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Comorbidity of Adult ADHD and Its Subtypes With Substance Use Disorder in a Large Population-Based Epidemiological Study.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in West Östergötland, Department of Medical Specialist in Motala.
Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
Karolinska Institutet, Stockholm, Sweden.
2016 (English)In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: The objective of the study is to explore the role and possible substance preference in ADHD and subtypes in substance use disorder (SUD).

METHOD: Using self-report data on ADHD Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV) symptoms and SUD (alcohol, illicit drugs, and nicotine) in 18,167 Swedish twins, aged 20 to 45 years, we obtained odds ratios (OR) from mixed effect logistic regression, controlling for age, sex, education, and nonindependence of twin data.

RESULTS: Increased ADHD symptoms were significantly associated with increased odds for all SUD. ORs ranged between 1.33 for regular nicotine (95% confidence interval [CI] = [1.12, 1.59]); 2.54 for multiple drug use (95% CI = [2.00, 3.23]), and 3.58 for alcohol dependence (95% CI = [2.86, 4.49]).

CONCLUSION: ADHD symptoms and subtypes in the population are associated with increased risks for all SUD outcomes, with no difference between ADHD subtypes, no substance preference, and no sex differences for the comorbidity. Clinicians need to consider ADHD evaluation and treatment as part of management of SUD in adults.

Place, publisher, year, edition, pages
2016.
Keyword [en]
ADHD subtypes; adult ADHD; alcohol; comorbidity; substance-related disorders
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:liu:diva-126285DOI: 10.1177/1087054715626511PubMedID: 26838558OAI: oai:DiVA.org:liu-126285DiVA: diva2:913371
Available from: 2016-03-21 Created: 2016-03-21 Last updated: 2016-08-22
In thesis
1. Environmental and Genetic Influences in Attention Deficit Hyperactivity Disorder (ADHD) and its Comorbidities
Open this publication in new window or tab >>Environmental and Genetic Influences in Attention Deficit Hyperactivity Disorder (ADHD) and its Comorbidities
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Research in past decades has demonstrated the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood, but many questions regarding prevalence, causes, and comorbidities of ADHD in adults remain to be investigated. Previous research focusing on childhood ADHD identified high heritability. Genetic and environmental influences on ADHD symptoms in adults and their association with comorbid conditions are not fully understood.

The overall aim of this thesis was to study adult ADHD symptoms in the population and investigate associations with substance use disorders (SUD) and binge eating. In all four papers, we used population-based self-report data from twins aged 20–46 years from the Swedish Twin Registry. We used twin methods to explore the role of genetic and environmental factors underlying ADHD symptoms and their comorbidities.

Study I examined the phenotypic association between ADHD and various forms of SUD. ADHD in adults was strongly associated with alcohol abuse and alcohol dependence, illicit drug use and regular nicotine use, with no differences between ADHD subtypes and no apparent substance preference. In Studies II and IV, we used bivariate twin models to examine the role of genetic and environmental factors in the association of adult ADHD symptoms with alcohol dependence (II) and with binge eating (IV). For ADHD symptoms and alcohol dependence, 64% of the overlap was explained by common genetic factors. The remaining variance was accounted for by environmental factors specific for each twin, with no sex differences for the overlap. Similarly, 91% of the association between ADHD symptoms and binge-eating behaviour was explained by common genetic factors. In Study III, using a within-twin pair analysis, we demonstrated that although most of the association between adult ADHD symptoms and self-reported childhood maltreatment (an environmental risk factor for ADHD) was explained by familial (genetic and environmental) confounding, our results were also consistent with a causal interpretation.

In conclusion, adult ADHD symptoms are associated with SUD and binge-eating behaviour. We replicated findings from adolescent studies regarding shared genetic risk factors for alcohol dependence and ADHD symptoms in adults. For binge eating, we showed for the first time that shared genetic factors mainly explained the association with ADHD symptoms. Alterations in mesolimbic reward processing as well as the frontal, executive and inhibitory systems have been described for ADHD, alcohol dependence and binge-eating behaviour, possibly suggesting common genetic and neurobiological factors for all three conditions. Results that support a causal hypothesis regarding the association between childhood maltreatment and ADHD symptoms in adults need follow-up in longitudinal clinical samples that can examine neurobiological underpinnings of environmental effects. Clinically, the results of this thesis support that ADHD in adults be considered and addressed in adults with SUD or binge-eating behaviour. Given the common genetic risk factors and the role of the early childhood environment, family interventions should be considered for these populations.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 92 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1522
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology Clinical Medicine Social Sciences Interdisciplinary
Identifiers
urn:nbn:se:liu:diva-130718 (URN)10.3384/diss.diva-130718 (DOI)9789176857588 (Print) (ISBN)
Public defence
2016-09-02, Belladonnasalen, Hus 511-001 plan 9 ingång 76, Campus US, Linköping, 09:00 (English)
Opponent
Supervisors
Available from: 2016-08-22 Created: 2016-08-22 Last updated: 2016-09-07Bibliographically approved

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Johansson Capusan, AndreaBendtsen, PrebenMarteinsdottir, Ina
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Division of Neuro and Inflammation ScienceFaculty of Medicine and Health SciencesDivision of Community MedicineDepartment of PsychiatryDepartment of Medical Specialist in Motala
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Journal of Attention Disorders
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