title: Attention deficit/hyperactivity disorders with co-existing substance use disorder is characterized by early antisocial behaviour and poor cognitive skills.
abstract: BACKGROUND
  Attention Deficit/Hyperactivity Disorder (ADHD) is associated with an increased risk of co-existing substance abuse. The Swedish legislation on compulsory healthcare can be applied to persons with severe substance abuse who can be treated involuntarily during a period of six months. This context enables a reliable clinical assessment of ADHD in individuals with severe substance use disorder (SUD).
  
  
  METHODS
  In the context of compulsory care for individuals with severe SUD, male patients were assessed for ADHD, co-morbid psychiatric symptoms, psychosocial background, treatment history, and cognition. The data from the ADHD/SUD group (n = 60) was compared with data from (1) a group of individuals with severe substance abuse without known ADHD (SUD group, n = 120), as well as (2) a group with ADHD from an outpatient psychiatric clinic (ADHD/Psych group, n = 107).
  
  
  RESULTS
  Compared to the general SUD group in compulsory care, the ADHD/SUD group had already been significantly more often in compulsory care during childhood or adolescence, as well as imprisoned more often as adults. The most common preferred abused substance in the ADHD/SUD group was stimulant drugs, while alcohol and benzodiazepine abuse was more usual in the general SUD group. Compared to the ADHD/Psych group, the ADHD/SUD group reported more ADHD symptoms during childhood and performed poorer on all tests of general intellectual ability and executive functions.
  
  
  CONCLUSIONS
  The clinical characteristics of the ADHD/SUD group differed from those of both the SUD group and the ADHD/Psych group in several respects, indicating that ADHD in combination with SUD is a particularly disabling condition. The combination of severe substance abuse, poor general cognitive ability, severe psychosocial problems, including indications of antisocial behaviour, and other co-existing psychiatric conditions should be considered in treatment planning for adults with ADHD and SUD.
authors: Berit
authors: B
authors: Bihlar Muld
authors: Jussi
authors: J
authors: Jokinen
authors: Sven
authors: S
authors: Bölte
authors: Department of Women's and Children's Health, Karolinska Institute, Pediatric Neuropsychiatry Unit, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Stockholm, Gävlegatan 22B, SE-113 30, Sweden. tatja.hirvikoski@ki.se.
authors: Tatja
authors: T
authors: Hirvikoski
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000523:psychology*; D003071:Cognition; D017831:Diagnosis, Dual (Psychiatry); D056344:Executive Function; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012919:Social Behavior; D019966:Substance-Related Disorders / Q000150:complications / Q000523:psychology*