Prevalence and implications of attention-deficit hyperactivity disorder among adolescents in treatment for substance abuse

Objective: Attention-deficit hyperactivity disorder (ADHD) is overrepresented among adults and adolescents in treatment for substance abuse. This study was designed to assess the prevalence of ADHD and to elucidate differences among adolescent substance abusers relative to ADHD symptomatology. Method: The Wender Utah Rating Scale and the Self-Evaluation (Teenager's) Self-Report were used to evaluate childhood history of ADHD and current symptoms, respectively, and the Child Attention Problems Scale was completed by treatment program clinicians. A quantitative substance use history and a subjective substance use interview were also administered. Results: A total of 50% of 14 females and 16 males, ranging in age from 14 to 19, met study criteria for ADHD. ADHD subjects began drug use at an earlier age, had more severe substance abuse, and had a more negative self-image prior to drug use and improved self-image with drug use. They experienced more negative affective responses related to substance use and more drug craving and attentional difficulties in treatment than control subjects. Conclusions: The results support a substantial comorbidity of ADHD among adolescent substance abusers, with indications of drug use for self-medication. Counseling for ADHD and medication may be indicated to improve treatment outcome and future functioning.