1. Background
The pattern of substance abuse has changed considerably in recent years and has changed from opiate to opioid with newer forms and artificial substances such as methamphetamine (1-4). Nowadays, among addiction types, addiction to methamphetamine is highlighted and one of the basic problems has changed (5-7).
Methamphetamine is a phenyl ethylamine compound and is a psychoactive substance that acts on the various regions of the brain leading to dopamine disorder and has severe effects on the sympathetic system. The direct harm that can be caused by use of methamphetamine in the person and the accompanying psychiatric symptoms can lead to significant disability in people (8-10).
Researchers have suggested that some drug abusers tend to use drugs or alcohol to mitigate their unpleasant emotional states (11). According to research reports, the relationship between the psychological state and drug abuse has been confirmed in most studies (12). The results of the current study show that both attention deficit hyperactivity disorder (ADHD) and drug abuse are the most common disorders in the general population and most often both appear simultaneously in one person. In addition, there is a close relationship between attention deficit hyperactivity disorder (ADHD) and drug use disorders (13). Attention deficit hyperactivity disorder (ADHD) is a kind of behavior that appears in ones childhood and progressively evolves with an inappropriate amount of lack of attention, impulsiveness, and aggressiveness (14). The prevalence of this disorder in children is 3% to 10%, of which 1/3 to 2/3 of them have a problem in adulthood and is estimated to be prevalent in the adult population from 1% to 6%. Contrary to the past, today it is believed that symptoms of this disorder continue to occur after puberty (15). This disorder causes many problems for affected people and affects the social, educational, and emotional development of affected people (16). On the other hand, this disorder increases the risk of substance abuse, delinquency, imprisonment, job failure, divorce, and marital problems (17). Prevalence of attention deficit hyperactivity disorder (ADHD) is estimated as 0.2% - 20% in primary school students (18); the prevalence of substance abuse disorders in teenagers who have had ADHD was significantly higher than teenagers that have not had ADHD (41% vs. 0.16); furthermore, the ratio of adults with drug abuse disorders who had ADHD in their childhood to a healthy adult is 0.52 vs. 0.27 (19). Hence, attention deficit hyperactivity disorder (ADHD) is not considered a childhood disorder and people with this disorder have encountered some consequences such as academic failure, occupational problems, and more risk behaviors such as drug use at a cognitive, behavioral, and emotional level (20).
Studies have been conducted on the co-occurrence of psychiatric disorders with materials such as cocaine. However, no similar study has been done to comprehensively assess the prevalence of attention deficit hyperactivity disorder (ADHD) and its clinical and demographic characteristics in methamphetamine dependence. Of course, limited studies have been generally conducted on the prevalence of comorbidities in psychiatric disorders such as mood disorders, psychotic disorders, and anxiety disorders. The assessment of this issue is important in such a way that comorbidities in psychiatric disorders will lead to undesirable effects on prognosis, response to treatment, and discontinuation of methamphetamine, and will reduce the individual’s adherence to treatment. The studies show that those patients who have mental health have better prognosis in the treatment process than those who have psychiatric problems. Therefore, the accurate diagnosis and description of abnormalities is the first step in the successful treatment of the drug abuser Therefore, the present study was conducted to determine the prevalence of attention deficit hyperactivity disorder (ADHD) in methamphetamine dependence.
2. Objectives
Given the significant prevalence of childhood ADHD in methamphetamine dependents and the continuation of this disorder until adulthood, also the likelihood of its impact on treatment outcomes, the diagnosis of this disorder is important in these patients.
3. Patients and Methods
This analytical cross - sectional study took nearly one year (2015-2016). The population of this study included all methamphetamine dependence individuals that referred to the Farabi Hospital in the city of Kermanshah, of them, 960 people were selected accessibly. The criteria to enter the study are: (a) aged between 15 and 75, and (b) taking methamphetamine in the form of drug dependency or drug abuse. The criterion for determining the dependence of methamphetamine was hospitalization and treatment due to methamphetamine use. The inclusion criteria for this study included (a) psychotic disorders (diagnosis of psychotic symptoms was done by a psychiatrist and based on clinical interview), (b) mental retardation, (c) signs and symptoms of toxicity and delirium due to methamphetamine, (d) co-dependency on several substances, and (e) those who have not been taking substance for more than one month.
3.1. Tools
3.1.1. Wender - Utah Test
In 1993, in the U.S., at Utah University, Wender et al., provided a questionnaire by which an adult can assess their condition in terms of attention deficit hyperactivity disorder (ADHD) during childhood. This questionnaire included 61 items in a Likert scale (rarely to very high). The studies that are conducted in various countries showed that the Wender - Utah test had a good validity and reliability and was suitable tool for examining attention deficit hyperactivity disorder in childhood. This test has been translated to different languages up to now (21). In Iran, this test is translated by Sarami Foroushani and its validity and reliability is examined by him (2000). The coefficient of test validity in Sarami Foroushani is reported 0.96 in the research. Then, in the stage of determining structural validity, the average score of the test was estimated as 25.62 in patients and average score of the test was estimated 8 in healthy subjects. There is significant difference between average scores of two groups in the test. In other words, this test has a suitable criterion validity (22).
3.1.2. Demographic Information Questionnaire
A demographic questionnaire was used to measure individual, social, and economic indicators.
3.2. Ethical Considerations
This study has been approved by the Ethics Committee of Kermanshah University of Medical Sciences, Kermanshah, Iran (Ethical code is 143).
The complete and clear information on the purpose of the research was given to all participants and they were assured that the questionnaires would be anonymous. Furthermore, we told them, “if they do not want to continue the project, they can leave the project at each stage”.
3.3. Statistical Analysis
The data were analyzed by SPSS software (version 18) using the statistical data of 2%. In order to summarize the data, two - dimensional tables are used to show the number and the percent.
4. Results
In this study, 960 methamphetamine dependence were studied in order to evaluate the frequency of attention deficit hyperactivity disorder (ADHD). The demographic and clinical features of the methamphetamine dependence are shown in Table 1.
Table 1.Demographic and Clinical Features of Methamphetamine Dependence
| Variable | Frequency | Percent |
|---|---|---|
| Sex | ||
| Male | 751 | 78.2 |
| Female | 194 | 20.00 |
| Marital Status | ||
| Single | 389 | 40.5 |
| Married | 416 | 43.5 |
| Divorced | 107 | 11.1 |
| Widowed | 32 | 3.3 |
| Unknown | 16 | 1.7 |
| Education | ||
| Primary | 211 | 21.10 |
| Under diploma | 367 | 38.2 |
| Diploma and higher | 349 | 36.4 |
| Unknown | 33 | 3.4 |
| Occupation | ||
| Jobless | 407 | 42.4 |
| Employed | 437 | 49.27 |
| Age group | ||
| 12 - 20 | 95 | 9.9 |
| 21 - 30 | 340 | 35.4 |
| 31 - 40 | 289 | 30.1 |
| 41 - 50 | 156 | 16.3 |
| 51 - 60 | 36 | 3.8 |
| 61 - 70 | 9 | 0.9 |
| Unknown | 35 | 3.6 |
| Disease pattern | ||
| Hyperactivity | 155 | 61.1 |
| Attention deficit | 402 | 41.9 |
| Hyper activity + Attention deficit | 141 | 14.7 |
| Unknown | 262 | 27.3 |
| Childhood ADHD | ||
| Yes | 287 | 29.9 |
| No | 673 | 70.1 |
Table 2.Relationship Between Demographic Characteristics and Clinical Records of Methamphetamine Dependence with Childhood Attention Deficit Hyperactivity Disorder (ADHD)
| Variable | ADHD, No. (%) | Total | K - Square Statistic | Significance Level | |
|---|---|---|---|---|---|
| Yes ≥ 46 | No < 46 | ||||
| Sex | 55.71 | < 0.0001 | |||
| Male | 266 (35.4) | 485 (64.6) | 751 (100) | ||
| Female | 15 (7.8) | 177 (92.2) | 192 (100) | ||
| Marital status | 56.27 | < 0.0001 | |||
| Single | 110 (28.3) | 279 (71.7) | 389 (100) | ||
| Married | 162 (38.9) | 254 (61.1) | 416 (100) | ||
| Divorced | 8 (7.5) | 99 (92.5) | 107 (100) | ||
| Widowed | 0 (0.0) | 32 (100) | 32 (100) | ||
| Education | 26.41 | < 0.0001 | |||
| Primary | 92 (43.6) | 119 (56.4) | 211 (100) | ||
| Under diploma | 91 (24.8) | 276 (75.2) | 367 (100) | ||
| Diploma and higher | 90 (25.8) | 259 (74.2) | 349 (100) | ||
| Occupation | 0.012 | 0.485 | |||
| Jobless | 121 (29.7) | 286 (70.3) | 407 (100) | ||
| Employed | 139 (29.4) | 334 (70.6) | 473 (100) | ||
| Age group | 54.79 | < 0.0001 | |||
| 15 - 20 | 7 (7.4) | 88 (92.6) | 95 (100) | ||
| 21 - 30 | 83 (24.4) | 257 (75.6) | 340 (100) | ||
| 31 - 40 | 97 (33.6) | 192 (66.4) | 289 (100) | ||
| 41 - 50 | 65 (41.7) | 91 (58.3) | 156 (100) | ||
| 51 - 60 | 19 (52.8) | 17 (47.2) | 36 (100) | ||
| 61 - 70 | 6 (66.7) | 3 (33.3) | 9 (100) | ||
| Age of first Meth use | 0.453 | 4.71 | |||
| 15 - 20 | 105 (30.4) | 240 (69.6) | 345 (100) | ||
| 21 - 25 | 47 (23.4) | 154 (76.6) | 201 (100) | ||
| 26 - 30 | 45 (27.4) | 119 (72.6) | 164 (100) | ||
| 31 - 35 | 12 (21.1) | 45 (78.9) | 57 (100) | ||
| 36 - 40 | 17 (24.3) | 53 (75.7) | 70 (100) | ||
| > 40 | 9 (26.5) | 25 (73.5) | 34 (100) | ||
There was a significant relationship between gender and prevalence of hyperactivity in childhood (P < 0.001), thus, the childhood hyperactivity in males was much higher than females. There was a significant relationship between marital status and hyperactivity in childhood (P < 0.001). The relationship between the levels of education and the prevalence of hyperactivity in childhood was significant, in the other word, those with a childhood hyperactivity were less successful in their educations. The results of the association showed that people who had a positive history of childhood hyperactivity took methamphetamine up to older ages. However, there was no significant statistical relationship between the prevalence of childhood hyperactivity and the onset of methamphetamine use (P = 0.453).
In addition, there was no significant relationship between the prevalence of childhood hyperactivity and occupational status (P = 0.484).
5. Discussion
In the current study, the comorbidity of attention deficit hyperactivity disorder (ADHD) with meth was studied. The prevalence of attention deficit hyperactivity disorder (ADHD) in adults and children in the drug-abuse population is estimated to be three times of the general population (23). Adults with a history of attention deficit hyperactivity disorder (ADHD) are exposed to more risk of substance use disorder than adults with no attention deficit hyperactivity disorder (24). Comorbidity of attention deficit hyperactivity disorder and drug abuse are associated with early onset, more severe period of drug - use disorder, weaker admission of treatment, very hard achievement to treatment goals, poor progression in treatment, and high rates of recurrence (25).
In the current study, the average age of meth abusers with ADHD is about 32.79 and average age of first meth abuse is 25.01. These findings are in line with studies conducted by Faraone et al., (26). Other research findings of the current study are that 35.4% of meth abusers who have ADHD are male and 78% are female. This finding is in line with study conducted by Biederman et al., (27-29).
Furthermore, there is significant difference between single subjects and married subjects in terms of ADHD. Approximately 38.9% of meth abusers who have ADHA are married and 61.1% of meth abusers are single, divorced, and widowed. This finding is not in line with the study of Sadeghi - Movahed (30). In regards to education, 38.2% of meth abusers with ADHS have an education lower than diploma and we cannot find a similar study in this respect. In the current study, we found out that 31% of meth abusers with ADHD are under 30 years old and this is in line with studies conducted by Wilens et al., (27).
Other findings of this research are that comorbidity between meth use and childhood ADHD disorder is 29.9%, this finding is in line with the study conducted by Biederman et al., (27, 28). Furthermore, this is in line with the research finding of Faraone et al., (26). The current study shows a relatively high prevalence of ADHD in the study population indicating a higher ratio than the study of Arabgol et al., (31). Wilens et al., shows that comorbidity between the drug use disorder and ADHD is strong (32).
With regard to the high prevalence of meth use and its increasing trend in the society, and according to the results of study in which the prevalence of childhood ADHA reaches high, we can say that ADHD can be seriously addressed as accompanying disorder with the meth abuse. If the ADHD is diagnosed in children very soon, it is possible to prevent them from meth abuse.
Regarding the high prevalence of psychiatric disorders in people taking meth in society, its financial costs, and its psychological consequences for the patients, their families, and the community, it is natural that the study of disorders in meth abusers is of great importance.
Some of the most important limitations of this research are (a) its cross - sectional nature, (b) the use of non - random and available samples, and (c) the possibility of unrealistic responses due to the use of self - report questionnaires.
The research findings of the current study can be used for treatment and prevention interventions. The results of the study have useful applications for therapists who work in the area of meth abuse treatment.
