Study of attention deficit hyperactive in alcoholic use disorders in Maharashtra population

 

 

Abstract              Background: Attention deficit Hyperactivity disorder (ADHD) is of great clinical importance not only because of its high prevalence but also due to the frequent co-morbid illness that are connected with this disorder. Several studies proved that ADHD constitutes a significant risk factor for the exacerbation of habit forming illness of addiction. Method: 85 adult alcoholic patents having symptoms of ADHD were studied. SADQ scale, CIWA scales to monitor the withdrawal syndrome. ASRS it an instrumental scale to assess adult ADHD was used. DSM-5 scale to study the symptom of ADHD. Results: Social manifestation were – 21 (25.6%) were illiterate, 30 (36.5%) had primary education, 19 (23.1%) were matriculate, 12 (14.6%) had passed intermediate education. The marital status was – 32 (39%) were married, 33 (46.3%) un-married, 11 (13.4%) were divorcee. The monthly income was > 5000in 58 (70.7%) patients, <5000 in 24 (29.2%) patients. The CIWA score was <9 in withdrawal patients. There was comparison between confirmed 16 (19.5%) patients and non-confirmed 66 (8.9%) ADHD patients SADQ score in ADHD patients was 37.8 (±1.38), 32.5 (±2.63) in non-confirmed ADHD patients. Study of age related to alcohol use, onset of craving, onset of withdrawal symptoms, age of onset of salience years was compared in both confirmed and non-confirmed groups and p value was highly significant (p<0.00). Conclusion: These results reveal that, habit forming illness can be associated with high co-morbidity with ADHD, expressed in the form of alcohol abuse. These findings underline the great importance of early and adequate diagnostics and therapy of ADHD for the prevention of habit-forming illness.

Keywords: SAD Q Score, ASRS scale, CIWA scale, AUD, Maharashtra

 

INTRODUCTION

Attention deficit Hyperactivity disorder (ADHD) is a chronic disorder often persists into adulthood.¹ Adults with ADHD are at increased risk of alcohol and/or drug abuse or dependence² ADHD doubles the life time risk of developing an addiction, with co-morbid depression, anxiety and conduct disorder potentially further increasing such risk. Majority of adults untreated ADHD have a substance use disorders (SUD), conversely, studies also show that, approximately 11-35% of adults with different forms of SUD experience ADHD³ substance use disorder that is co-morbid with ADHD typically has an earlier onset, in more severe and less responsive to treatment and has a longer duration than SUB without ADHD using extended release formulations of stimulants or the non-stimulant atomoxetine may be associated with lower risk of abuse, misuse, and/or diversion Compared with other agents and formulations.⁴ The aim of this study to evaluate the baseline ADHD symptoms or drinking behaviour were predictive of ADHD or alcohol use outcomes and compare the relationship between ADHD symptoms with drinking subjects.

 

MATERIAL AND METHOD

82 patients admitted at alcoholic de-addiction ward of psychiatry department of Prakash institute of medical sciences and researches Islampur Dist-Sangli, Maharashtra-415409 were studied.

Inclusion Criteria: Meeting the diagnostic criteria for AUD according to DSM 5; age between 20 to 60 years were selected for study.

Exclusion Criteria: Patients having substance use disorders (SUD) except, nicotine dependence, patients admitted primarily for another major psychiatric disorder patient having intellectual disability or mentally retarded were excluded from the study.

Method: All patients admitted at de-addiction ward of psychiatry department were clinically interviewed. Patients presenting with an index diagnosis of Alcohol use disorder (AUD) according to DSM-5 and co-operating for study is recorded. The patients underwent an assessment with SADQ to assess the severity of alcoholism and CIWA scale to monitor the withdrawal symptoms⁵ patients also undergone adult ADHD self-report scale (ASRS) after completion of detoxification and the CIWA score being <9.⁶ The patients who screened positive for ASRS score were taken for diagnostic confirmation using DSM-5. Clinical interview ASRS is an instrument used for screening adult ADHD and consists of two parts A and B. The scale was applied in English and Marathi forms which have been validated and translated by WHO. The diagnostic conformation of ADHD was done using DSM-5 by clinical interview method. The diagnostic criteria for adult ADHD were according to DSM-5 ⁽¹⁾ Patients had at least five of the inattention or hyperactivity and impulsivity symptoms.² Several symptoms were present prior to the age of 12 years³ Symptoms occur in more than two settings and⁴ symptoms cause social and occupational dysfunction. All patients admitted for alcohol de-addiction underwent both pharmacological and psychological interventions as part of the treatment protocol for managing withdrawal states and relapse prevention. The duration of study was from April-2020 to May-2021.

Statistical analysis: Various parameters of ADHD alcoholic were studied and classified percentage. The patients with ADHD and without ADHD were compared with various parameters by applying z test. The statistical analysis was carried out in SPSS software. The ratio of male and female 3:1.

This research paper was approved by Ethical committee of Prakash Institute of Medical science and research centre Islampur – Dist Sangli, Maharashtra – 415409.

 

OBSERVATION AND RESULTS

Table 1: Social manifestation in alcoholic use disorder patient.

1. Educational status – 21 (25.6%) were illiterate, 30 (36.5%) had primary education, 19 (23.1%) were matriculate, 23 (14.6%) were intermediate qualified.
2. Marital Status – 32 (39%) were married, 38 (46.3%) were un-married, 11 (13.4%) were divorcee
3. Monthly income of ADHD patients was 58 (70.7%) ≥5000 per month 24 (29.3%) ≤ 5000 per month.

 

Table 2: Comparison of characteristics and without ADHD – The age of first exposure to alcohol (years) 20.8 (±1.2) in with ADHD, 23.9 (±2.3) in without ADHD subjects, t test 7.69 and p<0.000.

Age of regular use (year) 26.1 (±1.8) in ADHD 28.8 (±2.22) in without ADHD, t test 4.49 and p<0.000, Age of onset of craving (year) 25.6 (±1.30) in ADHD 28.2 (±2.29) t test 7.48and p<0.000, Age of development of tolerance (year) 26.4 (±1.40) in ADHD patients, 29.6 (±2.10) t test 7.17 and p<0.00, The age of onset of withdrawal symptoms 27.3 (±1.28) in ADHD, 30.6 (±2.10) in without ADHD patient t test 8.07 and p<0.000, Age of development of loss of control (years) 27.3 (±1.30) in ADHD, 32.32 (±2.11) in without ADHD subjects, t test 11.8 and p<0.000, Age of onset salience (year) 27.3 (±1.29) in ADHD, 33.69 (±2.60) in without ADHD patients, t test 13.8 and p<0.000, Age of onset of early morning use (years) 29.8 (±1.30) in ADHD, 36.5 (±2.13) in without ADHD patients, t test 16.04 and p<0.000. Alcohol use in units, per day 24.2 (±1.42) in ADHD, 20.2 (±2.12) in without ADHD patients, t test 9.05 and p<0.000, SADQ score 37.8 (±1.38) in ADHD 32.52 (±2.63) in without ADHD patients, t test 11.2 and p<0.000. Mean value of longest duration of abstinence fromalcohol (days) 4.13 (±1.270) in ADHD, 150.2 (±2.76) in without ADHD patients, t test 79 and p<0.000.

 

 

 

 

 

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