Supplementary Material for: Attention Deficit/Hyperactivity Disorder and Global Severity Profiles in Treatment-Seeking Patients with Substance Use Disorders

Introduction: Comorbid attention deficit/hyperactivity disorder (ADHD) is present in 15–25% of all patients seeking treatment for substance use disorders (SUDs). Some studies suggest that comorbid ADHD increases clinical severity related to SUDs, other psychiatric comorbidities, and social impairment, but could not disentangle their respective influences. Objectives: To investigate whether comorbid adult ADHD in treatment-seeking SUD patients is associated with more severe clinical profiles in these domains assessed altogether. Methods: Treatment-seeking SUD patients from 8 countries (N = 1,294: 26% females, mean age 40 years [SD = 11 years]) were assessed for their history of DSM-IV ADHD, SUDs, and other psychiatric conditions and sociodemographic data. SUD patients with and without comorbid ADHD were compared on indicators of severity across 3 domains: addiction (number of SUD criteria and diagnoses), psychopathological complexity (mood disorders, borderline personality disorder, lifetime suicidal thoughts, or behavior), and social status (education level, occupational and marital status, and living arrangements). Regression models were built to account for confounders for each severity indicator. Results: Adult ADHD was present in 19% of the SUD patients. It was significantly associated with higher SUD severity, more frequent comorbid mood or borderline personality disorder, and less frequent “married” or “divorced” status, as compared with the absence of comorbid ADHD. ADHD comorbidity was independently associated with a higher number of dependence diagnoses (OR = 1.97) and more psychopathology (OR = 1.5), but not marital status. Conclusions: In treatment-seeking SUD patients, comorbid ADHD is associated with polysubstance dependence, psychopathological complexity, and social risks, which substantiates the clinical relevance of screening, diagnosing, and treating ADHD in patients with SUDs.

引言：共病注意缺陷多动障碍（attention deficit/hyperactivity disorder, ADHD）在所有寻求物质使用障碍（substance use disorders, SUDs）治疗的患者中占比达15%~25%。部分研究表明，共病ADHD会加重与物质使用障碍、其他精神共病以及社会功能损害相关的临床严重程度，但无法厘清各自的独立影响。

研究目标：本研究旨在探讨寻求治疗的物质使用障碍患者中共病成人ADHD，是否与上述多维度综合评估的更严重临床表型相关。

研究方法：本研究纳入来自8个国家的1294名寻求治疗的物质使用障碍患者（女性占比26%，平均年龄40岁，标准差SD=11岁），对其DSM-IV版ADHD病史、物质使用障碍病史、其他精神疾病情况及社会人口学数据进行评估。将共病与未共病ADHD的物质使用障碍患者，就成瘾、精神病理复杂性、社会地位三个维度的严重程度指标进行对比：成瘾维度（物质使用障碍症状条目数与诊断类型）、精神病理复杂性（心境障碍、边缘型人格障碍、终生自杀意念或行为）、社会地位（受教育水平、职业状况、婚姻状况及居住安排）。此外，构建回归模型以控制各项严重程度指标的混杂因素。

研究结果：本研究中19%的物质使用障碍患者合并成人ADHD。与未共病ADHD的患者相比，共病ADHD者的物质使用障碍严重程度更高，共病心境障碍或边缘型人格障碍的比例更高，且“已婚”或“离异”的占比更低。ADHD共病与更多的依赖障碍诊断（优势比odds ratio, OR=1.97）以及更复杂的精神病理表现（OR=1.5）独立相关，但与婚姻状况无独立关联。

研究结论：在寻求治疗的物质使用障碍患者中，共病ADHD与多物质依赖、精神病理复杂性升高以及社会风险相关，这一结果证实了在物质使用障碍患者中开展ADHD筛查、诊断与治疗的临床必要性。