الفهرس 
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Abstract
SUMMARY
ifferent models of comorbidity are generally proposed to
link different psychiatric illnesses to SUD.
Psychiatric disorders may be considered as a risk factor
for SUD or substances of abuse may be used as a selfmedication
to reduce symptoms of the psychiatric disorder.
Relation between ADHD and substance use have been
proposed, ADHD may be considered as a risk factor for SUD.
Common genetic background for both ADHD and SUD plays
also a contributing factor.
The presence of adult ADHD among patients with SUD
was associated with a more complicated course of SUDs and
severe dependence on cigarette, number of relapses and number
of hospitalization and had poor SUD treatment prognosis
Impulsivity and consequent risk-taking are associated
with both substance use disorder and ADHD. Impulsivity is a
core diagnostic feature of the hyperactive-impulsive and
combined presentations of ADHD and may be a determining
factor in the initiation and maintenance of substance use, with
increased levels of impulsivity consistently found among those
with SUDs. Accordingly, increased risk-taking is observed
among both SUD and ADHD populations.
D
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107
This study was conducted aiming to investigate the
association between the prevalence and severity of drug abuse
and co-occuring ADHD symptoms and to examine related risk
behaviors in females seeking treatment for SUD with co
occuring symptoms of ADHD.
The total number of participants was 30 female
participants with diagnosis of SUD (15 with ADHD
symptoms). All of them were located in Cairo. The study was
conducted at Abbasya mental health hospital from inpatients
ward during a period of nearly one year starting on September
2017 till July 2018.
All participants aged from 21 to 40 years old with single
or multiple substance use, patients with more than 15 days of
abstinence were included in the study after their consent.
Patients with any other psychiatric disorder other than SUD
were excluded.
All subjects of the study were assessed by using
Structured Clinical Interview for DSM-IV diagnostic tool to
diagnose SUD and exclude other Axis I diagnosis, also
Addiction severity index to address potential problem areas in
substance-abuse. The Arabic-translated and validated version of
the adult ADHD Self-Report Scale Symptom Checklist was
used for screening for adult ADHD symptoms, the Barratt
Impulsiveness Scale Version 11 and the Arabic version of
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hostility and aggression scale for adults were used to assess risk
behaviors. History taking was obtained according to the semistructured
psychiatric interview with sexual history to assess
sexual risk behaviors.
Results of this study revealed that:
The mean age of the patients sample was 23.6 ± 2.6 years.
As regard the marital status, 15 were single (50%), 11 were
married (36.7%) and 4 were divorced (13.3%). Those with
family history of substance use disorder were 16.7% while
10% had family history of ADHD, mood disorder were
16.7%. And there is no statistically significant difference
regarding family history.
Regarding the type of substance abuse, most of the patients
abused poly substances, 83.3% were abusing cannabinoids,
80% were abusing alcohol, 50% were abusing opiates,
23.3% were abusing pregabline, 30% were abusing tramadol
and 16.7% were abusing synthetic cannabinoids with no
statistically significant difference concerning the substance
of abuse between SUD patients with ADHD symptoms
group and SUD patients without ADHD symptoms group
except for synthetic cannabinoids which SUD patients with
ADHD symptoms group abused and difference was
statistically approaching significance.
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109
Regarding the mean age of onset of substance use was 15.5
± 2.6 years old, the mean age of onset of smoking was 13.5
± 3 years old. There is statistically significance supporting
that SUD patients with ADHD symptoms group start
smoking (nicotine use) and substance use at earlier age than
SUD patients without ADHD symptoms group.
Forty percent have considerable severity on addiction
severity index total score, 33.3% have extreme severity,
20% have mild severity and 6.7% have slight severity and
not problematic enough to affect their life socially or
financially with no statistically significance between SUD
patients with ADHD symptoms group and SUD patients
without ADHD symptoms group.
Forty percent of the study sample had slight health
problems. Regarding employment and support status, 53.3%
had considerable problems affecting their work and financial
situation. As regard drug and alcohol abuse and relapse,
40% had considerable problems related to daily doses of
substance use, hospital admission and trials of abstinence
and relapses. While regarding legal status, forty percent has
mild problems regarding doing illegal activities for profit
(sex trading, selling stolen gods, stealing) and regarding the
family and social relationships, forty percent has
considerable problems with family and friends affecting the
quality of the relationship.
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Comparison between SUD patients with ADHD symptoms
group and SUD patients without ADHD symptoms group
there is statically significance regarding employment and
financial support and employment and social status as
measured by addiction severity index.
Regarding Barrett impulsivity scale, 73.3% were severely
impulsive and 26.7% were moderately impulsive and there
is no statistically significance between the two groups.
Comparison between SUD patients with ADHD symptoms
group and SUD patients without ADHD symptoms group
using aggressive and hostility scale, there is no statistically
significance although it was found that about half of the
sample of patients had moderate physical aggression and
verbal aggression (43.3%, 63.3%). Regarding Anger, most
of the patients had moderate (40%) to severe anger (56.7%).
On the other hand, most of the patient had no (50%) or mild
(46.6%) hostility.
The mean age of first sexual activity was 16.8 ± 2.1 years and
the number of sexual partners from first sexual activity till the
time of the study is 3 ± 2-5 partners. And there is statistically
significant increase towards SUD patients with ADHD
symptoms group who started their sexual activity at earlier age
of 15.7 years and has mean number of 5 sexual partners.
Therefore all adults with ADHD should be
systematically queried for SUD and vice versa. Evaluation and
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treatment of comorbid ADHD and SUD should be part of a
plan in which consideration is given to all aspects of the adult’s
life. Any intervention in this group should follow a careful
evaluation of the patient, including psychiatric, addiction,
sexual, social, cognitive, educational and family evaluations