title: Attention-deficit/hyperactivity disorder subtypes and substance use and use disorders in NESARC.
abstract: BACKGROUND
  Attention-deficit/hyperactivity disorder (ADHD) is associated with substance use and substance use disorders (SUD). However, relatively little is known about the relationship between DSM-IV ADHD subtypes and substance use or DSM-IV abuse/dependence in epidemiological samples.
  
  
  METHODS
  Data were obtained from the National Epidemiologic Survey of Alcohol and Related Conditions (NESARC, N = 33,588). Respondents reported on ADHD symptoms (DSM-IV) for the period of time when they were 17 years or younger. Lifetime use and DSM-IV abuse/dependence of alcohol, nicotine, cannabis, cocaine, sedatives, stimulants and heroin/opiates were compared across those with ADHD symptoms but no diagnosis (ADHDsx; N = 17,009), the Combined (ADHD-C; N = 361), Predominantly Inattentive (ADHD-I; N = 325), and the Predominantly Hyperactive-Impulsive (ADHD-HI; N = 279) ADHD subtypes. Taking a more dimensional approach, inattentive and hyperactive-impulsive symptom counts and their associations with substance use and misuse were also examined.
  
  
  RESULTS
  After adjustments for conduct disorder, major depressive disorder, any anxiety disorder and other socio-demographic covariates, substance use and SUD were associated with ADHDsx, ADHD-C, ADHD-I and ADHD-HI. Overall, substance use and SUD were more weakly associated with the ADHDsx group compared to the three ADHD diagnostic groups. Statistically significant differences were not evident across the three diagnostic groups. Hyperactive-impulsive symptoms were more consistently associated with substance use and SUD compared to inattentive symptoms.
  
  
  CONCLUSIONS
  ADHD subtypes are consistently associated with substance use and SUD. The relatively stronger association of hyperactive/impulsive symptoms with substance use and abuse/dependence is consistent with the extant literature noting impulsivity as a precursor of substance use and SUD.
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA.
authors.forename: Duneesha
authors.initials: D
authors.lastname: De Alwis
authors.affiliation: Kings College, Addictions Department, London, UK.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Lynskey
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA.
authors.forename: Angela M
authors.initials: AM
authors.lastname: Reiersen
authors.affiliation: Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA. Electronic address: agrawala@psychiatry.wustl.edu.
authors.forename: Arpana
authors.initials: A
authors.lastname: Agrawal
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology; D001289:Attention Deficit Disorder with Hyperactivity / Q000145:classification / Q000453:epidemiology*; D019955:Conduct Disorder / Q000453:epidemiology; D003865:Major Depressive Disorder / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D057566:Self Report; D019966:Substance-Related Disorders / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: ADHD subtypes; Substance use; Substance use disorders