Prevalence of substance use disorder in individuals with attention deficit/hyperactivity disorder: associations with sex and psychiatric comorbidity
Open accessAbstract
Background: Several studies have reported associations between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD). However, sex-differences in ADHD and SUD, especially when associated with other psychiatric comorbidities, are less studied. Objective: To compare the prevalence of SUD among individuals with and without ADHD to describe groups, defined by sex and psychiatric comorbidity, who may benefit from targeted follow-up. Methods: Data from the Medical Birth Registry of Norway, the Norwegian Prescription Database and the Norwegian Patient Registry were linked. Individuals born 1988–2001 were identified and followed until 2019 (ages 18–31 years in 2019). Log binomial regression was used to calculate age-adjusted prevalence differences (PD) of SUD with 95% confidence intervals in males (N = 31,146) and females (N = 18,669) with ADHD, overall and with/without other psychiatric comorbidities, relative to those without ADHD (males N = 381,568; females N = 368,804). Results: ADHD was associated with SUD across all substances among both males and females (“Any SUD”: PD females 10.9% (10.4; 11.4); PD males 11.4% (11.0; 11.8). Compared to individuals without ADHD, PDs were larger in males with ADHD than females for disorders related to cannabis, sedatives, stimulants, other substances and multiple psychoactive substances. ADHD with psychiatric comorbidities was associated with even larger differences in SUD prevalence among both males and females, the largest for ADHD with psychosis/schizophrenia [PD males 49.0% (45.6; 52.4); PD females 40.6% (36.1; 45.1)] and ADHD with personality disorders [PD males 37.6% (35.2; 40.0); PD females 33.0% (31.0; 35.0)], compared to males and females without psychiatric disorders. For psychiatric comorbidities typically diagnosed in adulthood, PDs were larger in males than females with ADHD, whereas for comorbid childhood disorders, PDs were larger in females. Conclusion: The high prevalence of SUD associated with ADHD, with higher PDs in males than females for most specific SUDs, indicates a need for targeted prevention. The substantially higher prevalence of SUD in individuals with ADHD and comorbid psychiatric disorders emphasizes the need for close follow-up of individuals with ADHD both regarding SUD and other psychiatric disorders. Further studies are needed to evaluate potential causal relations between ADHD, other psychiatric comorbidities, and SUD, and to understand the sex-differences in SUD prevalence across psychiatric comorbidities in ADHD.
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Comorbid SUD in ADHD confers a more severe clinical profile, including higher rates of polysubstance use, emergency visits, suicidality, and treatment dropout.
“Comorbidity confers a more severe clinical profile, including higher rates of polysubstance use, emergency visits, suicidality, and treatment dropout [108].”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [108]
The Background (page unavailable) links co-occurring ADHD and SUD to more severe SUD and less successful treatment, and the Methods include a multiple-drug-use diagnosis. But the paper does not establish that comorbidity causes these outcomes or report higher emergency-visit, suicidality, or treatment-dropout rates; less successful treatment is not the same as dropout. (LLM, conf=0.88)
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- Authors
- Moldekleiv, C. D., Lundervold, A. J., Solberg, B. S., Engeland, A., Fadnes, L. T., Chalabianloo, F., & Klungsøyr, K.
- Affiliations
- University of Bergen (NO)
- Norwegian Institute of Public Health (NO)
- Haukeland University Hospital (NO)
- Corresponding author
- Klungsøyr, Kari
- ORCID
- Venue
- BMC Psychiatry
- Published
- 2025-10-07
- Volume
- 25
- Issue
- 1
- Pages
- 936-936
- ISSN
- 1471-244X (ISSN-L)
- PMC
- PMC12505809
- OpenAlex
- W4414892460
- Cited by
- 8
- References
- 65
- Citations by year
- 2026: 7 · 2025: 1
- FWCI
- 5.38
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BMC Psychiatry (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- University of Bergen
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Prenatal Substance Exposure Effects
- Keywords
- attention deficit hyperactivity disorder, substance use disorders, sex differences, psychiatric comorbidity, psychosis, schizophrenia, personality disorders, cannabis use, sedative use, stimulant use, substance use prevalence, young adults, childhood disorders, medical birth registry, prescription data, patient registry data
- MeSH terms
- Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Mental Disorders, Female, Humans, Male, Norway, Registries, Sex Factors, Comorbidity, Prevalence, Substance-Related Disorders, Young Adult
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