Prevalence and Clinical Correlates of Co-Occurring Attention Deficit/Hyperactivity Disorder and Posttraumatic Stress Disorder in a Sample of Inpatients Being Treated for Substance Use Disorder

Abstract

Attention-deficit/hyperactivity disorder (ADHD) and posttraumatic stress disorder (PTSD) commonly co-occur, and both have been recognized as risk factors for substance use disorder (SUD). Previous research has shown lifetime prevalence of PTSD was greater in adults with ADHD compared to controls, and those with both ADHD and PTSD had increased risk for other psychiatric comorbidities, higher functional impairment, and lower quality of life. However, no studies to date have examined the prevalence of these two disorders together in an inpatient population seeking treatment for SUD. The present study aims to examine the prevalence and clinical correlates of these two disorders in a sample of adults being treated for SUD. A sample of 293 participants being treated for SUD completed the Adult ADHD Self-Report Scale Symptom Checklist (ASRS-v1.1) and the PTSD Checklist 5 (PCL-5). SUD symptom severity was measured by the Brief Addiction Monitor (BAM) and the Brief Substance Craving Scale (BSCS). A linear regression analysis was run to characterize the association between ADHD and PTSD symptom severity and SUD symptom severity, controlling for clinical and demographic factors. Results indicated that ADHD and PTSD were highly prevalent in this setting, (39% and 35%, respectively). Diagnosis of one disorder was strongly associated with the likelihood of the other disorder (χ2 = 17.49, p = .001), and symptom severity for the two disorders was highly correlated (r = 0.50, p < .001). In multivariable models controlling for sociodemographic variables and primary substance of abuse, greater PTSD severity was associated with higher overall SUD severity, and greater ADHD symptom severity was associated with craving at a trend level. The prevalence of co-occurring ADHD and PTSD in this sample was at the high end of what has been previously cited in other settings, with significant associations between ADHD and PTSD symptoms and diagnosis likelihood. Even in this sample of adults with severe SUD, PTSD and ADHD symptoms were associated with greater SUD severity. Although integrated therapeutic modalities currently exist, additional study is needed to devise appropriate and efficacious behavioral interventions for this constellation of disorders.