Department of Psychiatry, Columbia Presbyterian Medical Center, New York, New York 10032 USA
Address for correspondence: Maria A. Sullivan, M.D., Ph.D., Department of Psychiatry, Columbia Presbyterian Medical Center, New York, NY 10032. Voice: 212-543-6525; fax: 212-543-6018.
sulliva{at}pi.cpmc.columbia.edu
Patterns of association between attention deficit hyperactivity
disorder (ADHD) and substance-use disorders are considered.
Recent investigations have found that up to 50% of individuals
with continuing ADHD symptoms have a substance-use disorder.
ADHD appears to represent an independent risk factor for substance
abuse. We review clinical challenges posed by the diagnosis
of ADHD in substance-abusing populations. Nicotine dependence
is also substantially more common among adults with ADHD (40%)
than in the general population (26%). While several classes
of substances of abuse may ameliorate various symptoms of ADHD,
individuals with ADHD may also be vulnerable to substance use
because of poor judgment or impulsive behavior in social settings.
Evidence is reviewed from genetic studies examining the role
of the dopamine D2 (DRD2) gene in the etiology of ADHD. The
presence of ADHD may affect the course of adolescent substance
abuse in several ways: predicting earlier age of onset, longer
duration of substance-use disorder, and progression of alcohol
abuse to another drug-use disorder. Individuals with ADHD have
been noted to have a shorter interval between the onsets of
drug abuse and drug dependence. Such individuals are also at
greater risk for treatment failure, as their disruptive behaviors
interfere with treatment access and response. Lastly, we review
advances in pharmacotherapeutic agents used for treating ADHD
and consider the impact of these interventions on comorbid substance-use
disorders. We suggest promising areas of focus for clinical
research trials targeting the subpopulation of substance abusers
with concurrent ADHD.
