Background: Adult Attention Deficit Hyperactivity Disoeder (A-ADHD) is one of the most important neuropsychiatric disorders originating in childhood. According to the last epidemiological studies, ADHD can be persistent into adulthood. Sixty percent of childhood ADHD cases present with at one or more symptoms in adulthood (Biedermann 2000, Wilens 2006). A prevalance rate of 4.4% of adults has been reported for ADHD (Fayyad 2007, Kessler 2006). Comorbidity with alcohol and substance use disorders in A-ADHD is also common and reported as 50%, which is 2-3 times more common than in the normal population (15%) (Katusic 2005). A-ADHD is reported to be an independent risk factor for substance abuse. Comorbid substance use disorders have been observed at rates of 9-30& (Wilens 2006). Individuals with substance use di?orders comorbid with A-ADHD do not differ in substance preference from individuals without A-ADHD comorbidity. Cannabis is the most abused substance.
Objective: We aimed to demonstrate the existence and intensity of Adult ADHD symptoms in cannabis dependent individiuals and discuss the importance of comorbid A-ADHD.
Methods: Seventy patients participated and gave informed consent. The participants were selected from patients who underwent inpatient treatment in the Department for Addiction at Samsun Neuropsychiatry Hospital. Diagnostic interviews were conducted for cannabis dependence syndrome (ICD 10; DSM-IV); the earliest interview was after 21 days of detoxification therapy. For assesment, the Adult ADD/ADHD DSM IV based Diagnostic Screening and Rating Scale was used. The reliability, validity, and transliteral equivalance study had been performed by Günay et.al in 2005 (Günay 2006). The scale was developed by Prof. Dr.Turgay, former Director of the Toronto ADHD Clinic, Ontario,Canada. It is a self assessment scale. General total and subscale mean scores and standard deviation of the ADHD scale according to group factors were calculated. Mean ADHD total and subscale scores were compared by using the group variable independent t test. The analyses were conducted using SPSS for Windows 16.00.
Results: The ADHD general total mean scores and subscale mean scores were compared between the groups. Considerably higher scores were observed in cannabis dependent individuals. Twenty-two patients met the criterion of inattention whereas 24 patients met both the criteria of hyperactivity and inattention. Twenty-four patients were re-evaluated and interviewed and Adult ADHD was diagnosed. Five individuals in the control group met the criterion of inattention, and there were no individuals who met the criteria for both hyperactivity and inattention. All three subdimensions of the Turgay Adult ADHD Scale were found to be statistically higher in the cannabis dependent patients.
Conclusions: As this study shows, Adult ADHD is highly represented in cannabis dependent patients.(in our sample 35% of patients were diagnosed with Adult ADHD). The awareness of the ADHD diagnosis in Turkey has rapidly increased over time. However it is not commonly researched, diagnosed, or treated in adult psychiatric units. A major difficulty may be that ADHD has been misdiagnosed because comorbidity is common and 90% of A-ADHD patients present with another psychiatric disorder in clinical practice. Recent studies clearly show a strong relation between ADHD and addiction, which supports the idea that a high percentage of drug dependent individuals are also suffering from undiagnosed A-ADHD. Individuals who are diagnosed and treated are less vulnerable to addiction (Biedermann 1999)
References: 1. Biederman J, Mick E, Faraone SV (2000) Age-de¬pendent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry 157:816–818 2. Wilens TE (2006) Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. Psychiatr Clin North Am 27:283–30. 3. Fayyad J, De GR, Kessler R et al (2007) Cross-national prevalence and correlates of adult attentionDeficit hyperactivity disorder. Br J Psychiatry 190:402–409 Bulletin of Clinical Psychopharmacology 2011;21(Suppl. 2):S158-9