Everyday Life Consequences of Substance use in Adult Patients With a Substance use Disorder (SUD) and Co-occurring Attention Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder (ASD)

A Patient's Perspective

Linda M Kronenberg; Karin Slager-Visscher; Peter JJ Goossens; Wim van den Brink; Theo van Achterberg


BMC Psychiatry. 2014;14(264) 

In This Article


Mental disorders can frequently co-occur with a substance use disorder (SUD) or some other disorder. Such co-occurrence is often referred to as a dual diagnosis, which can itself refer to either life-time co-occurrence or current co-occurrence. For clinical purposes and needs assessment, current co-occurrence is more important than life-time co-occurrence.

The co-occurrence of SUD and other mental disorders is very common: about 50% of individuals with severe and persistent mental disorders are affected by substance use.[1–3] Some studies have specifically examined the co-occurrence of SUD with schizophrenia, bipolar disorder, psychosis, depressive disorder or anxiety disorder.[1,4,5] Similarly, the co-occurrence of SUD with attention deficit/hyperactivity disorder (ADHD) has been examined quite extensively. And a recent meta-analysis of the prevalence of attention-deficit hyperactivity disorder in substance use disorder patients showed 23% of all patients with SUD to meet the criteria for adult ADHD.[6] Studies of the co-occurrence of SUD and autism spectrum disorders (ASD) are scarce.[7] In recent research, however, the lifetime prevalence of SUD in connection with ASD has been reported to range from 11% to 29%.[8–10] The sample sizes have been limited (n = 122, n = 54 and n = 70 respectively) in these studies, however.

A very recent study showed about 1% of the general population to have adult ADHD with a co-occurring SUD while 0.1–0.2% of the general population has an ASD with a co-occurring SUD.[11]

Studies have further shown the co-occurrence of SUD with other psychiatric disorders to be associated with not only ineffective treatment and care but also an unfavourable treatment course and outcome.[12–14] In a recent study the objective care needs of SUD patients with co-occurring ADHD or ASD were determined.[11] Met- and unmet needs were reported for several life domains and it was suggested that further research should focus on the (subjective) psychological consequences of substance use in SUD patients with ADHD (SUD + ADHD) or ASD (SUD + ASD). This calls for in-depth, qualitative study of substance use and related daily problems.

In light of the above, we undertook a qualitative, interview study to answer the following research question: What are the everyday life consequences of substance use in adult patients with a substance use disorder (SUD) and co-occurring attention deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) from a patient's perspective?