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Background <p>Several studies have reported associations between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, sex-differences in ADHD and SUD, especially when associated with other psychiatric comorbidities, are less studied.</p> Objective <p>To compare the prevalence of SUD among individuals with and without ADHD to describe groups, defined by sex and psychiatric comorbidity, who may benefit from targeted follow-up.</p> Methods <p>Data from the Medical Birth Registry of Norway, the Norwegian Prescription Database and the Norwegian Patient Registry were linked. Individuals born 1988–2001 were identified and followed until 2019 (ages 18–31&#xa0;years in 2019). Log binomial regression was used to calculate age-adjusted prevalence differences (PD) of SUD with 95% confidence intervals in males (<i>N</i> = 31,146) and females (<i>N</i> = 18,669) with ADHD, overall and with/without other psychiatric comorbidities, relative to those without ADHD (males <i>N</i> = 381,568; females <i>N</i> = 368,804).</p> Results <p>ADHD was associated with SUD across all substances among both males and females (“Any SUD”: PD<sub>females</sub> 10.9% (10.4; 11.4); PD<sub>males</sub> 11.4% (11.0; 11.8). Compared to individuals without ADHD, PDs were larger in males with ADHD than females for disorders related to cannabis, sedatives, stimulants, other substances and multiple psychoactive substances. ADHD with psychiatric comorbidities was associated with even larger differences in SUD prevalence among both males and females, the largest for ADHD with psychosis/schizophrenia [PD<sub>males</sub> 49.0% (45.6; 52.4); PD<sub>females</sub> 40.6% (36.1; 45.1)] and ADHD with personality disorders [PD<sub>males</sub> 37.6% (35.2; 40.0); PD<sub>females</sub> 33.0% (31.0; 35.0)], compared to males and females without psychiatric disorders. For psychiatric comorbidities typically diagnosed in adulthood, PDs were larger in males than females with ADHD, whereas for comorbid childhood disorders, PDs were larger in females.</p> Conclusion <p>The high prevalence of SUD associated with ADHD, with higher PDs in males than females for most specific SUDs, indicates a need for targeted prevention. The substantially higher prevalence of SUD in individuals with ADHD and comorbid psychiatric disorders emphasizes the need for close follow-up of individuals with ADHD both regarding SUD and other psychiatric disorders. Further studies are needed to evaluate potential causal relations between ADHD, other psychiatric comorbidities, and SUD, and to understand the sex-differences in SUD prevalence across psychiatric comorbidities in ADHD.</p>

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Prevalence of substance use disorder in individuals with attention deficit/hyperactivity disorder: associations with sex and psychiatric comorbidity

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月7日

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  • Camilla Djønne Moldekleiv,
  • Astri J. Lundervold,
  • Berit Skretting Solberg,
  • Anders Engeland,
  • Lars Thore Fadnes,
  • Fatemeh Chalabianloo,
  • Kari Klungsøyr

摘要

Background

Several studies have reported associations between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, sex-differences in ADHD and SUD, especially when associated with other psychiatric comorbidities, are less studied.

Objective

To compare the prevalence of SUD among individuals with and without ADHD to describe groups, defined by sex and psychiatric comorbidity, who may benefit from targeted follow-up.

Methods

Data from the Medical Birth Registry of Norway, the Norwegian Prescription Database and the Norwegian Patient Registry were linked. Individuals born 1988–2001 were identified and followed until 2019 (ages 18–31 years in 2019). Log binomial regression was used to calculate age-adjusted prevalence differences (PD) of SUD with 95% confidence intervals in males (N = 31,146) and females (N = 18,669) with ADHD, overall and with/without other psychiatric comorbidities, relative to those without ADHD (males N = 381,568; females N = 368,804).

Results

ADHD was associated with SUD across all substances among both males and females (“Any SUD”: PDfemales 10.9% (10.4; 11.4); PDmales 11.4% (11.0; 11.8). Compared to individuals without ADHD, PDs were larger in males with ADHD than females for disorders related to cannabis, sedatives, stimulants, other substances and multiple psychoactive substances. ADHD with psychiatric comorbidities was associated with even larger differences in SUD prevalence among both males and females, the largest for ADHD with psychosis/schizophrenia [PDmales 49.0% (45.6; 52.4); PDfemales 40.6% (36.1; 45.1)] and ADHD with personality disorders [PDmales 37.6% (35.2; 40.0); PDfemales 33.0% (31.0; 35.0)], compared to males and females without psychiatric disorders. For psychiatric comorbidities typically diagnosed in adulthood, PDs were larger in males than females with ADHD, whereas for comorbid childhood disorders, PDs were larger in females.

Conclusion

The high prevalence of SUD associated with ADHD, with higher PDs in males than females for most specific SUDs, indicates a need for targeted prevention. The substantially higher prevalence of SUD in individuals with ADHD and comorbid psychiatric disorders emphasizes the need for close follow-up of individuals with ADHD both regarding SUD and other psychiatric disorders. Further studies are needed to evaluate potential causal relations between ADHD, other psychiatric comorbidities, and SUD, and to understand the sex-differences in SUD prevalence across psychiatric comorbidities in ADHD.