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Objective: Attention-deficit/hyperactivity disorder (ADHD) is a common, neurodevelopmental disorder that begins in childhood and often persists into adulthood. Several studies indicate a high prevalence of ADHD in subjects with substance use disorders (SUDs). In this study, we aimed to determine the prevalence and clinical effects of ADHD in male heroin dependent patients. Additionally we examined some clinical conditions that may affect addiction severity, such as aggression, impulsivity, childhood trauma, anxiety sensitivity, anxiety and depression.
Method: A total of 100 consecutive male heroin dependent patients who were treated at the Alcohol and Drug Research, Treatment and Training Center (AMATEM) of the Konya Training and Research Hospital in Konya between January 2014 and May 2014 were included in the study. We performed a total of three interviews with volunteer participants who were stabilized on sublingual buprenorphinenaloxone combination throughout the study. In these three interviews conducted at different times, a sociodemographic form, the Addiction Severity Index (ASI), the Wender-Utah Rating Scale (WURS), the Adult ADHD Self-Report Scale (ASRS), the Barrat Impulsiveness Scale, Version 11 (BIS-11), the Diagnostic Interview for ADHD in Adults, second edition (DIVA 2.0), the Childhood Trauma Questionnaire (CTQ), the Buss-Perry Aggression Questionnaire (BPAQ), the Anxiety Sensitivity Index-3 (ASI-3), the Medical Outcomes Study Short Form36 (SF-36) Health Survey Questionnaire, the Hamilton Depression Rating Scale (HDRS) and the Hamilton Anxiety Rating Scale (HARS) were administered.
Results: We have determined 14% of participants had adult ADHD and 30% of participants had childhood ADHD retrospectively, using the DIVA 2.0. The childhood ADHD group had a statistically significant earlier age of onset of smoking, higher rates of imprisonment and higher rates of non-suicidal self-injury behavior. Childhood and adult ADHD groups had statistically significant higher total scores on CTQ, BIS-11, BPAQ, HARS and HDRS than non-ADHD groups. Also, childhood and adult ADHD groups had statistically significant higher scores in two ASI domains (legal status, psychiatric status) and overall lower scores were found in SF-36 domains. Finally, stepwise multiple linear regression analysis revealed that aggression is an important clinical condition affecting four of the six ASI domain scores (employment/ support status, legal status, drug use and psychiatric status).
Conclusion: These findings indicate that ADHD is a common comorbidity in heroin-dependent patients and emphasize the importance of ADHD management. On the other hand, aggression is an important clinical condition affecting several ASI domains. Therefore, aggression must be addressed in SUD management particularly