Attention-deficit/hyperactivity disorder (ADHD) is associated with substance use disorders (SUD; alcohol and/or drug dependence) and nicotine dependence. This study aims to advance our knowledge about the association between SUD, nicotine dependence, and the course of ADHD (persistent versus remittent ADHD and late-onset ADHD). ADHD, SUD, and nicotine dependence were longitudinally assessed (mean age at study entry 11.3 years, mean age at follow-up 21.1 years) using structured psychiatric interviews and multi-informant questionnaires in a subsample of the Dutch part of the International Multicenter ADHD Genetics study. Individuals with persistent ADHD (n = 62), remittent ADHD (n = 12), late-onset ADHD (n = 18; age of onset after 12 years), unaffected siblings (n = 50), and healthy controls (n = 47) were assessed. Hazard ratios (HR) with 95% confidence intervals (CIs) were estimated by Cox regression and adjusted for clustered family data, gender, follow-up length, and current age. Individuals with persistent ADHD were at significantly higher risk of development of SUD relative to healthy controls (HR = 4.56, CI 1.17–17.81). In contrast, levels of SUD in those with remittent ADHD were not different from healthy controls (HR = 1.00, CI .07–13.02). ADHD persisters had also higher prevalence rates of nicotine dependence (24.2%) than ADHD remitters (16.7%) and healthy controls (4.3%). A similar pattern was found in initially unaffected siblings who met ADHD criteria at follow-up (“late-onset” ADHD); they had also a higher prevalence of SUD (33%) compared to stable unaffected siblings (20%) and were at significantly increased risk of development of nicotine dependence compared to healthy controls (HR = 13.04, CI 2.08–81.83). SUD and nicotine dependence are associated with a negative ADHD outcome. Results further emphasize the need for clinicians to comprehensively assess substance use when diagnosing ADHD in adolescents and adults.

中文翻译：

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持续性，缓解性和迟发性多动症的物质使用和尼古丁依赖：一项从儿童期到成年期的十年纵向研究

注意缺陷/多动障碍（ADHD）与物质使用障碍（SUD；酒精和/或药物依赖性）和尼古丁依赖性有关。这项研究旨在增进我们对SUD，尼古丁依赖性和ADHD病程（持续性与缓解性ADHD和迟发性ADHD）之间关系的认识。在国际多中心ADHD遗传学荷兰部分的子样本中，使用结构化精神病学访谈和多信息问卷，纵向评估了ADHD，SUD和尼古丁依赖性（研究进入者的平均年龄11.3岁，平均随访年龄21.1岁）。学习。患有持续性ADHD（n = 62），缓解性ADHD（n = 12），迟发性ADHD（n = 18； 12岁后发病年龄），未受影响的兄弟姐妹（n = 50）和健康对照（n = 47）的个体）进行了评估。通过Cox回归估算具有95％置信区间（CI）的危险比（HR），并针对聚类的家庭数据，性别，随访时间和当前年龄进行了调整。与健康对照组相比，持续性多动症的人发生SUD的风险明显更高（HR = 4.56，CI 1.17-17.81）。相比之下，ADHD缓解者的SUD水平与健康对照者无差异（HR = 1.00，CI = 07.13.02）。与ADHD缓解者（16.7％）和健康对照者（4.3％）相比，ADHD坚持者的尼古丁依赖性患病率（24.2％）也更高。在随访时达到ADHD标准的最初未受影响的兄弟姐妹中也发现了类似的模式（“迟发性ADHD”）。与稳定的未患病兄弟姐妹（20％）相比，他们的SUD患病率更高（33％），与健康对照相比，他们对尼古丁依赖的发生风险显着增加（HR = 13.04，CI 2.08–81.83）。SUD和尼古丁依赖性与ADHD结果阴性有关。结果进一步强调了临床医生在诊断青少年和成人多动症时需要全面评估药物使用情况。