J Korean Neuropsychiatr Assoc.  2016 Nov;55(4):443-449. 10.4306/jknpa.2016.55.4.443.

The Effects of Attention-Deficit/Hyperactivity Disorder Symptom and Impulsivity on Abstinence Period of Male Patients with Alcohol Use Disorder

• Jo JM
• Won SD
• Jung KH
• Ahn DH

• KMID: 2361233
• DOI: http://doi.org/10.4306/jknpa.2016.55.4.443

Abstract

OBJECTIVES
Alcohol use disorder (AUD) is closely associated with attention-deficit/hyperactivity disorder (ADHD). However, the mechanism involved in this association remains unclear. Impulsivity is one of the core traits of ADHD, and an elevated level of impulsivity increases the risk of onset of AUD. Our study focused on impulsivity as the common trait factor of these disorders. We examined the effects of ADHD symptoms and impulsivity on the abstinence period of patients with AUD.
METHODS
Male participants with AUD completed the contents of the Adult ADHD Self-Report Scale and the Barratt Impulsiveness Scale. We investigated participant alcohol abstinence period to evaluate severity and frequency of relapse.
RESULTS
Both ADHD symptom presence and abstinence period were significantly correlated with impulsivity. Motor impulsivity showed the highest correlations with ADHD and abstinence. The results of hierarchical regression analysis showed that impulsivity is a predictor of abstinence period, while ADHD had a moderating effect on the relationships between impulsivity and abstinence period. Moreover, we undertook hierarchical regression analysis of motor, cognitive, and non-planning impulsivity ; only motor impulsivity and ADHD symptom showed a statistically significant interaction with abstinence period.
CONCLUSION
The results indicate a possible causal relationship between the treatment of ADHD symptoms and the extension of AUD abstinence period. In other words, treatment of ADHD symptoms may prevent AUD relapse. Impulsivity, especially motor impulsivity has an important role in the base mechanisms of these two disorders.

Keyword

Attention-deficit/hyperactivity disorder; Alcohol use disorder; Impulsivity; Motor impulsivity

MeSH Terms

Adult
Alcohol Abstinence
Humans
Impulsive Behavior*
Male*
Recurrence

Figure

• 

  Fig. 1 Simple slopes computations and verification for moderation effect of ASRS with BIS on abstinence period (n=63). p-value for the high level of ASRS : 0.928. p-value for the medium level of ASRS : 0.007. p-value for the low level of ASRS : <0.001. ASRS : Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale-V1.1, BIS : Barratt Impulsiveness Scale.

• 

  Fig. 2 Simple slopes computations and verification for moderation effect of ASRS with BIS_M on abstinence period (n=63). p-value for the high level of ASRS : 0.923. p-value for the medium level of ASRS : 0.001. p-value for the low level of ASRS : <0.001. ASRS : Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale-V1.1, BIS : Barratt Impulsiveness Scale, M : Motor.

Reference

1. Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62:593–602.

2. Goldstein BI, Shamseddeen W, Spirito A, Emslie G, Clarke G, Wagner KD, et al. Substance use and the treatment of resistant depression in adolescents. J Am Acad Child Adolesc Psychiatry. 2009; 48:1182–1192.

3. Cho SJ, Suh GH, Nam JJ, Suh T, Cho MJ. Correlates and risk factors of probable alcohol dependence group among Korean adult drinkers: Nationwide Probability Sample Survey. J Korean Neuropsychiatr Assoc. 1998; 37:1186–1200.

4. Kim JW, Park CS, Hwang JW, Shin MS, Hong KE, Cho SC, et al. Clinical and genetic characteristics of Korean male alcoholics with and without attention deficit hyperactivity disorder. Alcohol Alcohol. 2006; 41:407–411.

5. Klimkiewicz A, Klimkiewicz J, Jakubczyk A, Kieres-Salomoński I, Wojnar M. [Comorbidity of alcohol dependence with other psychiatric disorders. Part I. Epidemiology of dual diagnosis]. Psychiatr Pol. 2015; 49:265–275.

6. Biederman J, Wilens T, Mick E, Milberger S, Spencer TJ, Faraone SV. 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.

7. Knop J, Penick EC, Nickel EJ, Mortensen EL, Sullivan MA, Murtaza S, et al. Childhood ADHD and conduct disorder as independent predictors of male alcohol dependence at age 40. J Stud Alcohol Drugs. 2009; 70:169–177.

8. Jo JM, Lee DJ, Jung KH, Oh SI, Ahn DH. Clinical and neuropsychological characteristics of adult alcohol use disorder patients with or without attention-deficit hyperactivity symptom. J Korean Acad Child Adolesc Psychiatry. 2014; 25:209–216.

9. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. fifth edition. Arlington, VA: American Psychiatric Association;2013.

10. Winstanley CA, Eagle DM, Robbins TW. Behavioral models of impulsivity in relation to ADHD: translation between clinical and preclinical studies. Clin Psychol Rev. 2006; 26:379–395.

11. Evenden JL. Varieties of impulsivity. Psychopharmacology (Berl). 1999; 146:348–361.

12. Moeller FG, Barratt ES, Dougherty DM, Schmitz JM, Swann AC. Psychiatric aspects of impulsivity. Am J Psychiatry. 2001; 158:1783–1793.

13. Dick DM, Smith G, Olausson P, Mitchell SH, Leeman RF, O'Malley SS, et al. Understanding the construct of impulsivity and its relationship to alcohol use disorders. Addict Biol. 2010; 15:217–226.

14. Pedersen SL, Walther CA, Harty SC, Gnagy EM, Pelham WE, Molina BS. The indirect effects of childhood attention deficit hyperactivity disorder on alcohol problems in adulthood through unique facets of impulsivity. Addiction. 2016; 111:1582–1589.

15. Sadock BJ, Sadock VA, Ruiz P. Kaplan and Sadock's Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 11th ed. Philadelphia: Wolters Kluwer Health;2014.

16. Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychol Med. 2005; 35:245–256.

17. Kim JH, Lee EH, Joung YS. The WHO Adult ADHD Self-Report Scale: reliability and validity of the Korean version. Psychiatry Investig. 2013; 10:41–46.

18. Barratt EE. Anxiety and impulsiveness related to psychomotor efficiency. Percept Mot Skills. 1959; 9:191–198.

19. Lee H. Impulsivity Test. Seoul: Korean Guidance;1992.

20. Aiken LS, West SG. Multiple regression: testing and interpreting interactions. Newbury Park, CA: Sage;1991.

21. Rooney M, Chronis-Tuscano AM, Huggins S. Disinhibition mediates the relationship between ADHD and problematic alcohol use in college students. J Atten Disord. 2015; 19:313–327.

22. Roberts W, Peters JR, Adams ZW, Lynam DR, Milich R. Identifying the facets of impulsivity that explain the relation between ADHD symptoms and substance use in a nonclinical sample. Addict Behav. 2014; 39:1272–1277.

23. Harden KP, Carlson MD, Kretsch N, Corbin WR, Fromme K. Childhood sexual abuse and impulsive personality traits: mixed evidence for moderation by DRD4 genotype. J Res Pers. 2015; 55:30–40.

24. Heath AC, Bucholz KK, Madden PA, Dinwiddie SH, Slutske WS, Bierut LJ, et al. Genetic and environmental contributions to alcohol dependence risk in a national twin sample: consistency of findings in women and men. Psychol Med. 1997; 27:1381–1396.

25. Kreek MJ, Nielsen DA, Butelman ER, LaForge KS. Genetic influences on impulsivity, risk taking, stress responsivity and vulnerability to drug abuse and addiction. Nat Neurosci. 2005; 8:1450–1457.

26. Biederman J. Pharmacotherapy for attention-deficit/hyperactivity disorder (ADHD) decreases the risk for substance abuse: findings from a longitudinal follow-up of youths with and without ADHD. J Clin Psychiatry. 2003; 64:Suppl 11. 3–8.

27. Wilens TE, Adler LA, Weiss MD, Michelson D, Ramsey JL, Moore RJ, et al. Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders. Drug Alcohol Depend. 2008; 96:145–154.

28. Weafer J, Dzemidzic M, Eiler W 2nd, Oberlin BG, Wang Y, Kareken DA. Associations between regional brain physiology and trait impulsivity, motor inhibition, and impaired control over drinking. Psychiatry Res. 2015; 233:81–87.

29. Marinkovic K, Halgren E, Klopp J, Maltzman I. Alcohol effects on movement-related potentials: a measure of impulsivity? J Stud Alcohol. 2000; 61:24–31.

30. Alterman AI, Petrarulo E, Tarter R, McGowan JR. Hyperactivity and alcoholism: familial and behavioral correlates. Addict Behav. 1982; 7:413–421.