Iranian Journal of Psychiatry 2018. 13(2):112-119.

Attention-Deficit Hyperactivity Disorder in Adults Using Methamphetamine: Does It Affect Comorbidity, Quality of Life, and Global Functioning?
Zahra Shahrivar, Ronak Mihan, Javad Mahmoudi-Gharaei, Alia Shakiba, Mostafa Hosseini


Objective: Attention-deficit hyperactivity disorder (ADHD) is common in adulthood, and it is associated with different high- risk behaviors, particularly substance use. Evidence suggests a high prevalence of ADHD in adults who take methamphetamine (METH). This study aimed at comparing functional level, quality of life, and psychiatric comorbidities in METH users with and without adult ADHD (A-ADHD).

Method: In this cross-sectional study, 134 patients who had a history of METH use (at least once in lifetime) were selected from among inpatient and outpatient referrals to a psychiatric hospital. DIVA was performed for those who were positive on the Conners' Adult ADHD Rating Scales–Self-Report-Screening Version (CAARS-SR-SV). The Global Assessment of Functioning (GAF) and World Health Organization Quality of Life Scale-Brief (WHOQoL-BREF) were used to assess the participants’ level of functioning and quality of life, respectively. Psychiatric comorbidities including substance use disorders were evaluated using the Structured Clinical Interview for DSM-IV-Axis I (SCID-I).

Results: Among the METH users, 10.4% were diagnosed as having A-ADHD. A-ADHD was more prevalent among female METH users than males. The hyperactive-impulsive and combined types were more common than the inattentive type. Opiates and cannabis were the most commonly abused drugs by the 2 groups, while sedative-hypnotic use was significantly higher in the individuals with A-ADHD. Substance-induced mood disorder was the most prevalent comorbidity in the 2 groups and was higher in those with A-ADHD. quality of life and the GAF scores were significantly lower in those with A-ADHD and duration of METH use was higher Compared to the METH users without A-ADHD, (p>0.05).

Conclusion: This study provided some preliminary findings supporting the prevalence of Adult ADHD among METH users and its negative impacts on their global functioning and quality of life. To provide more effective intervention for METH users, detection and treatment of those with A-ADHD can be of clinical value.


Adult; Attention Deficit Hyperactivity Disorder; Comorbidity; Function; Methamphetamine; Quality of Life

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Bonvicini C, Faraone SV, Scassellati C. Attention-deficit hyperactivity disorder in adults: A systematic review and meta-analysis of genetic, pharmacogenetic and biochemical studies. Mol Psychiatry 2016; 21: 872-884.

Levin FR, Evans SM, Brooks DJ, Kalbag AS, Garawi F, Nunes EV. Treatment of methadone-maintained patients with adult ADHD: double-blind comparison of methylphenidate, bupropion and placebo. Drug Alcohol Depend 2006; 81: 137-148.

Sadock BJ. Kaplan and Sadock's Comprehensive Textbook of Psychiatry: Wolters Kluwer Health; 2009.

Young SE, Friedman NP, Miyake A, Willcutt EG, Corley RP, Haberstick BC, et al. Behavioral disinhibition: Liability for externalizing spectrum disorders and its genetic and environmental relation to response inhibition across adolescence. J Abnorm Psychol 2009; 118: 117-130.

Zulauf CA, Sprich SE, Safren SA, Wilens TE. The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders. Curr Psychiatry Rep 2014; 16: 436.

Bayrami M, Goradel JA, Hashemi T, Mahmood-Alilu M. Predicting a tendency to use drugs from child and adult attention deficit hyperactivity disorder symptoms in adults. Int J High Risk Behav Addict 2012; 1: 104-108.

Mariani JJ, Levin FR. Treatment strategies for co‐occurring ADHD and substance use disorders. Am J Addict 2007; 16 Suppl 1: 45-54.

Biederman J, Wilens T, Mick E, Faraone SV, Weber W, Curtis S, et al. Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. J Am Acad Child Adolesc Psychiatry 1997; 36: 21-29.

United Nations Office on Drugs and Crime, World Drug Report 2017 (ISBN: 978-92-1-148291-1, eISBN: 978-92-1-060623-3, United Nations publication, Sales No. E.17.XI.6).

Scott JC, Woods SP, Matt GE, Meyer RA, Heaton RK, Atkinson JH, et al. Neurocognitive effects of methamphetamine: a critical review and meta-analysis. Neuropsychol Rev 2007; 17: 275-297.

Shariatirad S, Maarefvand M, Ekhtiari H. Emergence of a methamphetamine crisis in Iran. Drug Alcohol Rev 2013; 32: 223-234.

Kousha M, Alaghbandrad J, Shahrivar Z, Tehrani Doust M, Mohammadi Mr, Kiani Sa. [Relationship Between Attention Deficit/Hyperactivity Disorder And Pattern Of Substance Use In Male Adolescents (In persian)]. Advances in Cognitive Science 2004; 5: 64-72.

Conners C, Erhardt D, Epstein J, Parker J, Sitarenios G, Sparrow E. Self-ratings of ADHD symptoms in adults I: Factor structure and normative data. Journal of Attention Disorders 1999; 3: 141-151.

Hines JL, King TS, Curry WJ. The adult ADHD self-report scale for screening for adult attention deficit–hyperactivity disorder (ADHD). J Am Board Fam Med 2012; 25: 847-453.

Arabgol F, Hayati M, Hadid M. Prevalence of Attention-Deficit/Hyperactivity Disorder in a Group of University Students. 2004.

First MB, Spitzer, Robert L, Gibbon Miriam, and Williams, Janet B.W. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington DC: American Psychiatric Press, Inc; 1996.

Sharifi V, Assadi SM, Mohammadi MR, Amini H, Kaviani H, Semnani Y, et al. A Persian translation of the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition: psychometric properties. Compr Psychiatry 2009; 50: 86-91.

Aas IM. Global Assessment of Functioning (GAF): properties and frontier of current knowledge. Ann Gen Psychiatry 2010; 9: 20.

Ramos-Quiroga JA, Nasillo V, Richarte V, Corrales M, Palma F, Ibáñez P, et al. Criteria and concurrent validity of DIVA 2.0: A semi-structured diagnostic interview for adult ADHD. Journal of attention disorders. 2016:1087054716646451.

Zamani L. Evaluation of concurrent validity and reliability of Persian version of a diagnostic interview for ADHD in adults (DIVA). Tehran: Tehran University of Medical Sciences; 2017.

Mas-Expósito L, Amador-Campos JA, Gómez-Benito J, Lalucat-Jo L. The World Health Organization quality of life scale brief version: a validation study in patients with schizophrenia. Qual Life Res 2011; 20: 1079-1089.

Nedjat S, Montazeri A, Holakouie K, Mohammad K, Majdzadeh R. Psychometric properties of the Iranian interview-administered version of the World Health Organization's Quality of Life Questionnaire (WHOQOL-BREF): a population-based study. BMC Health Serv Res 2008; 8: 61.

Dakwar E, Mahony MA, Pavlicova M, Glass MA, Brooks MD, Mariani JJ, et al. The utility of attention-deficit/hyperactivity disorder screening instruments in individuals seeking treatment for substance use disorders. J Clin Psychiatry 2012; 73: e1372–e1378.

Obermeit LC, Cattie JE, Bolden KA, Marquine MJ, Morgan EE, Franklin DR, et al. Attention-deficit/hyperactivity disorder among chronic methamphetamine users: frequency, persistence, and adverse effects on everyday functioning. Addict Behav 2013; 38: 2874-2878.

Liebrenz M, Gamma A, Ivanov I, Buadze A, Eich D. Adult attention-deficit/hyperactivity disorder: Associations between subtype and lifetime substance use–a clinical study. F1000Research. 2015; 4: 407.

Wilens TE, Biederman J, Faraone SV, Martelon M, Westerberg D, Spencer TJ. Presenting ADHD symptoms, subtypes, and comorbid disorders in clinically referred adults with ADHD. J Clin Psychiatry 2009; 70: 1557-1562.

Murphy K, Barkley RA. Prevalence of DSM-IV symptoms of ADHD in adult licensed drivers: Implications for clinical diagnosis. Journal of Attention Disorders 1996; 1: 147-161.

Sobanski E, Brüggemann D, Alm B, Kern S, Philipsen A, Schmalzried H, et al. Subtype differences in adults with attention-deficit/hyperactivity disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity and psychosocial adjustment. Eur Psychiatry 2008; 23: 142-149.

Disney ER, Elkins IJ, McGue M, Iacono WG. Effects of ADHD, conduct disorder, and gender on substance use and abuse in adolescence. Am J Psychiatry 1999; 156: 1515-1521.

Lewis M. Child and Adolescent Psychiatry: A Comprehensive Textbook: Lippincott Williams & Wilkins; 2002.

Abedi S, Shirazi E, Hajebi A. Is attention deficit hyperactivity disorder more common in substance dependency? Iranian Journal of Psychiatry and Clinical Psychology 2007; 13: 227-231.

Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry 2006; 163: 716-723.

Biederman J, Newcorn J, Sprich S. Comorbidity of attention deficit hyperactivity disorder with conduct, depressive, anxiety, and other disorders. Am J Psychiatry 1991; 148: 564-77.

Kousha M, Shahrivar Z, Alaghband-rad J. Substance use disorder and ADHD: is ADHD a particularly “specific” risk factor? J Atten Disord 2012; 16: 325-332.

Matthies S, Sadohara-Bannwarth C, Lehnhart S, Schulte-Maeter J, Philipsen A. The Impact of Depressive Symptoms and Traumatic Experiences on Quality of Life in Adults with ADHD. J Atten Disord 2018; 22: 486-496.


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