Are attention-deficit/hyperactivity disorder symptoms associated with a more severe course of substance use? A longitudinal study with young Swiss men

Introduction

Adults with attention-deficit/hyperactivity disorder (ADHD) symptoms show higher prevalence rates for substance use disorders (SUD).

Objectives

Few longitudinal studies have been conducted to observe the course of substance use among adults with ADHD.

Aims

This study examined the predictive value of ADHD symptoms during the course of substance use in a population sample.

Methods

In two waves data from a representative sample of 5103 Swiss men in their early 20s were collected (baseline and 15-month follow-up) in the longitudinal “Cohort Study on Substance Use Risk Factors” (C-SURF). ADHD symptoms and substance use were assessed using the adult ADHD Self-Report Scale (ASRS-v1.1) and self-administered SUD questionnaires, respectively. Individuals who screened positive for ADHD (ADHD+) were compared to those who screened negative (ADHD−).

Results

At baseline, the 215 individuals in the ADHD+ group (4.2%) showed considerably higher prevalence and frequency of substance use and prevalence of alcohol, tobacco, and cannabis use disorders relative to the ADHD− group. While alcohol, tobacco, cannabis, and heroin use remained stable from baseline to follow-up, the ADHD+ group was more likely to begin using illicit drugs (i.e. amphetamines, speed, ecstasy, hallucinogens, and cocaine) and initiate nonmedical use of prescription drugs (i.e. stimulants/amphetamines, hypnotics, and tranquilizers) relative to the ADHD− group.

Conclusions

Young men with ADHD symptoms displayed more severe substance use patterns and were at a high risk of initiating drug use within 15 months. The identification of ADHD symptoms during early adulthood may be relevant in early interventions to lower the risk of drug use.

Disclosure of interest

The author has not supplied his declaration of competing interest.

Assessment ofFusariuminfection in wheat heads using a quantitative polymerase chain reaction (qPCR) assay

The accuracy of a quantitative polymerase chain reaction assay in quantifying the DNA of trichothecene-producing F. culmorum and F. graminearum within harvested wheat grains and head tissue was evaluated in comparison with incidences of infected kernels and deoxynivalenol levels. In a first experiment, six durum and bread wheat varieties were grown in randomized plots for a 2-year period, and inoculated with Fusarium macroconidia at six growth stages between heading and dough ripening, to obtain a wide range of Fusarium head blight incidences. There was a close relationship between fungal DNA and the amount of deoxynivalenol, and this relationship was consistent over Fusarium species, wheat species and varieties, and over a wide range of Fusarium head blight infection. In a second experiment potted wheat plants were grown under environmentally controlled conditions and inoculated with the two Fusarium species at full flowering; head samples were collected before inoculation and after 6 h to 12 days, and processed by the quantitative polymerase chain reaction assay. This assay made it possible to detect the dynamic of fungal invasion in planta after infection had occurred, and to single out the presence of infection before the onset of the disease symptoms: A robust detection of the infection occurred within 18-24 h for F. culmorum, and within 2-9 days for F. graminearum.

[Possible genetic link between Darier's disease and depression. Review of the literature and case history]

Darier's disease is a rare, inherited autosomal dominant skin disorder caused by a mutation in the sarcoendoplasmatic reticulum calcium transporter (SERCA)-2-gene. In a number of pedigrees, Darier's disease closely relates with affective disorder. The most likely hypothesis for this is a susceptibility gene for affective disorder near the SERCA-2-gene. A 6.5-megabase region could be identified as a susceptibility locus. This region constitutes a susceptability locus also in affective disorder without Darier's disease. The underlying gene has not yet been identified.

Nurse-patient sexual contact in psychiatric hospitals

Sexual contacts between nurses and patients in psychiatric hospitals have not been investigated systematically. The aim of the present study was to determine the frequency of nurse-patient sexual relationships and their prominent characteristics on the one hand and the nurses' attitudes towards these contacts on the other. A questionnaire was mailed to 714 nurses employed at two psychiatric hospitals. Although 94% of the 279 respondents considered sexual contact (defined as "physical contact between a patient and a nurse, in which sexual arousal occurred in the nurse") to be inappropriate, 17% of the male and 11% of the female responding nurses reported having had such contacts with patients.

Dual diagnosis patients in substance abuse treatment: relationship of general coping and substance-specific coping to 1-year outcomes

AIMS

This study examined general and substance-specific coping skills and their relationship to treatment climate, continuing care and 1-year post-treatment functioning among dual diagnosis patients (i.e. co-occurrence of substance use and psychiatric disorders).

DESIGN

In a prospective multi-site study, dual diagnosis patients participating in substance abuse treatment were assessed at intake, discharge and at a 1-year follow-up.

SETTING

Patients were recruited from 15 substance abuse treatment programs, which were selected from a larger pool of 174 inpatient treatment programs in the Department of Veterans Affairs Health Care System.

PARTICIPANTS

A total of 981 male dual diagnosis patients participated in the study.

MEASUREMENTS

Assessments included general and substance-specific coping skills, treatment climate, continuing outpatient care, abstinence and clinically significant psychiatric symptoms.

FINDINGS

Dual diagnosis patients modestly improved on general and substance-specific coping skills over the 1-year follow-up period. Patients who were in programs with a 'dual diagnosis treatment climate' and who participated in more 12-Step self-help groups showed slightly more gains in adaptive coping. Both general and substance-specific coping were associated with abstinence, but only general coping was associated with freedom from significant psychiatric symptoms.

CONCLUSIONS

Enhancing general and substance-specific coping skills in substance abuse treatment may reduce dual diagnosis patients' post-treatment substance use and improve their psychological functioning.

Effectiveness of treatment for substance abuse and dependence for dual diagnosis patients: a model of treatment factors associated with one-year outcomes

OBJECTIVE

This study examines a model of treatment for substance abuse and dependence for patients with substance use disorders and concomitant psychiatric disorders. The model focuses on five interrelated sets of variables (social background, intake functioning. dual diagnosis treatment orientation, patients' change on proximal outcomes, and aftercare participation) that are hypothesized to affect dual diagnosis patients' 1-year posttreatment outcomes.

METHOD

A total of 981 male dual diagnosis patients completed assessment at intake, discharge and 1-year follow-up. The relative importance of each set of variables as predictors of outcome was estimated by constructing block variables and conducting path analyses.

RESULTS

Dual diagnosis patients had a higher abstinence rate at follow-up (39%) than at intake (2%); they also improved on freedom from psychiatric symptoms (from 60% to 68%) and employment (from 20% to 29%). At follow-up, patients in programs with a stronger dual diagnosis treatment orientation showed a higher rate of freedom from psychiatric symptoms (71%) than did patients in weaker dual diagnosis treatment oriented programs (65%); they also were more likely to be employed (34% vs 25%). More change on proximal outcomes and more aftercare participation were also associated with better 1-year outcomes. Patients with less severe psychiatric disorders improved more and responded better to dual diagnosis oriented treatments than did patients with more severe psychiatric disorders.

CONCLUSION

Treatment programs for substance use disorders that adhere to principles of dual diagnosis treatment obtain better outcomes for dual diagnosis patients, especially for patients with less severe psychiatric disorders.

One-year outcome of an integrative inpatient treatment for dual diagnosis patients

The purpose of this study was to evaluate a 4-month dual diagnosis inpatient treatment program that was based on integrative models for patients with substance use and psychiatric disorders. At intake and at 1-year follow-up, dual diagnosis patients (N = 52) were assessed on housing and subsistence level, substance use and psychiatric symptoms. At 1-year follow-up, dual diagnosis patients reported a higher level of housing and subsistence, and less intensive psychiatric symptoms. No change occurred on frequencies of substance use. General improvement may occur even if psychotropic substances are used. Controlled studies are needed on extended inpatient treatment for dual diagnosis patients and outcomes in longer follow-ups.

[Dual diagnoses: addiction and other psychiatric disease. Theory, empirical findings and basic therapeutic considerations of a new concept]

A special group of psychiatric patients appeared during the last few years; patients who confront their therapists with many diagnostical and therapeutic problems, namely patients with dual diagnosis. These patients suffer from a severe psychiatric illness (such as schizophrenia) and at the same from an addition (e.g. an alcohol-dependency). The management for patients with dual diagnosis is inappropriate as well in psychiatric units as in specialized addition units. Today specialized units for patients with dual diagnosis are non-existent in Switzerland. The following review presents theoretical implications, empirical data and therapeutic possibilities for patients with dual diagnosis.