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


Study Design and Procedure

A qualitative, interview study was conducted among a population of treatment-seeking patients with a dual diagnosis of SUD and ADHD or SUD and ASD.

Open, in-depth semi-structured interviews were used in which patients in both groups were questioned about the consequences of their illness for everyday life using the patient's perspective as the guiding principle. The study was approved by a certified medical ethics committee (Commissie Mensgebonden Onderzoek Regio Arnhem-Nijmegen) and by the institutional review board of Dimence (Commissie Wetenschappelijk Onderzoek). All participants signed informed consent for participation in the study.

The interviews were conducted first with a group of SUD + ADHD patients in the period of December 2011 to May 2012 and then with a group of SUD + ASD patients in the period of June 2012 to October 2012. All of the interviews were conducted by one of two researchers who thus conducted half of the interviews for each patient group. The interviews were then transcribed verbatim.

Target Patient Population and Selection Criteria

Patients with SUD and a co-occurring ADHD or ASD were recruited using the following inclusion and exclusion criteria. Inclusion: outpatient treatment for SUD; age 18–65; IQ >80; current DSM-IV diagnosis of SUD and current DSM-IV diagnosis of ADHD or ASD; mastery of the Dutch language. Exclusion: diagnoses of SUD and both ADHD and ASD. All patients were recruited from an outpatient, dual diagnosis, treatment facility in the Netherlands.

Out of 122 patients, 72 told that they were willing to participate in the further study. Of these 72 patients, nine were diagnosed with both ADHD and ASD in addition to SUD and therefore excluded from further inclusion, leaving a total of 63 eligible patients.

A total of 37 SUD + ADHD patients were then approached for this study: seven patients could no longer be reached and 13 refused to participate despite their initial willingness to do so. An interview was thus planned for 17 patients, but 5 did not show up then. One patient also had to be excluded due to hospitalization at the time of the planned interview. This left 11 SUD + ADHD patients to participate in the study.

A total of 26 SUD + ASD patients were approached for this study as well: 5 could no longer be reached and 7 refused to participate despite initial willingness to do so. An interview was planned for 14 patients, but 2 of them did not show up. In the end, 12 SUD + ASD patients were interviewed for a total of 23 patients participating in the present study.

Interview Topics

The in-depth interviews were conducted with the aid of a topic list which draws upon the results of a previous-study.[11] Impairments, unmet needs, and clearly met needs were probed for a number of life domains (see Table 1).

The topic list was used as guidance during the interview. By posing open questions, the patients were invited to describe in detail their ideas, attitudes, experiences, and behaviour. Sample questions were: What are your problems like, and how do they relate to your alcohol or drug use? What does this combination of SUD and ADHD/ASD mean for you? and How does the combination of SUD and ADHD/ASD relate to your everyday life?

Coding and Analysis of the Interview Transcripts

Given the qualitative nature of our study, the interview transcripts were coded and analyzed in a cyclic process. However, keeping the groups separated helped to focus on the in-depth knowledge within each group. Throughout this process, the routines followed and the coding procedures applied were discussed between the researchers and, in this manner, consistency of assessment was assured. The coding and analysis of the data was performed using the MAXQDA2010 software. And, in doing this, the seven steps for descriptive phenomenology outlined by Colaizzi[15] were followed.

In order to gain an overall impression of the data, the interview transcripts were first read as a whole (step 1). Then both interviewers independently selected and coded significant statements (steps 2 and 3). Related codes were then identified and grouped together under the themes they represented (step 4). Thereafter, a subset of 6 of the 23 interview transcripts was coded by both researchers and the findings compared.

After the completion of the first 7 interviews for each of the patient groups, an interim analysis was performed (step 5). The results of this analysis were then used to guide the subsequent interviews. The emerging themes and insights were thoroughly discussed in preparation for the subsequent interviews.

In the subsequent interviews, the themes identified in step 5 were used to determine whether new codes would emerge which could not be grouped within the existing themes or data saturation was reached.

In the next step of the analyses, the interviews from the two groups were examined as a whole but also compared to identify general and group-specific themes (step 6). The outcomes of the analyses were then summarized and sent to the participants for feedback and validation of the results (written member check, step 7). Unfortunately, none of the participants responded to our request for a written member check.