The British Journal of Psychiatry (2007) 191: 457. doi: 10.1192/bjp.191.5.457
© 2007 The Royal College of Psychiatrists
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Correspondence

Substance misuse disguised as ADHD?

J. E. Berg

Department of Psychiatry, Lovisenberg Diakonale Hospital, Oslo, Norway. Email: john{at}pong.no

EDITED BY KIRIAKOS XENITIDIS and COLIN CAMPBELL

Attention-deficit hyperactivity disorder (ADHD) is a rather novel disease in adults. It has drawn increasing attention and at present there is no deficit of studies of ADHD in adults (Fayyad et al, 2007). Several studies have shown a considerable risk of co-occurring substance misuse in adults given the diagnosis of ADHD (Aanonsen, 1999; Wilson, 2007). Symptoms of ADHD seem to hamper success in methadone maintenance treatment (Kolpe & Carlson, 2007). Fayyad et al indicate in Table 5 that in 99% of cases adult ADHD occurs first in patients with a co-occurring substance use disorder but this is not commented upon in the discussion part of their paper. Respondents were classified retrospectively as having met full ADHD criteria in childhood. To ascertain the presence of ADHD in adulthood respondents were asked a single question only, whether they continued to have problems with attention or hyperactivity.

In Norway we have an impression that people with substance misuse tend to ask for a diagnosis of ADHD, as this may lead to better treatment within the psychiatric care system. The finding of Fayyad et al of higher prevalences in high-income countries, with purportedly better services for the treatment of ADHD, may be an indication of common presenting symptoms in substance use disorder and ADHD. Could the authors have observed symptoms and behaviour related to substance misuse and not ADHD?

REFERENCES

  1. Aanonsen, N. O. (1999) Sentralstimulerende legemidler og misbrukspotensial ved hyperkinetisk forstyrrelse. Tidsskrift for den Norske Lægeforening, 119, 4040 –4042.
  2. Fayyad, J., De Graaf, R., Kessler, R. C., et al (2007) Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. British Journal Psychiatry, 190, 402 –409.[Abstract/Free Full Text]
  3. Kolpe, M. & Carlson, G. (2007) Influence of attention-deficit/hyperactivity disorder symptoms on methadone treatment outcome. American Journal of Addiction, 16, 46 –48.[CrossRef][Medline]
  4. Wilson, J. (2007) ADHD and substance use disorders: developmental aspects and the impact of stimulant treatment. American Journal on Addictions, 16 (suppl. 1), 5 –11.[CrossRef][Medline]




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