Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom (ADHS) bei erwachsenen Alkoholabhängigen

N. Wodarz; R. Laufkötter; K. Lange; M. Johann

doi:10.1055/s-0038-1626421

Nervenheilkunde, Inhaltsverzeichnis

Nervenheilkunde 2004; 23(09): 527-532
DOI: 10.1055/s-0038-1626421

Original- und Übersichtsarbeiten - Original and Review Articles

Schattauer GmbH

Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom (ADHS) bei erwachsenen Alkoholabhängigen

Attention-deficit hyperactivity disorder in adult alcohol dependence

N. Wodarz

¹Klinische Suchtmedizin, Klinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum (Direktor: Prof. Dr. med. H. E. Klein)

,

R. Laufkötter

¹Klinische Suchtmedizin, Klinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum (Direktor: Prof. Dr. med. H. E. Klein)

,

K. Lange

¹Klinische Suchtmedizin, Klinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum (Direktor: Prof. Dr. med. H. E. Klein)

,

M. Johann

¹Klinische Suchtmedizin, Klinik für Psychiatrie und Psychotherapie der Universität Regensburg am Bezirksklinikum (Direktor: Prof. Dr. med. H. E. Klein)

› Institutsangaben

Abstract

Zusammenfassung

Die Prävalenz des Aufmerksamkeitsdefizit-Hyperaktivitätssyndroms (ADHS) im Erwachsenenalter wird auf ca. 2% der Bevölkerung geschätzt. Eine hohe Komorbidität mit Substanzabhängigkeiten wird im angloamerikanischen Sprachraum postuliert. Um zu ermitteln, ob alkoholabhängige Erwachsene mit komorbidem ADHS klinische Besonderheiten aufweisen, wurden 314 konsekutiv behandelte alkoholabhängige Patienten mittels standardisierter und evaluierter Erhebungsinstrumente untersucht. 21,3% der Alkoholabhängigen zeigten ein ADHS im Erwachsenenalter. Die ADHS-positive Gruppe wies im Vergleich zur ADHS-negativen Gruppe einen um ca. 6 Jahre früheren Beginn der Alkoholabhängigkeit auf. Auch die tägliche Trinkmenge war um ca. 30% höher und soziale sowie justiziale Belastungen traten mal häufiger auf. Die Suizidalität war mehr als doppelt so hoch. 51% in der ADHS-positiven Gruppe wiesen Kriterien der antisozialen Persönlichkeitsstörung auf.

Daraus lässt sich ableiten, dass erwachsene Alkoholabhängige mit persistierenden Symptomen eines ADHS eine besondere Subgruppe mit frühem Beginn und besonders schwerem Verlauf der Abhängigkeitserkrankung definieren. Der Nutzen ADHS-spezifischer Therapieangebote für den Verlauf der Alkoholabhängigkeit sollte dringend in kontrollierten Studien überprüft werden.

Summary

The estimated prevalence for attention-deficit hyperactivity disorder (ADHD) in adulthood is 2%. ADHD is discussed as a risk factor for the development of a more severe substance abuse disorder in later life. We investigated 314 adult alcoholics for the presence of an ADHD and asked if adult alcoholics with comorbid ADHD have clinical particularities. 21,3% of the alcoholics fulfilled DSM-IV-criteria of ADHD with ongoing symptoms in adulthood. The subgroup of alcoholics with comorbid ADHD was significantly younger at age of onset of alcoholism (24 years versus 30 years) and had a significantly higher daily alcohol intake (253 g EtOH versus 196 g EtOH). They also had significantly more social stress and lifetime experiences in court proceedings against them (11% versus 2%). The suicidal ideation was higher (25% versus 11%). In the subgroup of alcoholics with ADHD 51% fulfilled criteria of antisocial personality disorder. The early onset of alcoholism was most pronounced in this subgroup (21 years). In our sample, persistence of ADHD symptoms from childhood into adulthood contributes to an increased vulnerability and morbidity of alcohol dependence with early onset and greater severity of the disorder.

Schlüsselwörter

Alkohol - Abhängigkeit - Aufmerksamkeitsdefizit - Hyperaktivität

Keywords

Alcohol dependence - attention-deficit hyperactivity disorder - comorbidity

Volltext

Referenzen

Literatur
1 Ebert D, Krause J, Roth-Sackenheim C. ADHD in adulthood-guidelines based on expert consensus with DGPPN support. Der Nervenarzt 2003; 74 (10) 939-46.
2 Krause KH, Krause J, Trott GE. Hyperkinetic syndrome (attention deficit-/hyperactivity disorder) in adulthood. Der Nervenarzt 1998; 69 (07) 543-56.
3 Rowland AS, Lesesne CA, Abramowitz AJ. The epidemiology of attention-deficit/hyperactivity disorder (ADHD): a public health view. Mental Retardation And Developmental Disabilities Research Reviews 2002; 08 (03) 162-70.
4 Roy-Byrne P, Scheele L, Brinkley J. et al. Adult attention-deficit hyperactivity disorder: assessment guidelines based on clinical presentation to a specialty clinic. Compr Psychiatry 1997; 38 (03) 133-40.
5 Wender PH. The diagnosis and treatment of attention-deficit hyperactivity disorder in adults. In: Dunner DL. (ed.). Current psychiatric therapy. Philadelphia. London, Toronto: Saunders; 1993: 489-93.
6 Biederman J, Wilens T, Mick E. et al. Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity. Am J Psychiatry 1995; 152 (11) 1652-1658.
7 Simonoff E, Elander J, Holmshaw J. et al. Predictors of antisocial personality. Continuities from childhood to adult life. Br J Psychiatry 2004; 184: 118-27.
8 Barkley RA, Fischer M, Smallish L. et al. Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry 2004; 45 (02) 195-211.
9 Murphy KR, Barkley RA, Bush T. Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational, and clinical history. J Nerv Ment Dis 2002; 190 (03) 147-57.
10 Robins LN. Deviant Children Grown Up: A Sociological and Psychiatric Study of Sociopathic Personality. Baltimore: Williams & Wilkins; 1966
11 Rydelius PA. Alcohol-abusing teenage boys. Testing a hypothesis on the relationship between alcohol abuse and social background factors, criminality and personality in teenage boys. Acta Psychiatr Scand 1983; 68 (05) 368-80.
12 McCord J. Identifying developmental paradigms leading to alcoholism. J Stud Alcohol 1988; 49 (04) 357-62.
13 Caspi A, Moffitt TE, Newman DL. et al. Behavioral observations at age 3 predict adult psychiatric disorders. Longitudinal evidence from a birth cohort. Arch Gen Psychiatry 1996; 53 (11) 1033-9.
14 Clure C, Brady KT, Saladin ME. et al. Attention-deficit/hyperactivity disorder and substance use: symptom pattern and drug choice. Am J Drug Alcohol Abuse 1999; 25 (03) 441-8.
15 Schubiner H, Tzelepis A, Milberger S. et al. Prevalence of attention-deficit/hyperactivity disorder and conduct disorder among substance abusers. J Clin Psychiatry 2000; 61 (04) 244-51.
16 Sullivan MA, Rudnik-Levin F. Attention deficit/hyperactivity disorder and substance abuse. Diagnostic and therapeutic considerations. Ann NY Acad Sci 2001; 931: 251-70.
17 Lynskey MT, Hall W. Attention deficit hyperactivity disorder and substance use disorders: Is there a causal link?. Addiction 2001; 96 (06) 815-22.
18 Kuperman S, Schlosser SS, Kramer JR. et al. Developmental sequence from disruptive behavior diagnosis to adolescent alcohol dependence. Am J Psychiatry 2001; 158 (12) 2022-6.
19 Molina BSG, Pelham WEJ. Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. J Abnorm Psychology 2003; 112 (03) 497-507.
20 Ercan ES, Coskunol H, Varan A. et al. Childhood attention deficit/hyperactivity disorder and alcohol dependence: a 1-year follow-up. Alcoho Alcohol 2003; 38 (04) 352-6.
21 Johann M, Bobbe G, Putzhammer A. et al. Comorbidity of alcohol dependence with attention-deficit hyperactivity disorder: differences in phenotype with increased severity of the substance disorder, but not in genotype (serotonin transporter and 5-hydroxytryptamine-2c receptor). Alcohol Clin Exp Res 2003; 27 (10) 1527-34.
22 Cloninger CR, Bohman M, Sigvardsson S. Inheritance of alcohol abuse. Cross-fostering analysis of adopted men. Arch Gen Psychiatry 1981; 38 (08) 861-8.
23 Sigvardsson S, Bohman M, Cloninger CR. Replication of the Stockholm Adoption Study of alcoholism. Confirmatory cross-fostering analysis. Arch Gen Psychiatry 1996; 53 (08) 681-7.
24 Biederman J, Faraone SV, Monuteaux MC. et al. Gender effects on attention-deficit/hyperactivity disorder in adults, revisited. Biol Psychiatry 2004; 55 (07) 692-700.
25 Davids E, Gastpar M. Attention-deficit/hyperactivity disorder and substance abuse. Psychiatr Prax 2003; 30 (04) 182-6.
26 Whalen CK, Jamner LD, Henker B. et al. The ADHD spectrum and everyday life: experience sampling of adolescent moods, activities, smoking, and drinking. Child Dev 2002; 73 (01) 209-27.
27 Flory K, Milich R, Lynam DR. et al. Relation between childhood disruptive behavior disorders and substance use and dependence symptoms in young adulthood: individuals with symptoms of attention-deficit/hyperactivity disorder and conduct disorder are uniquely at risk. Psychol Addict Behav 2003; 17 (02) 151-8.
28 Wilens TE, Biederman J, Mick E. Does ADHD affect the course of substance abuse? Findings from a sample of adults with and without ADHD. Am J Addic 1998; 07 (02) 156-163.
29 Grant BF, Stinson FS, Harford TC. Age at onset of alcohol use and DSM-IV alcohol abuse and dependence: a 12-year follow-up. J Subst Abuse 2001; 13 (04) 493-504.
30 DiFranza JR, Guerrera MP. Alcoholism and smoking. J Stud Alcohol 1990; 51 (02) 130-5.
31 Krause KH, Dresel SH, Krause J. et al. Stimulant-like action of nicotine on striatal dopamine transporter in the brain of adults with attention deficit hyperactivity disorder. Int J Neuropsychopharmacol 2002; 05 (02) 111-3.
32 Chambers RA, Taylor JR, Potenza MN. Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability. Am J Psychiatry 2003; 160 (06) 1041-52.
33 Mueser KT, Drake RE, Wallach MA. Dual diagnosis: a review of etiological theories. Addictive Behaviors 1998; 23 (06) 717-34.
34 Kelly TM, Cornelius JR, Clark DB. Psychiatric disorders and attempted suicide among adolescents with substance use disorders. Drug Alcohol Depend 2004; 73 (01) 87-97.
35 Prescott CA, Kendler KS. Genetic and environmental contributions to alcohol abuse and dependence in a population-based sample of male twins. Am J Psychiatry 1999; 156 (01) 34-40.
36 Faraone SV, Biederman J. Neurobiology of attention-deficit hyperactivity disorder. Biol Psychiatry 1998; 44 (10) 951-8.
37 Faraone SV, Spencer T, Aleardi M. et al. Metaanalysis of the efficacy of methylphenidate for treating adult attention-deficit/hyperactivity disorder. J Clin Psychopharmacol 2004; 24 (01) 24-9.
38 Schubiner H, Saules KK, Arfken CL. et al. Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Exp Clin Psychopharmacol 2002; 10 (03) 286-94.
39 Wilens TE, Faraone SV, Biederman J. et al. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics 2003; 111 (01) 179-85.
40 Huss M, Lehmkuhl U. Methylphenidate and substance abuse: a review of pharmacology, animal, and clinical studies. J Attent Disord 2002; 06 (Suppl. 01) 65-71.