Prevalence of Attention-Deficit/Hyperactivity Disorder and Conduct Disorder Among Substance Abusers.
J Clin Psychiatry 2000;61(4):244-251
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: This cross-sectional study sought to
determine the prevalence of attention-deficit/hyperactivity
disorder (ADHD) and conduct disorder among adults admitted to 2
chemical dependency treatment centers. It was hypothesized that
ADHD alone or in combination with conduct disorder would be
overrepresented in a population of patients with psychoactive
substance use disorders.
Method: Two hundred one participants were
selected randomly from 2 chemical dependency treatment centers.
Standardized clinical interviews were conducted using the
Structured Clinical Interview for DSM-IV, the Addiction Severity
Index, and DSM-IV criteria for ADHD. Reliabilities for the
diagnostic categories were established using the Cohen kappa, and
the subgroups of individuals with and without ADHD and conduct
disorder were compared.
Results: Forty-eight (24%) of the participants
were found to meet DSM-IV criteria for ADHD. The prevalence of
ADHD was 28% in men (30/106) and 19% in women (18/95; NS).
Seventy-nine participants (39%) met criteria for conduct
disorder, and 34 of these individuals also had ADHD. Overall,
individuals with ADHD (compared with those without ADHD) were
more likely to have had more motor vehicle accidents. Women with
ADHD (in comparison with women without ADHD) had a higher number
of treatments for alcohol abuse. Individuals with conduct
disorder (in comparison with those without conduct disorder) were
younger, had a greater number of jobs as adults, and were more
likely to repeat a grade in school, have a learning disability,
be suspended or expelled from school, have an earlier age at
onset of alcohol dependence, and have had a greater number of
treatments for drug abuse. They were more likely to have a
lifetime history of abuse of and/or dependence on cocaine,
stimulants, hallucinogens, and/or cannabis.
Conclusion: A significant overrepresentation of
ADHD exists among inpatients with psychoactive substance use
disorders. Over two thirds of those with ADHD in this sample also
met criteria for conduct disorder. Our sample had a very large
overlap between ADHD and conduct disorder, and the major
comorbidities identified here were attributable largely to the
presence of conduct disorder. Individuals who manifest conduct
disorder and/or ADHD represent a significant proportion of those
seeking treatment for psychoactive substance use disorders. They
appear to have greater comorbidity and may benefit from a
treatment approach that addresses these comorbidities
specifically through medical and behavioral therapies.