Posted on October 9, 2014 in Addiction

Substance Use Disorder Plus ADHD Increases Risky Behavior

Substance use disorder and ADHD are two health conditions known for their ability to increase affected individuals’ involvement in unusually risky behavior. People diagnosed with ADHD have statistically increased chances of developing substance use disorder at some point in their lifetimes. In a study scheduled for publication in 2014 in the journal Drug and Alcohol Dependence, a team of Australian and Dutch researchers sought to determine if individuals with co-occurring cases of the two conditions have even higher chances of engaging in various kinds of risky behavior.

Substance Use Disorder

Substance use disorder is an umbrella term used by the American Psychiatric Association (APA) to describe all forms of substance addiction and life-impairing substance abuse. Since the vast majority of mental health professionals in the U.S. use APA definitions when diagnosing their patients, this term has seen widespread use since its creation in May 2013. The underlying principle of the substance use disorder diagnosis is the highly interconnected nature of substance abuse and substance addiction. Any given person affected by an addiction to drugs or alcohol can easily have one or more symptoms normally used to diagnose non-addicted substance abuse. In turn, any given person affected by non-addicted substance abuse can easily have one or more symptoms normally used to diagnose substance addiction.

In addition to using the substance use disorder diagnosis to identify overlapping cases of abuse and addiction, doctors use the diagnosis to describe cases only involving symptoms of substance abuse and cases only involving symptoms of substance addiction. Subtypes of the disorder include alcohol use disorder, stimulant use disorder, opioid use disorder, inhalant use disorder, cannabis use disorder and the multi-part sedative, hypnotic or anxiolytic use disorder.

ADHD

People with attention-deficit hyperactivity disorder have at least six symptoms that indicate an unusually hyperactive and impulsive mental state, an unusually inattentive mental state or a combination of unusual hyperactivity/impulsivity and unusual inattentiveness. According to standard criteria in use across the U.S., affected individuals must have these symptoms for half a year or more before receiving an official diagnosis. As a rule, ADHD makes its first appearance in early childhood, even if it goes undetected until a much later date. Roughly 9 percent of all American teens have diagnosable cases of the disorder; in addition, roughly 4 percent of all American adults have diagnosable ADHD.

Substance Use Disorder and ADHD

In a report published in June 2014, the American Academy of Pediatrics identified a clear connection between the presence of attention-deficit hyperactivity disorder and heightened chances of eventually developing diagnosable problems with substance abuse/addiction. Compared to the general population, children with ADHD have a roughly 200 percent higher chance of later getting addicted to nicotine, a roughly 100 percent higher chance of later developing alcohol abuse/addiction, a roughly 100 percent higher chance of later developing cocaine abuse/addiction and a roughly 50 percent higher chance of later developing cannabis abuse/addiction.

Impact on Risky Behavior

In the study scheduled for publication in Drug and Alcohol Dependence, researchers from four Australian institutions and two Dutch institutions used an examination of 489 adults affected by substance use disorder to help determine if co-occurring cases of this disorder and ADHD lead to a higher level of participation in risky behavior than either condition would typically produce on its own. All of these adults submitted detailed information on their substance use disorder histories, their ADHD histories and their involvement in risky behaviors related to sexual activity (e.g., having unprotected sex), substance intake (e.g., participating in unsanitary injection drug use) and operation of a motor vehicle.

The researchers found that 32 percent of the study participants had a history of childhood ADHD. Compared to the rest of the participants, these individuals were unusually likely to have started substance use before reaching age 15. The researchers concluded that the combination of substance use disorder and ADHD apparently does not further increase the odds of risky behavior in the context of substance use or in the context of sexual activity. However, they also concluded that the combination of the two disorders does further increase the odds of risky behavior in a driving context, including doing such things as failing to wear a seatbelt and driving without a license. Compared to the rest of the study participants, those individuals affected by substance use disorder and ADHD had more ticketable driving infractions, caused more accidents and had a higher rate of driving privilege suspension.

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