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Psychiatr Prax 2003; 30(4): 182-186
DOI: 10.1055/s-2003-39496
Übersicht
© Georg Thieme Verlag Stuttgart · New York

Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung und Substanzmittelabhängigkeit

Attention-Deficit/Hyperactivity Disorder and Substance AbuseEugen  Davids1 , Markus  Gastpar1
  • 1Rheinische Kliniken Essen, Klinik für Psychiatrie und Psychotherapie der Universität Duisburg-Essen
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Publikationsverlauf

Publikationsdatum:
27. Mai 2003 (online)

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Zusammenfassung

Mögliche Assoziationen einer Substanzmittelabhängigkeit und der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) wurden anhand einer Literaturrecherche untersucht. Die ADHS scheint ein Risikofaktor für die Entwicklung einer Substanzmittelabhängigkeit zu sein. Bis zu 50 % der Patienten mit aus dem Kindesalter ins Erwachsenenalter hineinreichenden ADHS-Symptomen entwickeln eine Substanzmittelabhängigkeit. Möglicherweise basierend auf pathophysiologischen Gemeinsamkeiten erscheint die Kokain- und Nikotinabhängigkeit von besonderer Bedeutung bei Adoleszenten oder Erwachsenen mit ADHS zu sein. Die Präsenz einer ADHS vermag möglicherweise eine Substanzmittelabhängigkeit im Adoleszenten- und Erwachsenenalter auf unterschiedliche Weise zu beeinflussen: früherer Abhängigkeitsbeginn, höhere Konsumfrequenz, längere Dauer der Abhängigkeit und Wechsel von Alkoholmissbrauch zu anderer Substanzabhängigkeit. Mögliche pharmakologische und nichtpharmakologische therapeutische Strategien bei Patienten mit ADHS und Substanzmittelabhängigkeit werden diskutiert.

Abstract

Recent investigations of possible associations between attention deficit hyperactivity disorder (ADHD) and substance-use disorders are reviewed. ADHD seems to represent a possible risk factor for developing a substance abuse, up to 50 % of patients with on continuing ADHD symptoms from childhood were found to develop a substance-use disorder. Based on possible pathophysiological similarities, especially cocaine and nicotine dependence are of focused interest in adolescents and adults with ADHD. The presence of ADHD may influence adolescent and adult substance-use disorders in different ways: earlier age of onset, higher frequency, longer duration of substance abuse and transition from alcohol-abuse to other substance-use disorders. Possible pharmacological and non-pharmacological therapeutic strategies in patients with ADHD and substance abuse are discussed.

Literatur

  • 1 Barkley R A. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD.  Psychol Bull. 1997;  121 65-94
    CrossrefPubMedGoogle Scholar
  • 2 Castellanos F X. Toward a pathophysiology of attention-deficit/hyperactivity disorder.  Clin Pediatr. 1997;  36 381-393
    PubMedGoogle Scholar
  • 3 Internationale Klassifikation psychischer Störungen, ICD-10, Kapitel V (F), Weltgesundheitsorganisation. Göttingen; Verlag Hans Huber 1991
    Google Scholar
  • 4 American Psychiatric Association .Diagnostic and Statistical Manual of Mental Disorders, 4th edit. Washington, DC; 1994
    Google Scholar
  • 5 Barkley R A, Fischer M, Edelbrock C S, Smallish L. The adolescent outcome of hyperactive children diagnosed by research criteria: I. An 8-year prospective follow-up study.  J Am Acad Child Adolesc Psychiatry. 1990;  29 546-557
    CrossrefPubMedGoogle Scholar
  • 6 Gallagher R, Blader J. The diagnosis and neuropsychological assessment of adult attention deficit/hyperactivity disorder.  Ann N Y Acad Sci. 2001;  931 148-171
    PubMedGoogle Scholar
  • 7 Groß J, Blocher D, Trott G E, Rösler M. Erfassung des hyperkinetischen Syndroms bei Erwachsenen.  Nervenarzt. 1999;  70 20-25
    CrossrefPubMedGoogle Scholar
  • 8 Krause K H, Krause J, Trott G E. Das hyperkinetische Syndrom (Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung) des Erwachsenenalters.  Nervenarzt. 1998;  69 543-556
    CrossrefPubMedGoogle Scholar
  • 9 Blocher D, Henkel K, Retz W, Retz-Junginger P, Thome J, Rösler M. Symptome aus dem Spektrum des hyperkinetischen Syndroms bei Sexualdelinquenten.  Fortschr Neurol Psychiat. 2001;  69 453-459
    PubMedGoogle Scholar
  • 10 Faraone S V, Biederman J. Neurobiology of attention-deficit hyperactivity disorder.  Biol Psychiatry. 1998;  44 951-958
    CrossrefPubMedGoogle Scholar
  • 11 Mannuzza S, Klein R G, Bessler A, Malloy P, LaPadula M. Adult outcome of hyperactive boys. Educational achievement, occupational rank, and psychiatric status.  Arch Gen Psychiatry. 1993;  50 565-576
    PubMedGoogle Scholar
  • 12 Mannuzza S, Klein R G, Bonagura N, Malloy P, Giampino T L, Addalli K A. Hyperactive boys almost grown up. V. Replication of psychiatric status.  Arch Gen Psychiatry. 1991;  48 77-83
    PubMedGoogle Scholar
  • 13 Marks D J, Newcorn J H, Halperin J M. Comorbidity in adults with attention-deficit/hyperactivity disorder.  Ann N Y Acad Sci. 2001;  931 216-238
    PubMedGoogle Scholar
  • 14 Biederman J, Wilens T E, Mick E, Faraone S V, Spencer T. Does attention-deficit hyperactivity disorder impact the developmental course of drug and alcohol abuse and dependence?.  Biol Psychiatry. 1998;  44 269-273
    CrossrefPubMedGoogle Scholar
  • 15 Biederman J, Wilens T, Mick E, Milberger S, Spencer T J, Faraone S V. Psychoactive substance use disorders in adults with attention deficit hyperactivity disorder (ADHD): effects of ADHD and psychiatric comorbidity.  Am J Psychiatry. 1995;  152 1652-1658
    PubMedGoogle Scholar
  • 16 Clure C, Brady K T, Sladin M E, Johnson D, Waid R, Rittenbury M. Attention-deficit/hyperactivity disorder and substance use: symptom pattern and drug choice.  Am J Drug Alcohol Abuse. 1999;  25 441-448
    PubMedGoogle Scholar
  • 17 Robbins T W. ADHD and addiction.  Nat Med. 2002;  8 24-25
    PubMedGoogle Scholar
  • 18 Wilson J J, Levin F R. Attention deficit hyperactivity disorder (ADHD) and substance use disorders.  Curr Psychiatry Rep. 2001;  3 497-506
    PubMedGoogle Scholar
  • 19 Lynskey M T, Hall W. Attention deficit hyperactivity disorder and substance use disorders: is there a causal link?.  Addiction. 2001;  96 815-822
    CrossrefPubMedGoogle Scholar
  • 20 Sullivan M A, Rudnik-Levin F. Attention deficit/hyperactivity disorder and substance abuse. Diagnostic and therapeutic considerations.  Ann N Y Acad Sci. 2001;  931 251-270
    PubMedGoogle Scholar
  • 21 Bemporad J R. Aspects of psychotherapy with adults with attention deficit disorder.  Ann N Y Acad Sci. 2001;  931 302-309
    PubMedGoogle Scholar
  • 22 Levin F R, Kleber H D. Attention-deficit hyperactivity disorder and substance abuse: relationships and implications for treatment.  Harv Rev Psychiatry. 1995;  2 246-258
    PubMedGoogle Scholar
  • 23 Simkin D R. Adolescent substance use disorders and comorbidity.  Pediatr Clin North Am. 2002;  49 463-477
    CrossrefPubMedGoogle Scholar
  • 24 Murphy K R, Barkley R A, Bush T. Young adults with attention deficit hyperactivity disorder: subtype differences in comorbidity, educational, and clinical history.  J Nerv Ment Dis. 2002;  190 147-157
    CrossrefPubMedGoogle Scholar
  • 25 Stratton J, Gailfus D. A new approach to substance abuse treatment. Adolescents and adults with ADHD.  J Subst Abuse Treat. 1998;  15 89-94
    CrossrefPubMedGoogle Scholar
  • 26 Wilens T E, Biederman J, Mick E, Faraone S V, Spencer T. Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders.  J Nerv Ment Dis. 1997;  185 475-482
    CrossrefPubMedGoogle Scholar
  • 27 Wilens T E, Biederman J, Spencer T J, Frances R J. Comorbidity of attention-deficit hyperactivity and psychoactive substance use disorders.  Hosp Community Psychiatry. 1994;  45 421-423
    PubMedGoogle Scholar
  • 28 DeMilio L. Psychiatric syndromes in adolescent substance abusers.  Am J Psychiatry. 1989;  146 1212-1214
    PubMedGoogle Scholar
  • 29 Cocores J A, Davies R K, Mueller P S, Gold M S. Cocaine abuse and adult attention deficit disorder.  J Clin Psychiatry. 1987;  48 376-377
    PubMedGoogle Scholar
  • 30 Rounsaville B J, Anton S F, Carroll K, Budde D, Prusoff B A, Gawin F. Psychiatric diagnoses of treatment-seeking cocaine abusers.  Arch Gen Psychiatry. 1991;  48 43-51
    PubMedGoogle Scholar
  • 31 Schubiner H, Tzelepis A, Isaacson J H, Warbasse L H, Zacharek M, Musial J. The dual diagnosis of attention-deficit/hyperactivity disorder and substance abuse: case reports and literature review.  J Clin Psychiatry. 1995;  56 146-150
    PubMedGoogle Scholar
  • 32 Khantzian E J. Self-regulation and self-medication factors in alcoholism and the addictions. Similarities and differences.  Recent Dev Alcohol. 1990;  8 255-271
    PubMedGoogle Scholar
  • 33 Coger R W, Moe K L, Serafetinides E A. Attention deficit disorder in adults and nicotine dependence: psychobiological factors in resistance to recovery.  J Psychoactive Drugs. 1996;  28 229-240
    PubMedGoogle Scholar
  • 34 Conners C K, Levin E D, Sparrow E, Hinton S C, Erhardt D, Meck W H, Rose J E, March J. Nicotine and attention in adult attention deficit hyperactivity disorder (ADHD).  Psychopharmacol Bull. 1996;  32 67-73
    PubMedGoogle Scholar
  • 35 Krause K H, Dresel S H, Krause J, Kung H F, Tatsch K, Ackenheil M. Stimulant-like action of nicotine on striatal dopamine transporter in the brain of adults with attention deficit hyperactivity disorder.  Int J Neuropsychopharmacol. 2002;  5 111-113
    PubMedGoogle Scholar
  • 36 Lambert N M, Hartsough C S. Prospective study of tobacco smoking and substance dependencies among samples of ADHD and non-ADHD participants.  J Learn Disabil. 1998;  31 533-544
    CrossrefPubMedGoogle Scholar
  • 37 Levin E D, Conners C K, Sparrow E, Hinton S C, Erhardt D, Meck W H, Rose J E, March J. Nicotine effects on adults with attention-deficit/hyperactivity disorder.  Psychopharmacology. 1996;  123 55-63
    PubMedGoogle Scholar
  • 38 Milberger S, Biederman J, Faraone S V, Chen L, Jones J. Is maternal smoking during pregnancy a risk factor for attention deficit hyperactivity disorder in children?.  Am J Psychiatry. 1996;  153 1138-1142
    PubMedGoogle Scholar
  • 39 Milberger S, Biederman J, Faraone S V, Chen L, Jones J. ADHD is associated with early initiation of cigarette smoking in children and adolescents.  J Am Acad Child Adolesc Psychiatry. 1997;  36 37-44
    PubMedGoogle Scholar
  • 40 Pomerleau O F, Downey K K, Stelson F W, Pomerleau C S. Cigarette smoking in adult patients diagnosed with attention deficit hyperactivity disorder.  J Subst Abuse. 1995;  7 373-378
    CrossrefPubMedGoogle Scholar
  • 41 Tercyak K P, Lerman C, Audrain J. Association of attention-deficit/hyperactivity disorder symptoms with levels of cigarette smoking in a community sample of adolescents.  J Am Acad Child Adolesc Psychiatry. 2002;  41 799-805
    PubMedGoogle Scholar
  • 42 Kent L, Green E, Holmes J, Thapar A, Gill M, Hawi Z, Fitzgerald M, Asherson P, Curran S, Mills J, Payton A, Craddock N. No association between CHRNA7 microsatellite markers and attention-deficit hyperactivity disorder.  Am J Med Genet. 2001;  105 686-689
    CrossrefPubMedGoogle Scholar
  • 43 Kent L, Middle F, Hawi Z, Fitzgerald M, Gill M, Feehan C, Craddock N. Nicotinic acetylcholine receptor alpha4 subunit gene polymorphism and attention deficit hyperactivity disorder.  Psychiatr Genet. 2001;  11 37-40
    CrossrefPubMedGoogle Scholar
  • 44 Gilbert D G. Paradoxical tranquilizing and emotion-reducing effects of nicotine.  Psychol Bull. 1979;  86 643-661
    CrossrefPubMedGoogle Scholar
  • 45 Levin E D, Rezvani A H. Development of nicotinic drug therapy for cognitive disorders.  Eur J Pharmacol. 2000;  393 141-146
    CrossrefPubMedGoogle Scholar
  • 46 Popper C W. Pharmacologic alternatives to psychostimulants for the treatment of attention-deficit/hyperactivity disorder.  Child Adolesc Psychiatr Clin No Am. 2000;  9 605-646
    PubMedGoogle Scholar
  • 47 Levin E D, Conners C K, Silva D, Hinton S C, Meck W H, March J, Rose J E. Transdermal nicotine effects on attention.  Psychopharmacology. 1998;  140 135-141
    CrossrefPubMedGoogle Scholar
  • 48 Wilens T E, Biederman J, Spencer T J, Bostic J, Prince J, Monuteaux M C, Soriano J, Fine C, Abrams A, Rater M, Polisner D. A pilot controlled trial of ABT-418, a cholinergic agonist, in the treatment of adults with attention deficit hyperactivity disorder.  Am J Psychiatry. 1999;  156 1931-1937
    PubMedGoogle Scholar
  • 49 Lerman C, Audrain J, Tercyak K, Hawk L W, Bush A, Crystal-Mansour S, Rose C, Niaura R, Epstein L H. Attention-deficit hyperactivity disorder (ADHD) symptoms and smoking patterns among participants in a smoking-cessation program.  Nicotine Tob Res. 2001;  3 353-359
    PubMedGoogle Scholar
  • 50 Tarter R E. Psychosocial history, minimal brain dysfunction and differential drinking patterns of male alcoholics.  J Clin Psychol. 1982;  38 867-873
    PubMedGoogle Scholar
  • 51 De Obaldia R, Parsons O A, Yohman R. Minimal brain dysfunction symptoms claimed by primary and secondary alcoholics: relation to cognitive functioning.  Int J Neurosci. 1983;  20 173-181
    PubMedGoogle Scholar
  • 52 Alterman A I, Tarter R E, Baughman T G, Bober B A, Fabian S A. Differentiation of alcoholics high and low in childhood hyperactivity.  Drug Alcohol Depend. 1985;  15 111-121
    PubMedGoogle Scholar
  • 53 Shekim W O, Asarnow R F, Hess E, Zaucha K, Wheeler N. A clinical and demographic profile of a sample of adults with attention deficit hyperactivity disorder, residual state.  Compr Psychiatry. 1990;  31 416-425
    CrossrefPubMedGoogle Scholar
  • 54 Tims F M, Dennis M L, Hamilton N, Buchan B, Diamond G, Funk R, Brantley L B. Characteristics and problems of 600 adolescent cannabis abusers in outpatient treatment.  Addiction. 2002;  97 (Suppl 1) 46-57
    CrossrefPubMedGoogle Scholar
  • 55 Levin F R, Evans S M, Kleber H D. Prevalence of adult attention-deficit hyperactivity disorder among cocaine abusers seeking treatment.  Drug Alcohol Depend. 1998;  52 15-25
    PubMedGoogle Scholar
  • 56 King V L, Brooner R K, Kidorf M S, Stoller K B, Mirsky A F. Attention deficit hyperactivity disorder and treatment outcome in opioid abusers entering treatment.  J Nerv Ment Dis. 1999;  187 487-485
    CrossrefPubMedGoogle Scholar
  • 57 Eyre S L, Rounsaville B J, Kleber H D. History of childhood hyperactivity in a clinic population of opiate addicts.  J Nerv Ment Dis. 1982;  170 522-529
    PubMedGoogle Scholar
  • 58 Wender P H. Pharmacotherapy of attention-deficit/hyperactivity disorder in adults.  J Clin Psychiatry. 1998;  59 (Suppl 7) 76-79
    PubMedGoogle Scholar
  • 59 Wilens T E, Biederman J, Spencer T J, Prince J. Pharmacotherapy of adult attention/deficit hyperactivity disorder: a review.  J Clin Psychopharmacol. 1995;  15 270-279
    CrossrefPubMedGoogle Scholar
  • 60 Levin F R, Evans S M, McDowell D M, Kleber H D. Methylphenidate treatment for cocaine abusers with adult attention-deficit/hyperactivity disorder: a pilot study.  J Clin Psychiatry. 1998;  59 300-305
    PubMedGoogle Scholar
  • 61 Schubiner H, Saules K K, Arfken C L, Johanson C E, Schuster C R, Lockhart N, Edwards A, Donlin J, Pihlgren E. Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence.  Exp Clin Psychopharmacol. 2002;  10 286-294
    CrossrefPubMedGoogle Scholar
  • 62 Castaneda R, Levy R, Hardy M, Trujillo M. Long-acting stimulants of attention-deficit disorder in cocaine-dependent adults.  Psychiatr Serv. 2000;  51 169-171
    CrossrefPubMedGoogle Scholar
  • 63 Vaiva G, de Lenclave M B, Bailly D. Treatment of comorbid opiate addiction and attention-deficit hyperactivity disorder (residual type) with moclobemide: a case report.  Prog Neuropsychopharmacol Biol Psychiatry. 2002;  26 609-611
    CrossrefPubMedGoogle Scholar
  • 64 Levin F R, Evans S M, McDowell D M, Brooks D J, Nunes E. Bupropion treatment for cocaine abuse and adult attention-deficit/hyperactivity disorder.  J Addict Dis. 2002;  21 1-16
    PubMedGoogle Scholar
  • 65 Biederman J, Wilens T, Mick E, Spencer T, Faraone S V. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder.  Pediatrics. 1999;  104 e20
    CrossrefPubMedGoogle Scholar
  • 66 Hechtman L. Adolescent outcome of hyperactive children treated with stimulants in childhood: a review.  Psychopharmacol Bull. 1985;  21 178-191
    PubMedGoogle Scholar
  • 67 Barkley R A, Fischer M, Smallish L, Fletcher K. Does the treatment of attention-deficit/hyperactivity disorder with stimulants contribute to drug use/abuse? A 13-year prospective study.  Pediatrics. 2003;  111 97-109
    CrossrefPubMedGoogle Scholar
  • 68 Wilens T E, Faraone S V, Biederman J, Gunawardene S. Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analysic review of the literature.  Pediatrics. 2003;  111 179-185
    CrossrefPubMedGoogle Scholar
  • 69 Carroll K M, Rounsaville B J, Gordon L T, Nich C, Jatlow P, Bisighini R M, Gawin F H. Psychotherapy and pharmacotherapy for ambulatory cocaine abusers.  Arch Gen Psychiatry. 1994;  51 177-187
    PubMedGoogle Scholar

Dr. med. Eugen Davids

Klinik für Psychiatrie und Psychotherapie der Universität Duisburg-Essen · Rheinische Kliniken Essen

Virchowstraße 174

45147 Essen

eMail: eugen.davids@uni-essen.de