Aufmerksamkeitsdefizit-Hyperaktivitätssyndrom (ADHS) bei erwachsenen Alkoholabhängigen

Zusammenfassung

Die Prävalenz des Aufmerksamkeitsdefizit-Hyperaktivitätssyndroms (ADHS) im Erwachsenenalter wird auf ca. 2% der Bevölkerung geschätzt. Eine hohe Komorbidität mit Substanzabhängigkeiten wird im angloamerikanischen Sprachraum postuliert. Um zu ermitteln, ob alkoholabhängige Erwachsene mit komorbidem ADHS klinische Besonderheiten aufweisen, wurden 314 konsekutiv behandelte alkoholabhängige Patienten mittels standardisierter und evaluierter Erhebungsinstrumente untersucht. 21,3% der Alkoholabhängigen zeigten ein ADHS im Erwachsenenalter. Die ADHS-positive Gruppe wies im Vergleich zur ADHS-negativen Gruppe einen um ca. 6 Jahre früheren Beginn der Alkoholabhängigkeit auf. Auch die tägliche Trinkmenge war um ca. 30% höher und soziale sowie justiziale Belastungen traten mal häufiger auf. Die Suizidalität war mehr als doppelt so hoch. 51% in der ADHS-positiven Gruppe wiesen Kriterien der antisozialen Persönlichkeitsstörung auf.

Daraus lässt sich ableiten, dass erwachsene Alkoholabhängige mit persistierenden Symptomen eines ADHS eine besondere Subgruppe mit frühem Beginn und besonders schwerem Verlauf der Abhängigkeitserkrankung definieren. Der Nutzen ADHS-spezifischer Therapieangebote für den Verlauf der Alkoholabhängigkeit sollte dringend in kontrollierten Studien überprüft werden.

Summary

The estimated prevalence for attention-deficit hyperactivity disorder (ADHD) in adulthood is 2%. ADHD is discussed as a risk factor for the development of a more severe substance abuse disorder in later life. We investigated 314 adult alcoholics for the presence of an ADHD and asked if adult alcoholics with comorbid ADHD have clinical particularities. 21,3% of the alcoholics fulfilled DSM-IV-criteria of ADHD with ongoing symptoms in adulthood. The subgroup of alcoholics with comorbid ADHD was significantly younger at age of onset of alcoholism (24 years versus 30 years) and had a significantly higher daily alcohol intake (253 g EtOH versus 196 g EtOH). They also had significantly more social stress and lifetime experiences in court proceedings against them (11% versus 2%). The suicidal ideation was higher (25% versus 11%). In the subgroup of alcoholics with ADHD 51% fulfilled criteria of antisocial personality disorder. The early onset of alcoholism was most pronounced in this subgroup (21 years). In our sample, persistence of ADHD symptoms from childhood into adulthood contributes to an increased vulnerability and morbidity of alcohol dependence with early onset and greater severity of the disorder.

Schlüsselwörter

Alkohol - Abhängigkeit - Aufmerksamkeitsdefizit - Hyperaktivität

Keywords

Alcohol dependence - attention-deficit hyperactivity disorder - comorbidity

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