Double Diagnosis: ADHD and Alcohol Use Disorder

Attention deficit hyperactivity disorder (ADHD) is a well-documented, independent risk factor for all kind of substance use disorders including problematic alcohol use and alcohol use disorders (AUD) in adolescence and adulthood. According to meta-analytic data the risk for AUD in young adulthood is increased to 1.7 for patients with childhood ADHD. Comorbidity of ADHD and AUD arises up to one quarter of patients with AUD suffering from ADHD and vice versa. A variety of studies also shows, that the comorbidity of ADHD and AUD is associated with earlier onset and more severe course of AUD, more severe psychosocial impairment and negative impact on treatment efficacy and adherence in both disorders. However, in current clinical reality, ADHD often goes unrecognized in patients with AUD and ADHD-patients may also often dissimulate alcohol misuse if not asked explicitly. This probably is accounted for by a variety of reasons, for example withdrawal and intoxication symptoms or emotional dysregulation, anxiety, sleep disturbances, stress sensitivity and dysphoria during early abstinence in SUD-patients, that might interfere with the diagnostic process of ADHD or due to shame and social conventions in ADHD-patients. However, clinical strategies for diagnosis and caring for patients with ADHD and SUD should take into account both disorders due to the high comorbidity. The talk will provide a clinical overview of the topic and discuss patients at risk for both disorders.