Prevalence of attention-deficit/hyperactivity disorder and conduct disorder among substance abusers

Background: This cross-sectional study sought to determine the prevalence o f attention-deficit/hyperactivity disorder (ADHD) and conduct disorder amon g adults admitted to 2 chemical dependency treatment centers. It was hypoth esized that ADHD alone or in combination with conduct disorder would be ove rrepresented in a population of patients with psychoactive substance use di sorders. Method. Two hundred one participants were selected randomly from 2 chemical dependency treatment centers. Standardized clinical interviews were conduc ted using the Structured Clinical Interview for DSM-IV, the Addiction Sever ity Index, and DSM-IV criteria for ADHD. Reliabilities for the diagnostic c ategories were established using the Cohen kappa, and the subgroups of indi viduals with and without ADHD and conduct disorder were compared. Results. Forty-eight (24%) of the participants were found to meet DSM-IV cr iteria for ADHD. The prevalence ADHD was 28% in men (30/106) and 19% in wom en (18/95; NS). Seventy-nine participants (39%) met criteria for conduct di sorder, and 34 of these individuals also had ADHD. Overall, individuals wit h ADHD (compared with those without ADHD) were more likely to have had more motor vehicle accidents. Women with ADHD (in comparison with women with AD HD) had a higher number of treatments for alcohol abuse. Individuals with c onduct disorder (in comparison with those without conduct disorder) were yo unger, had a greater number of jobs as adults, and were more likely to repe at a grade in school, have a learning disability, be suspended or expelled from school, have an earlier age at onset of alcohol dependence, and have h ad a greater number of treatments for drug abuse. They were more likely to have a lifetime history of abuse of and/or dependence on cocaine, stimulant s, hallucinogens, and/or cannabis. Conclusion: A significant overrepresentation of ADHD exists among inpatient s with psychoactive substance use disorders. Over two thirds of those with ADHD in this sample also met criteria for conduct disorder. Our sample had a very large overlap between ADHD and conduct disorder, and the major comor bidities identified here were attributable largely to the presence of condu ct disorder. Individuals who manifest portion of those seeking treatment fo r psychoactive substance use disorders. They appear to have greater comorbi dity and may benefit from a treatment approach that addresses these comorbi dities specifically through medical and behavioral therapies.