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Heroin Addiction and Related Clinical Problems: 2012, 14, 3 (pages: 71 - 76)

Is Substance Use disorder with comorbid adult Attention Deficit Hyperactivity Disorder and Bipolar Disorder a distinct clinical phenothype?

Ceraudo G., Toni C., Vannucchi G., Rizzato S., Casalini F., Dell'osso L., Maremmani I., Perugi G.

Summary: Objectives: Comorbidity between substance use disorder (SUD) and attention deficit hyperactivity disorder (ADHD) in adulthood has been reported in epidemiological and clinical samples. With the aim of assessing the impact of comorbid ADHD, we have investigated the prevalence, clinical and epidemiological features associated with that comorbidity in a sample of adult patients diagnosed with SUD. Methods: A total of 109 outpatients (aged 18-65 years) with SUD (high prevalence of heroin addicts) were included. All patients were screened using the Adult ADHD Self-report Scale (ASRS) and the Diagnostic, Clinical and Therapeutic Checklist (DCTC), a semi-structured interview developed for the exploration of the criteria of major Axis I and Axis II diagnoses, according to DSM-IV criteria. The DCTC also includes the Clinical Global Impression Bipolar (CGI-BP) scale, Global Assessment of Functioning (GAF) scale and the Sheehan Disability Scale (SDS). Results: Twenty patients out of 109 (18.35%) fulfilled both DSM-IV and ASRS criteria for ADHD. No significant differences were observed between ADHD and non-ADHD patients in age, sex, marital status, employment, education or type(s) of substance used. ADHD patients showed a higher prevalence of Bipolar Disorder (80% vs 43.2%, chi-square = 8.84, p=.003) and of current manic or mixed episode at the time of observation (40% vs 16.9%, chi-square=3.29, p=.027) than Non-No-ADHD patients. No significant difference between ADHD and non-ADHD patients were observed in terms of prevalence of comorbid Anxiety Disorders and Impulse Control Disorders. “Treatment resistance” (15% vs 3.4%, chi-square= 4.25, p=.039) and “irritability” (35% vs 15.7%, chi-square=3.90, p=.048) in response to previous treatment with antidepressants were more frequently reported by ADHD than by non-ADHD patients. Conclusion: In patients with SUD (with high prevalence of heroin addicted patients) the presence of comorbid adult ADHD influences a patient's course, prognosis and therapeutic management. Patients with SUD and adult ADHD present high rates of comorbid BD. Patients with ADHD, SUD and BD seems to be a distinct phenotype characterized by early onset and mood instability. Further research is needed to confirm our findings, and the clinical and therapeutic implications of SUD-ADHD-BD comorbidity.