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Official websites use. Share sensitive information only on official, secure websites. Reviewed by: Mario R. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Undiagnosed individuals often turn to psychoactive substance to minimize the negative aspects of functioning and improve quality of life. The study was conducted online using random sampling through a Facebook group administered by physicians and targeted to patients diagnosed with ADHD. The study was naturalistic and exploratory, therefore no hypothesis was made. Analysis of the results showed that people with ADHD turn to psychoactive substances relatively frequently. In the study population, methylphenidate is the most commonly used drug among patients. After treatment with psychostimulants, the majority of respondents note a decrease in symptoms of hyperactivity disorder, especially in male patients. It is necessary to perform proper diagnostics and actively look for ADHD symptoms in patients who tend to use psychoactive substances. Keywords: ADHD, psychoactive substance, psychoactive substance abuse, addiction, addiction psychiatry. However, it is now known that in a significant proportion of individuals with ADHD, symptoms persist into adulthood 1 , 2. The prevalence of the disorder varies between 2. According to ICD, ADHD is diagnosed when there is a persistent pattern of symptoms that include inattention, hyperactivity, and impulsivity. The symptoms should last for at least six months and have a significant negative impact on academic, occupational, or social functioning. The symptoms should also be present in multiple situations or settings, such as at home, school, work, or with friends and relatives. However, the specific symptoms may vary depending on the structure and demands of the setting. Studies have shown that, in contrast to children, adults suffering from ADHD have fewer symptoms from the hyperactivity and impulsivity spectrum, while symptoms from the inattention group seem to predominate 5. In adults, additional symptoms include emotional lability, irritability, increased talkativeness, and rest problems, and difficulties in completing complex tasks, time management, and easy distractibility occur in the context of attention deficit 6. There are the following subtypes of ADHD: predominantly inattentive or predominantly hyperactive—impulsive and mixed. Each subtype may be associated with a predisposition to certain behaviors-the inattentive subtype may be associated with low self-esteem and negative performance in the workplace, while the hyperactive—impulsive subtype may result in a greater tendency toward aggression, risky driving behaviors, and more frequent peer rejection 7. Substance abuse problems affect 1 in 5 adults diagnosed with ADHD; moreover, these patients are significantly less likely to maintain abstinence from psychoactive substances, and they have lower remission rates while participating in drug rehab programs and require a longer duration to achieve a satisfactory outcome 9. Problems with alcohol abuse are more common in adults than in adolescents Psychostimulants, especially amphetamine derivatives or methylphenidate, are most commonly used to treat attention deficit hyperactivity disorder, whereas atomoxetine is used when there are existing contraindications to the use of psychostimulants or when it is poorly tolerated. For stimulant abuse, methylphenidate in the form of OROS is the preferred choice, while atomoxetine is preferred for alcohol abusers. Of note, bupropion has shown benefits in trials for the treatment of ADHD in combination with addiction and depressive disorders When a comparision was made between several medications — lisdexamfetamine, mixed amphetamine salts, modafinil, and methylphenidate — the first one, lisdexamfetamine, had the most promising efficacy, acceptability, and tolerability in patients with ADHD Unfortunately, it is not available for a regular prescriber in Poland. It seems noteworthy that, although further research is needed on this topic, the available research suggests that pharmacological treatment of ADHD related mental disorders, especially when it begins earlier and lasts longer, seems to be associated with a reduction in the development of dependence on psychoactive substances It is critical to expand awareness and attention to symptoms that may be associated with ADHD in adults because the consequences of untreated attention deficit hyperactivity disorder, although affecting individual patient functioning, are often marginalized by researchers because they assume that the disorder is due to the nature of the patient. Undiagnosed individuals often turn to stimulants to minimize the negative aspects of functioning and make life more enjoyable It is also important because ADHD is linked to higher mortality rates, especially when diagnosed in adulthood. Comorbid conditions like oppositional defiant disorder, conduct disorder, and substance use disorder further increase the mortality risk. Even after accounting for these comorbidities, ADHD remains associated with excess mortality, particularly in females, with accidents being the leading cause of death in individuals with ADHD The association documented to date between nonmedical use of psychoactive substances and ADHD justifies the need to expand knowledge in this area. The aim of our study was to collect baseline demographic-epidemiological data on psychoactive substance use in patients diagnosed with ADHD and to determine whether adults struggling with ADHD have a greater predisposition to psychoactive substance use and whether and how treatment affects stimulant use. The study was designed by psychiatrists and conducted in accordance with the Declaration of Helsinki and good clinical practice guidelines. Because the study was naturalistic, we did not conduct any pilot study. According to the Ethical Committee of Medical University of Silesia anonymous, internet surveys that do not allow to deanonymize respondents do not require approval. A separate questionnaire was created to survey the population, which included basic sociodemographic questions and several other questions related to diagnoses or treatments for attention deficit hyperactivity disorder, among other factors such as psychoactive substance of choice. The list of psychoactive substance was based on PolDrugs, the biggest Polish naturalistic epidemiological psychoactive users survey for psychoactive users AUDIT is a widely used screening tool designed to assess alcohol consumption patterns, alcohol-related problems, and alcohol dependence. DUDIT is also a screening tool but specifically designed to assess drug use patterns, drug-related problems, and drug dependence. The survey was conducted online, using convenience sampling through an online Facebook group that was created for people who were interested in ADHD, managed by physicians. The platform used to created the survey was Google Forms, an easy-to-use tool for creating anonymous online surveys. Because the survey was an internet one, the consent was also web based and the respondents could not move to the survey without accepting the terms. Data were collected between October 13, and October 24, Only after agreeing to participate was it possible to take part in the survey. A total of completed questionnaires were collected from people who declared having ADHD diagnosed by a physician. The survey was constructed in a way that did not allow user to submit incomplete data however we cannot estimate how many people resigned from filling the survey while completing the survey. The study was an exploratory and naturalistic study, i. The chi-square test was used for the comparison of qualitative variables. For quantitative variables, the Mann—Whitney U test was used for the comparison of two independent groups, whereas the Kruskal-Wallis test was used for the comparison of multiple independent groups. Four hundred thirty-eight correctly completed questionnaires were received. The characteristics of the study population are shown in Table 1. Due to the small group of respondents identifying as non-binary gender 4. M and other vs. K; NS M vs. The characteristics of pharmacotherapy used by the respondents are shown in Table 2. We did not collect information about methylphenidate formula. No statistically significant differences were found between genders and medications taken. A summary of psychoactive substance use is described in Table 3. Otherwise, there were no gender differences. In the univariate analysis for AUDIT, the variables age and rehabilitation history were found to be statistically significant. The results are presented in Table 6. In the multivariate model, 2 variables were found to be statistically significant-the type of ADHD and history of rehospitalization. The results are presented in Table 7. Attention deficit hyperactivity disorder ADHD is a disorder that affects many areas of human life. Among other things, people with ADHD show a greater tendency to engage in risky behaviors, such as gambling, they tend to leave their jobs abruptly and spend their money recklessly, and they have a higher risk of physical injury or suicide in accidents 1. Meta-analyzes have also shown that people with ADHD are significantly more likely to use psychoactive substance also including alcohol and nicotine In a study we conducted, methylphenidate was found to be the most commonly used medication among people with ADHD in both males and females. This drug is also the most thoroughly studied and has a proven efficacy benefit: symptoms improve shortly after ingestion, and the effect lasts until metabolism in the body is complete It also seems important to note that immediate-release methylphenidate is the only medication with proven efficacy in ADHD patients who use psychoactive substances A significant proportion of respondents to our survey indicated that substance abuse had decreased since treatment began, particularly in the male group, which appears to be important information in the context of conducting appropriate diagnostic testing and treatment engagement. The results of previous studies on the impact of appropriate treatment on reducing psychoactive substance use remain mixed. In part, it has been suggested that treatment use is neither protective nor beneficial for the development of psychoactive substance use disorders later in life On the other hand, the literature also shows that the use of stimulants to treat ADHD in childhood significantly reduces the risk of developing dependence later in life An interesting observation seems to be the fact that in a study investigating the effect of treatment on nicotine addiction, it was shown that patients were significantly less likely to use tobacco products after pharmacotherapy with stimulants Studies showing improvement in both clinical symptoms and reduction in substance use during treatment with stimulants required the use of high doses of medication, which necessitates further research on the topic For example, atomoxetine is generally considered a safe and well-tolerated drug, but it is important for physicians to be mindful of the potential cardiovascular adverse effects associated with its use to prevent cardiovascular complications, including the possibility of myocardial dysfunction These tend to get worse with high doses. The validated DUDIT scale shows that a significant percentage of respondents are highly likely to have a substance abuse problem, and a small percentage are highly likely to exhibit characteristics of substance dependence. It is worth noting that despite the fact that divergent results can be found in the literature, a significant number of meta-analyses indicate that childhood pharmacotherapy with simulants is associated with a reduction in the risk of later use of alcohol and psychoactive substances Appropriate treatment of people with ADHD is important because it also helps to reduce the risk of injury in accidents, including by reducing the risk of turning to psychoactive substances, which also means a lower rate of injury Men were significantly more likely than women to admit to using MDMA and opioids, whereas the differences for the other psychoactive substance were not significant. A study found that women are statistically more likely to become addicted to marijuana, as well as alcohol It is important to note the prevalence of the extent of marijuana use in ADHD patients, as there are reports suggesting that cannabis abuse is genetically positively correlated with the occurrence of ADHD, schizophrenia, and major depressive episodes One of the better studied substances among ADHD users is cocaine. There are reports that patients with ADHD turn to marijuana on their own and use it to self-medicate, although there is no clinical evidence of its efficacy. This is a troubling phenomenon that needs to be investigated and monitored, as respondents in our study also reported THC as the substance they resorted to most often In the context of individuals with co-occurring bipolar disorder and ADHD and substance abuse tendencies, it has been observed that the inclusion of non-stimulants in treatment may be more beneficial than taking stimulants, but their full therapeutic effects last longer On the AUDIT scale, we observed a tendency toward risky alcohol consumption among the respondents, but also some of the respondents met the criteria for alcohol dependence. Previous studies have concluded that a higher AUDIT score is significantly correlated not only with previously diagnosed ADHD, but also with comorbid schizophrenia and major depressive disorder In addition, individuals who had attention deficit hyperactivity disorder and concurrent bipolar affective disorder showed an increased tendency to abuse alcohol compared to the healthy population This is an important observation, as our study demonstrated that individuals previously diagnosed with ADHD score higher on the DUDIT scale and have a higher propensity to take psychoactive substance. There is also a correlation between the AUDIT and DUDIT scales, which is also reflected in previous observations demonstrating that individuals with attention deficit hyperactivity disorder not only have an increased tendency to use psychoactive substances, but also develop symptoms of alcohol dependence syndrome 3. It is crucial to highlight the fact that only Additionally, discussing substance use opens the door for early detection and intervention for substance use disorders, promoting holistic care and improved patient outcomes. It is of utmost importance to properly diagnose and recognize characteristics that may indicate addiction development in patients, as people burdened by mental illness who use psychoactive substance have the highest mortality rate among other diagnoses 39 , In the study population, methylphenidate is the drug most commonly used by patients. After treatment with psychoactive substance, there is a decrease in attention deficit hyperactivity disorder symptoms in most respondents, especially in male patients. It is important to perform proper diagnostics in patients prone to psychoactive substance use and to proactively screen for symptoms of ADHD, as properly applied treatment can help reduce troublesome symptoms. The survey was distributed online without identifying respondents, so it is not possible to assess long-term substance use in the context of reducing psychoactive substance use. Because of the way the survey was distributed, it was not possible to calculate response rates. There was no way to verify the truthfulness of the answers given. The survey was exploratory in nature, and the topic needs to be further researched, as it seems important to make an accurate diagnosis and choose reasonable treatment at a time when ADHD is becoming more widely known, in order to minimize the potential health, social, and economic consequences of an untreated disorder. Because the study was naturalistic, there was no hypothesis and study conducted without a hypothesis lacks a clear research direction, which can lead to unfocused data collection and analysis. Some of the limitations lay also in the statistical methods used, as univariate linear regression analysis is limited in capturing the complexities of real-world relationships involving multiple predictors and assumes a linear relationship between a single predictor and the dependent variable. Multivariate linear regression analysis assumes no multicollinearity between predictors, and if present, it can lead to unstable coefficient estimates and difficulties in interpreting the relationships accurately. Both univariate and multivariate linear regression analyses may not account for non-linear relationships, outliers, or other underlying factors that can affect the accuracy and reliability of the regression model. The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation. Ethical review and approval was not required for the study on human participants in accordance with the local legislation and institutional requirements. Online written informed consent for participation was obtained from the participants. GW: conceptualization, methodology, visualization, investigation, data curation, and writing—reviewing and editing. IS and MS: software, investigation, data curation, and writing—original draft preparation. WW: supervision, data curation, and investigation. PG: supervision and funding acquisition. TG: visualization, data curation, investigation, and writing—reviewing and editing. All authors contributed to the article and approved the submitted version. IS received support for attending meetings from: Lek-AM. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. This section collects any data citations, data availability statements, or supplementary materials included in this article. As a library, NLM provides access to scientific literature. Front Psychiatry. Find articles by Piotr Gorczyca. Find articles by Tomasz M Gondek. Received Mar 10; Accepted Jun 27; Collection date No Open in a new tab. Yes, I am taking them less Yes Many Not Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel. ADHD with predominance of hyperactivity and impulsivity. How many medications are currently being used. Have you noticed any improvement in ADHD symptoms after the current treatment regimen? AFTER you started treatment, did your psychiatrist talk to you about the psychoactive substance you were using? Have you noticed a change in psychoactive substance use since starting treatment? No, I do not use psychoactive substance or their frequency of use has not changed. Do you use psychoactive substances other than alcohol below? How many psychoactive substances do you use? ADHD with predominantly attention deficit disorder. Change of psychoactive substance use after treatment.