Remember me
European Addiction Research
Coetzee C.a,b· Schellekens A.F.A.c,d,f· Truter I.a· Meyer A.a,eaDepartment of Pharmacy, Drug Utilization Research Unit (DURU), Nelson Mandela University, Port Elizabeth, South Africa
bDepartment of Pharmacy, University of Limpopo, Sovenga, South Africa
cDepartment of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behaviour, Department of Psychiatry, Nijmegen, The Netherlands
dNijmegen Institute for Scientist Practitioners in Addiction (NISPA), Radboud University, Nijmegen, The Netherlands
eDepartment of Research Administration and Development, University of Limpopo, Sovenga, South Africa
fInternational Collaboration on ADHD and Substance Abuse (ICASA), Nijmegen, The Netherlands
Log in to MyKarger to check if you already have access to this content.
Buy FullText & PDF Unlimited re-access via MyKarger Unrestricted printing, no saving restrictions for personal use read more
CHF 38.00 *
EUR 35.00 *
USD 39.00 *
Buy a Karger Article Bundle (KAB) and profit from a discount!
If you would like to redeem your KAB credit, please log in.
Save over 20% compared to the individual article price. Access via DeepDyve Unlimited fulltext viewing Of this article Organize, annotate And mark up articles Printing And downloading restrictions apply Subscribe Access to all articles of the subscribed year(s) guaranteed for 5 years Unlimited re-access via Subscriber Login or MyKarger Unrestricted printing, no saving restrictions for personal use read more Select* The final prices may differ from the prices shown due to specifics of VAT rules.
Article / Publication DetailsFirst-Page Preview
Received: August 06, 2021
Accepted: July 22, 2022
Published online: November 04, 2022
Number of Print Pages: 10
Number of Figures: 0
Number of Tables: 2
ISSN: 1022-6877 (Print)
eISSN: 1421-9891 (Online)
For additional information: https://www.karger.com/EAR
AbstractBackground: Substance use disorders (SUDs) are a considerable public health problem. Attention-deficit/hyperactivity disorder (ADHD) frequently occurs in patients with SUD. Several studies demonstrated that ADHD constitutes a significant risk factor for the development of SUDs and suggest that childhood ADHD pharmacotherapy might help prevent development of SUD. Objectives: The study aimed to explore the effect of childhood ADHD pharmacotherapy on later life’s functional impairment and substance use patterns. Methods: Treatment-seeking SUD patients with ADHD (n = 52) were recruited from various rehabilitation facilities in South Africa. Adult ADHD individuals without SUD (n = 48) were recruited from clinicians, retail pharmacies, and the general public. SUD participants in rehabilitation facilities were screened for and diagnosed with ADHD. Lifetime substance use was assessed using self-report. ADHD-related functional impairment was assessed by the Weiss Functional Impairment Rating Scale (WFIRS). Information on present and lifetime use of ADHD medication was obtained. Clinical outcomes between those with and without a history of ADHD pharmacotherapy were compared. Results: Medicated participants (n = 59) showed lower levels of ADHD-related impairment across all functional domains (p < 0.001), compared to non-medicated participants (n = 41). They also consumed less alcohol (p = 0.04), cannabis (p < 0.001), and illicit drugs (p = 0.006) compared to the non-medicated group. Furthermore, medicated participants had a lower frequency of tobacco use compared to non-medicated participants (p = 0.04). ADHD patients without SUD also more often received medication (100% vs. 18.6%; p < 0.001) and for a longer time (121.10 vs. 9.52 months; p < 0.001). Conclusion: Childhood ADHD pharmacotherapy might be associated with a decreased risk for substance use in adulthood and lower ADHD-related impairment. Despite study limitations, these findings underline the importance of early ADHD detection and treatment, which might prevent SUD.
© 2022 S. Karger AG, Basel
References Faraone SV, Banaschewski T, Coghill D, Zheng Y, Biederman J, Bellgrove MA, et al. The world federation of ADHD international consensus statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021;128:789–818. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5®). 5th ed. Arlington, VA: American Psychiatric Publishing; 2013. Polanczyk G, De Lima MS, Horta BL, Biederman J, Rohde LA. The worldwide prevalence of ADHD: A systematic review and metaregression analysis. Am J Psychiatry. 2007;164(6):942–8. Willcutt EG. The prevalence of DSM-IV attention-deficit/hyperactivity disorder: a meta-analytic review. Neurotherapeutics. 2012;9(3):490–9. Xu G, Strathearn L, Liu B, Yang B, Bao W. Twenty-year trends in diagnosed attention-deficit/hyperactivity disorder among US children and adolescents, 1997-2016. JAMA Netw Open. 2018;1(4):e181471. Lara C, Fayyad J, De Graaf R, Kessler RC, Aguilar-Gaxiola S, Angermeyer M, et al. Childhood predictors of adult attention-deficit/hyperactivity disorder: results from the World Health Organization World Mental Health Survey Initiative. Biol Psychiatry. 2009;65(1):46–54. DuPaul GJ, Weyandt LL, O'Dell SM, Varejao M. College students with ADHD: Current status and future directions. J Atten Disord. 2009;13(3):234–50. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med. 2006;36(2):159–65. Barkley RA, Fischer M, Smallish L, Fletcher K. Young adult outcome of hyperactive children: adaptive functioning in major life activities. J Am Acad Child Adolesc Psychiatry. 2006;45(2):192–202. Adler LA, Faraone SV, Spencer TJ, Berglund P, Alperin S, Kessler RC. The structure of adult ADHD. Int J Methods Psychiatr Res. 2017;26(1):e1555. Wender PH, Wolf LE, Wasserstein J. Adults with ADHD. An overview. Ann N Y Acad Sci. 2001;931(1):1–16. Elkins IJ, McGue M, Iacono WG. Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry. 2007;64(10):1145–52. Mannuzza S, Klein RG, Bessler A, Malloy P, Hynes ME. Educational and occupational outcome of hyperactive boys grown up. J Am Acad Child Adolesc Psychiatry. 1997;36(9):1222–7. Eakin L, Minde K, Hechtman L, Ochs E, Krane E, Bouffard R, et al. The marital and family functioning of adults with ADHD and their spouses. J Atten Disord. 2004;8(1):1–10. Weafer J, Milich R, Fillmore MT. Behavioral components of impulsivity predict alcohol consumption in adults with ADHD and healthy controls. Drug Alcohol Depend. 2011;113(2–3):139–46. Crunelle C, Matthys F. Cocaine dependence and attention deficit hyperactivity disorder. The neuroscience of cocaine. London: Elsevier; 2017. p. 383–93. Biederman J, Wilens TE, Mick E, Faraone SV, Spencer T. Does attention-deficit hyperactivity disorder impact the developmental course of drug and alcohol abuse and dependence? Biol Psychiatry. 1998;44(4):269–73. Charach A, Yeung E, Climans T, Lillie E. Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. J Am Acad Child Adolesc Psychiatry. 2011;50(1):9–21. Groenman AP, Janssen TWP, Oosterlaan J. Childhood psychiatric disorders as risk factor for subsequent substance abuse: a meta-analysis. J Am Acad Child Adolesc Psychiatry. 2017;56(7):556–69. Szobot CM, Rohde LA, Bukstein O, Molina BSG, Martins C, Ruaro P, et al. Is attention-deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? A community-based case–control study. Addiction. 2007;102(7):1122–30. van Emmerik-van Oortmerssen K, van de Glind G, van den Brink W, Smit F, Crunelle CL, Swets M, et al. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend. 2012;122(1–2):11–9. Wilens TE, Morrison NR. The intersection of attention-deficit/hyperactivity disorder and substance abuse. Curr Opin Psychiatry. 2011;24(4):280–5. Schellekens AFA, van den Brink W, Kiefer F, Goudriaan AE. Often overlooked and ignored, but do not underestimate its relevance: ADHD in addiction–addiction in ADHD. Eur Addict Res. 2020;26(4–5):169–72. Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Har Rev of Psychiatry. 1997;4(5):231–44. Wilens TE. Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. Psychiatri Clin. 2004;27(2):283–301. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716–23. Crunelle CL, van den Brink W, Moggi F, Konstenius M, Franck J, Levin FR, et al. International consensus statement on screening, diagnosis and treatment of substance use disorder patients with comorbid attention deficit/hyperactivity disorder. Eur Addict Res. 2018;24(1):43–51. Özgen H, Spijkerman R, Noack M, Holtmann M, Schellekens ASA, Van De Glind G, et al. International consensus statement for the screening, diagnosis, and treatment of adolescents with concurrent attention-deficit/hyperactivity disorder and substance use disorder. Eur Addict Res. 2020;26(4–5):223–32. Barkley RA, Murphy KR. Impairment in occupational functioning and adult ADHD: the predictive utility of executive function (EF) ratings versus EF tests. Arch Clin Neuropsychol. 2010;25(3):157–73. Biederman J, Faraone SV, Spencer TJ, Mick E, Monuteaux MC, Aleardi M. Functional impairments in adults with self-reports of diagnosed ADHD: a controlled study of 1001 adults in the community. J Clin Psychiatry. 2006;67(4):524–40. Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP. Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01600. Weiss MD, McBride NM, Craig S, Jensen P. Conceptual review of measuring functional impairment: findings from the Weiss functional impairment rating scale. Evid Based Ment Health. 2018;21(4):155–64. Biederman J, Monuteaux MC, Spencer T, Wilens TE, Faraone SV. Do stimulants protect against psychiatric disorders in youth with ADHD? A 10-year follow-up study. Pediatrics. 2009;124(1):71–8. Groenman AP, Schweren LJS, Weeda W, Luman M, Noordermeer SDS, Heslenfeld DJ, et al. Stimulant treatment profiles predicting co-occurring substance use disorders in individuals with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry. 2019;28(9):1213–22. Wilens TE, Adamson J, Monuteaux MC, Faraone SV, Schillinger M, Westerberg D, et al. Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents. Arch Pediatr Adolesc Med. 2008;162(10):916–21. Heatherton TF, Kozlowski LT, Frecker RC, Fagerstrom KO. The Fagerström test for nicotine dependence: a revision of the Fagerström tolerance questionnaire. Br J Addict. 1991;86(9):1119–27. Pomerleau OF, Downey KK, Stelson FW, Pomerleau CS. Cigarette smoking in adult patients diagnosed with attention deficit hyperactivity disorder. J Subst Abuse. 1995;7(3):373–8. Vink JM, Willemsen G, Beem AL, Boomsma DI. The Fagerström Test for Nicotine Dependence in a Dutch sample of daily smokers and ex-smokers. Addict Behav. 2005;30(3):575–9. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005;35(2):245–56. Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry. 2007;190(5):402–9. Takeda T, Tsuji Y, Kurita H. Psychometric properties of the Japanese version of the Adult Attention-deficit hyperactivity disorder (ADHD) Self-Report Scale (ASRS-J) and its short scale in accordance with DSM-5 diagnostic criteria. Res Dev Disabil. 2017;63:59–66. Yeh CB, Gau SSF, Kessler RC, Wu YY. Psychometric properties of the Chinese version of the adult ADHD self-report Scale. Int J Methods Psychiatr Res. 2008;17(1):45–54. Van de Glind G, van den Brink W, Koeter MWJ, Carpentier P-J, van Emmerik-van Oortmerssen K, Kaye S, et al. Validity of the Adult ADHD Self-Report Scale (ASRS) as a screener for adult ADHD in treatment seeking substance use disorder patients. Drug Alcohol Depend. 2013;132(3):587–96. Kooij J, Francken M. DIVA 2.0. Diagnostic interview Voor ADHD in adults bij volwassenen [DIVA 2 0 diagnostic interview ADHD in adults]. The Netherlands: DIVA Foundation; 2010. http://www.divacenter.eu/DIVA.aspx. Fadeuilhe Grau C, Palma-Álvarez R, Nasillo V, Palomar G, Corrales M, Richarte V, et al. Criteria and concurrent validity of DIVA 2.0: a semi-structured diagnostic interview for adult ADHD. Eur Psychiatry. 2016;33(S1):S630–S. Ramos-Quiroga JA, Nasillo V, Richarte V, Corrales M, Palma F, Ibáñez P, et al. Criteria and concurrent validity of DIVA 2.0: a semi-structured diagnostic interview for adult ADHD. J Atten Disord. 2019;23(10):1126–35. Canu WH, Hartung CM, Stevens AE, Lefler EK. Psychometric properties of the Weiss Functional Impairment Rating Scale: Evidence for utility in research, assessment, and treatment of ADHD in emerging adults. J Atten Disord. 2020;24(12):1648–60. Thompson T, Lloyd A, Joseph A, Weiss M. The Weiss functional impairment rating scale-parent form for assessing ADHD: evaluating diagnostic accuracy and determining optimal thresholds using ROC analysis. Qual Life Res. 2017;26(7):1879–85. Castells X, Ramos-Quiroga JA, Rigau D, Bosch R, Nogueira M, Vidal X, et al. Efficacy of methylphenidate for adults with attention-deficit hyperactivity disorder: a meta-regression analysis. CNS drugs. 2011;25(2):157–69. Koesters M, Becker T, Kilian R, Fegert JM, Weinmann S. Limits of meta-analysis: methylphenidate in the treatment of adult attention-deficit hyperactivity disorder. J Psychopharmacol. 2009;23(7):733–44. Fredriksen M, Halmøy A, Faraone SV, Haavik J. Long-term efficacy and safety of treatment with stimulants and atomoxetine in adult ADHD: a review of controlled and naturalistic studies. Eur Neuropsychopharmacol. 2013;23(6):508–27. Carpentier P-J, Levin FR. Pharmacological treatment of ADHD in addicted patients: what does the literature tell us? Harv Rev Psychiatry. 2017;25(2):50–64. Kooij JJS, Bijlenga D, Salerno L, Jaeschke R, Bitter I, Balázs J, et al. Updated European consensus statement on diagnosis and treatment of adult ADHD. Eur Psychiatry. 2019;56:14–34. Gudjonsson GH, Sigurdsson JF, Sigfusdottir ID, Young S. An epidemiological study of ADHD symptoms among young persons and the relationship with cigarette smoking, alcohol consumption and illicit drug use. J Child Psychol Psychiatry. 2012;53(3):304–12. Kaye S, Darke S, Torok M. Attention deficit hyperactivity disorder (ADHD) among illicit psychostimulant users: a hidden disorder? Addiction. 2013;108(5):923–31. Coetzee C, Truter I, Meyer A. Prevalence and characteristics of South African treatment-seeking patients with substance use disorder and co-occurring attention-deficit/hyperactivity disorder. Expert Rev Clin Pharmacol. 2020;13(11):1271–80. Wilens TE, Adamson J, Sgambati S, Whitley J, Santry A, Monuteaux MC, et al. Do individuals with ADHD self‐medicate with cigarettes and substances of abuse? Results from a controlled family study of ADHD. Am J Addict. 2007;16(Suppl 1):14–21; quiz 22–3. Wise RA. Roles for nigrostriatal: not just mesocorticolimbic – dopamine in reward and addiction. Trends Neurosci. 2009;32(10):517–24. Paraskevopoulou M, van Rooij D, Batalla A, Chauvin R, Luijten M, Schene AH, et al. Effects of substance misuse on reward-processing in patients with attention-deficit/hyperactivity disorder. Neuropsychopharmacology. 2021;46(3):622–31. Volkow ND, Fowler JS, Wang GJ, Baler R, Telang F. Imaging dopamine's role in drug abuse and addiction. Neuropharmacology. 2009;56(Suppl 1):3–8. Roncero C, Ortega L, Pérez-Pazos J, Lligoña A, Abad AC, Gual A, et al. Psychiatric comorbidity in treatment-seeking alcohol dependence patients with and without ADHD. J Atten Disord. 2019;23(12):1497–504. Biederman J, Monuteaux MC, Spencer T, Wilens TE, MacPherson HA, Faraone SV. Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: a naturalistic controlled 10-year follow-up study. Am J Psychiatry. 2008;165(5):597–603. Hammerness P, Petty C, Faraone SV, Biederman J. Do stimulants reduce the risk for alcohol and substance use in youth with ADHD? A secondary analysis of a prospective, 24-month open-label study of osmotic-release methylphenidate. J Atten Disord. 2017;21(1):71–7. Benjamin J, Li L, Patterson C, Greenberg BD, Murphy DL, Hamer DH. Population and familial association between the D4 dopamine receptor gene and measures of novelty seeking. Nat Genet. 1996;12(1):81–4. Ebstein RP, Belmaker RH. Saga of an adventure gene: novelty Seeking, substance abuse and the dopamine D4 receptor (D4DR) exon III repeat polymorphism. Mol Psychiatry. 1997;2(5):381–4. Swanson JM, Flodman P, Kennedy J, Spence MA, Moyzis R, Schuck S, et al. Dopamine genes and ADHD. Neurosci Biobehav Rev. 2000;24(1):21–5. Faraone SV, Doyle AE, Mick E, Biederman J. Meta-analysis of the association between the 7-repeat allele of the dopamine D4 receptor gene and attention deficit hyperactivity disorder. Am J Psychiatry. 2001;158(7):1052–7. Guelke L. Freehold farmers and frontier settlers, 1657-1780: The shaping of South African society; 1989. p. 1652–840. Giliomee HB. MbengaHistory of South Africa BN: Nb Pub Limited; 2007. Dunne EM, Hearn LE, Rose JJ, Latimer WW. ADHD as a risk factor for early onset and heightened adult problem severity of illicit substance use: an accelerated gateway model. Addict Behav. 2014;39(12):1755–8. Asherson P, Akehurst R, Kooij JJS, Huss M, Beusterien K, Sasané R, et al. Under diagnosis of adult ADHD: cultural influences and societal burden. J Atten Disord. 2012;16(5 Suppl l):20S–38S. Dalsgaard S, Mortensen PB, Frydenberg M, Thomsen PH. ADHD, stimulant treatment in childhood and subsequent substance abuse in adulthood: a naturalistic long-term follow-up study. Addict Behav. 2014;39(1):325–8. Icick R, Moggi F, Slobodin O, Dom G, Mathys F, van den Brink W, et al. Attention deficit/hyperactivity disorder and global severity profiles in treatment-seeking patients with substance use disorders. Eur Addict Res. 2020;26(4–5):201–10. Sánchez-García NC, González RA, Ramos-Quiroga JA, van den Brink W, Luderer M, Blankers M, et al. Attention deficit hyperactivity disorder increases nicotine addiction severity in adults seeking treatment for substance use disorders: the role of personality disorders. Eur Addict Res. 2020;26(4–5):191–200. Ilbegi S, Groenman AP, Schellekens A, Hartman CA, Hoekstra PJ, Franke B, et al. Substance use and nicotine dependence in persistent, remittent, and late-onset ADHD: a 10-year longitudinal study from childhood to young adulthood. J Neurodev Disord. 2018;10(1):42. World Medical Association . World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79(4):373. Article / Publication DetailsFirst-Page Preview
Received: August 06, 2021
Accepted: July 22, 2022
Published online: November 04, 2022
Number of Print Pages: 10
Number of Figures: 0
Number of Tables: 2
ISSN: 1022-6877 (Print)
eISSN: 1421-9891 (Online)
For additional information: https://www.karger.com/EAR
Copyright / Drug Dosage / Disclaimer Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Comments (0)