title: Adult attention deficit hyperactivity disorder symptom profiles and concurrent problems with alcohol and cannabis: sex differences in a representative, population survey.
abstract: BACKGROUND
  Adult attention deficit hyperactivity disorder (ADHD) shows a robust association with alcohol and cannabis misuse, and these relationships are expressed differently in males and females. Manifestation of specific ADHD symptom profiles, even in the absence of the full disorder, may also be related to problems with alcohol and cannabis, although these relationships have not been investigated in epidemiological studies. To address this question, we studied the sex-specific associations of ADHD symptomatology with problematic alcohol and cannabis use in a representative sample of adults aged 18 years and older residing in Ontario, Canada.
  
  
  METHODS
  Data were obtained from the Centre for Addiction and Mental Health Monitor, an ongoing cross-sectional telephone survey, between January 2011 and December 2013. Respondents (n =  5080) reported on current ADHD symptomatology, measured using the Adult ADHD Self-Report Version 1.1 Screener (ASRS-V1.1) and four additional items, and alcohol and cannabis use, which were measured using the Alcohol Use Disorders Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST), respectively. Logistic regression analyses were conducted in men and women to test the association of each ADHD symptom cluster (hyperactivity, inattentiveness, impulsivity) with problematic alcohol and cannabis use.
  
  
  RESULTS
  After controlling for age, education, and comorbid internalizing and externalizing psychopathology, hyperactive symptoms were associated with problematic alcohol use in both men and women and with problematic cannabis use in men. Impulsive symptoms were independently associated with problematic cannabis use in men. By contrast, inattentive symptomatology predicted problems with alcohol and cannabis only in women. In all models, age was negatively associated with substance misuse and externalizing behavior was positively correlated and the strongest predictor of hazardous alcohol and cannabis use.
  
  
  CONCLUSIONS
  ADHD symptom expression in adulthood is related to concurrent hazardous use of alcohol and cannabis. Distinctive ADHD symptom profiles may confer increased risk for substance misuse in a sex-specific manner.
authors.affiliation: Centre for Addiction and Mental Health, Toronto, ON, Canada. nathan.kolla@mail.utoronto.ca.|Department of Psychiatry, University of Toronto, Toronto, ON, Canada. nathan.kolla@mail.utoronto.ca.|CAMH, 250 College Street, Toronto, ON, Canada. nathan.kolla@mail.utoronto.ca.
authors.forename: Nathan J
authors.initials: NJ
authors.lastname: Kolla
authors.affiliation: Centre for Addiction and Mental Health, Toronto, ON, Canada. mark.vandermaas@utoronto.ca.|Department of Sociology, University of Toronto, Toronto, ON, Canada. mark.vandermaas@utoronto.ca.
authors.forename: Mark
authors.initials: M
authors.lastname: van der Maas
authors.affiliation: Department of Psychology, York University, Toronto, ON, Canada. mtoplak@yorku.ca.
authors.forename: Maggie E
authors.initials: ME
authors.lastname: Toplak
authors.affiliation: Department of Sociology, University of Toronto, Toronto, ON, Canada. pat.erickson@utoronto.ca.
authors.forename: Patricia G
authors.initials: PG
authors.lastname: Erickson
authors.affiliation: Centre for Addiction and Mental Health, Toronto, ON, Canada. robert.mann@camh.ca.|Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada. robert.mann@camh.ca.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Mann
authors.affiliation: Department of Family Medicine, University of Western Ontario, London, ON, Canada. jsseeley@uwo.ca.
authors.forename: Jane
authors.initials: J
authors.lastname: Seeley
authors.affiliation: Department of Family Medicine, University of Western Ontario, London, ON, Canada. evingili@uwo.ca.
authors.forename: Evelyn
authors.initials: E
authors.lastname: Vingilis
mesh_terms: D000328:Adult; D000428:Alcohol Drinking / Q000453:epidemiology*; D001289:Attention Deficit Disorder with Hyperactivity / Q000453:epidemiology*; D002188:Cannabis; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D002189:Marijuana Abuse / Q000453:epidemiology*; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D057566:Self Report; D017678:Sex Distribution; D019966:Substance-Related Disorders / Q000453:epidemiology