title: Psychiatric comorbidity in treatment-seeking substance use disorder patients with and without attention deficit hyperactivity disorder: results of the IASP study.
abstract: OBJECTIVE
  To determine comorbidity patterns in treatment-seeking substance use disorder (SUD) patients with and without adult attention deficit hyperactivity disorder (ADHD), with an emphasis on subgroups defined by ADHD subtype, taking into account differences related to gender and primary substance of abuse.
  
  
  METHODS
  Data were obtained from the cross-sectional International ADHD in Substance use disorder Prevalence (IASP) study.
  
  
  METHODS
  Forty-seven centres of SUD treatment in 10 countries.
  
  
  METHODS
  A total of 1205 treatment-seeking SUD patients.
  
  
  METHODS
  Structured diagnostic assessments were used for all disorders: presence of ADHD was assessed with the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID), the presence of antisocial personality disorder (ASPD), major depression (MD) and (hypo)manic episode (HME) was assessed with the Mini International Neuropsychiatric Interview-Plus (MINI Plus), and the presence of borderline personality disorder (BPD) was assessed with the Structured Clinical Interview for DSM-IV Axis II (SCID II).
  
  
  RESULTS
  The prevalence of DSM-IV adult ADHD in this SUD sample was 13.9%. ASPD [odds ratio (OR) = 2.8, 95% confidence interval (CI) = 1.8-4.2], BPD (OR = 7.0, 95% CI = 3.1-15.6 for alcohol; OR = 3.4, 95% CI = 1.8-6.4 for drugs), MD in patients with alcohol as primary substance of abuse (OR = 4.1, 95% CI = 2.1-7.8) and HME (OR = 4.3, 95% CI = 2.1-8.7) were all more prevalent in ADHD(+) compared with ADHD(-) patients (P < 0.001). These results also indicate increased levels of BPD and MD for alcohol compared with drugs as primary substance of abuse. Comorbidity patterns differed between ADHD subtypes with increased MD in the inattentive and combined subtype (P < 0.01), increased HME and ASPD in the hyperactive/impulsive (P < 0.01) and combined subtypes (P < 0.001) and increased BPD in all subtypes (P < 0.001) compared with SUD patients without ADHD. Seventy-five per cent of ADHD patients had at least one additional comorbid disorder compared with 37% of SUD patients without ADHD.
  
  
  CONCLUSIONS
  Treatment-seeking substance use disorder patients with attention deficit hyperactivity disorder are at a very high risk for additional externalizing disorders.
authors.affiliation: Arkin Mental Health and Addiction Treatment Center, Amsterdam, the Netherlands; Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
authors.forename: Katelijne
authors.initials: K
authors.lastname: van Emmerik-van Oortmerssen
authors.forename: Geurt
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authors.lastname: van de Glind
authors.forename: Maarten W J
authors.initials: MW
authors.lastname: Koeter
authors.forename: Steve
authors.initials: S
authors.lastname: Allsop
authors.forename: Marc
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authors.lastname: Auriacombe
authors.forename: Csaba
authors.initials: C
authors.lastname: Barta
authors.forename: Eli Torild H
authors.initials: ET
authors.lastname: Bu
authors.forename: Yuliya
authors.initials: Y
authors.lastname: Burren
authors.forename: Pieter-Jan
authors.initials: PJ
authors.lastname: Carpentier
authors.forename: Susan
authors.initials: S
authors.lastname: Carruthers
authors.forename: Miguel
authors.initials: M
authors.lastname: Casas
authors.forename: Zsolt
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authors.lastname: Demetrovics
authors.forename: Geert
authors.initials: G
authors.lastname: Dom
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Faraone
authors.forename: Melina
authors.initials: M
authors.lastname: Fatseas
authors.forename: Johan
authors.initials: J
authors.lastname: Franck
authors.forename: Brian
authors.initials: B
authors.lastname: Johnson
authors.forename: Máté
authors.initials: M
authors.lastname: Kapitány-Fövény
authors.forename: Sharlene
authors.initials: S
authors.lastname: Kaye
authors.forename: Maija
authors.initials: M
authors.lastname: Konstenius
authors.forename: Frances R
authors.initials: FR
authors.lastname: Levin
authors.forename: Franz
authors.initials: F
authors.lastname: Moggi
authors.forename: Merete
authors.initials: M
authors.lastname: Møller
authors.forename: J Antoni
authors.initials: JA
authors.lastname: Ramos-Quiroga
authors.forename: Arild
authors.initials: A
authors.lastname: Schillinger
authors.forename: Arvid
authors.initials: A
authors.lastname: Skutle
authors.forename: Sofie
authors.initials: S
authors.lastname: Verspreet
authors.forename: Wim
authors.initials: W
authors.lastname: van den Brink
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schoevers
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications*; D001714:Bipolar Disorder / Q000150:complications*; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000150:complications*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010554:Personality Disorders / Q000150:complications*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D019966:Substance-Related Disorders / Q000150:complications / Q000628:therapy*; D055815:Young Adult
keywords: ADHD; antisocial personality disorder; bipolar disorder; borderline personality disorder; comorbidity; depression; substance use disorder