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Substance use disorders in association with attention-deficit/hyperactivity disorder, co-morbid mental disorders, and medication in a nationwide sample


Steinhausen, Hans-Christoph; Bisgaard, Charlotte (2014). Substance use disorders in association with attention-deficit/hyperactivity disorder, co-morbid mental disorders, and medication in a nationwide sample. European Neuropsychopharmacology, 24(2):232-241.

Abstract

BACKGROUND
The association of substance use disorders (SUD) with attention-deficit disorder (ADHD), co-morbid mental disorders, and medication has only been studied in isolation and in rather small samples.

PROCEDURE
Data were based on four Danish national registers covering a total of 20,742 patients with ADHD, their dispensed medications, co-morbid mental disorders, and associated SUD between 1994 and 2010. The analyses considered the risk of various medications (methylphenidate only, antidepressants only, antipsychotic only, mixed medication) in comparison to a control group of non-medicated patients with ADHD, various co-morbid disorders, duration of medication, age at diagnosis, year of birth, and sex for developing SUD.

RESULTS
The observation period of the cohort ranged between 2.25 and 66.21 years and the prevalence for SUD was 9.51%. The SUD rates were significantly higher prior to, compared to following the onset of medication in the methylphenidate and the mixed medication subgroup, whereas they were significantly higher following onset of medication in the antidepressants and the antipsychotics subgroups. However, the SUD rates were significantly higher in all drug conditions except for methylphenidate after onset of medication compared to the non-medicated subgroup. Risk factors obtained by regression analysis did not include methylphenidate but did include antidepressants, antipsychotics, and mixed medications, in combination with co-morbid mood, anxiety, personality, and conduct disorders, and older age at diagnosis. Longer duration of medication and female sex were protective factors.

CONCLUSIONS
This representative study based on a large nationwide psychiatric sample provides solid evidence into the patterns of SUD in patients with ADHD based on medication use and co-morbidities.

BACKGROUND
The association of substance use disorders (SUD) with attention-deficit disorder (ADHD), co-morbid mental disorders, and medication has only been studied in isolation and in rather small samples.

PROCEDURE
Data were based on four Danish national registers covering a total of 20,742 patients with ADHD, their dispensed medications, co-morbid mental disorders, and associated SUD between 1994 and 2010. The analyses considered the risk of various medications (methylphenidate only, antidepressants only, antipsychotic only, mixed medication) in comparison to a control group of non-medicated patients with ADHD, various co-morbid disorders, duration of medication, age at diagnosis, year of birth, and sex for developing SUD.

RESULTS
The observation period of the cohort ranged between 2.25 and 66.21 years and the prevalence for SUD was 9.51%. The SUD rates were significantly higher prior to, compared to following the onset of medication in the methylphenidate and the mixed medication subgroup, whereas they were significantly higher following onset of medication in the antidepressants and the antipsychotics subgroups. However, the SUD rates were significantly higher in all drug conditions except for methylphenidate after onset of medication compared to the non-medicated subgroup. Risk factors obtained by regression analysis did not include methylphenidate but did include antidepressants, antipsychotics, and mixed medications, in combination with co-morbid mood, anxiety, personality, and conduct disorders, and older age at diagnosis. Longer duration of medication and female sex were protective factors.

CONCLUSIONS
This representative study based on a large nationwide psychiatric sample provides solid evidence into the patterns of SUD in patients with ADHD based on medication use and co-morbidities.

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8 citations in Web of Science®
8 citations in Scopus®
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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Center for Child and Adolescent Psychiatry
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:February 2014
Deposited On:16 Sep 2014 14:33
Last Modified:05 Apr 2016 18:22
Publisher:Elsevier
ISSN:0924-977X
Publisher DOI:https://doi.org/10.1016/j.euroneuro.2013.11.003
PubMed ID:24314850
Permanent URL: https://doi.org/10.5167/uzh-98688

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