008691:Methadone / Q000627:therapeutic use*; D009426:Netherlands / Q000453:epidemiology; D058850:Opiate Substitution Treatment / Q000523:psychology*; D009293:Opioid-Related Disorders / Q000188:drug therapy / Q000453:epidemiology* / Q000523:psychology; D015995:Prevalence; D011788:Quality of Life / Q000523:psychology; D012959:Socioeconomic Factors
D008691:Methadone