Adult ADHD Diagnosis, Symptoms of Impulsivity, and Emotional Dysregulation in a Clinical Sample of Outpatients Consulting for a Behavioral Addiction.

OBJECTIVE: This study aimed to investigate ADHD in adult outpatients seeking treatment for a behavioral addiction and to identify the specificity of psychopathological features if the behavioral addiction cooccurs with adult ADHD. METHOD: Sixty-five outpatients consulting for a behavioral addiction were assessed for ADHD (DIVA-5), addictive disorder (alcohol, tobacco, cannabis, gambling, gaming, food, and sex), impulsivity (UPPS-P), and emotion dysregulation (DERS-36). RESULTS: In our sample of outpatients seeking treatment for a behavioral addiction, adult ADHD was independently associated with higher compulsive sexual behavior disorder severity, "sensation seeking," "positive urgency," difficulties in "goal-directed behavior," "impulse control," and use of "emotion regulation strategies" in the context of intense emotions. A 29% of the sample was diagnosed for adult ADHD. CONCLUSION: The association of adult ADHD with specific dimensions of impulsivity and emotion dysregulation, pave the way for future clinical and research perspectives.

Childhood Trauma and Dissociation Correlates in Alcohol Use Disorder: A Cross-Sectional Study in a Sample of 587 French Subjects Hospitalized in a Rehabilitation Center.

This study aimed to determine whether dissociative symptoms and childhood trauma (CT) may help identify a specific subgroup of patients among those hospitalized for alcohol use disorder (AUD). We assessed 587 patients hospitalized for an AUD in a French addiction rehabilitation center (cross-sectional study) regarding dissociative symptoms (DES-taxon), childhood trauma (CTQ), depression (BDI), anxiety (STAI-state and STAI-trait), posttraumatic stress disorder (PTSD; PCL-5), and AUD symptoms (AUDIT). We ran a hierarchical cluster analysis and compared the clusters in terms of dissociation and CT, as well as AUD, depressive, anxiety, and PTSD symptoms. We identified three clusters of patients: (1) patients with low AUD severity and low dissociation (LALD); (2) patients with high AUD severity and low dissociation (HALD); (3) patients with high AUD severity and high dissociation (HAHD). Patients from the HAHD group had significantly higher dissociation and more severe depression, anxiety, and PTSD symptoms than those with LALD and HALD. They also reported more emotional and sexual abuse than those with LALD. Among patients with an AUD, those with high dissociation may constitute an independent subgroup that exhibits a higher prevalence for CT and higher AUD severity, as well as higher depression, anxiety, and PTSD symptoms. Patients with more severe AUD and associated psychiatric symptoms should be systematically screened for dissociation and provided with tailor-based treatments.

Posttraumatic Stress Disorder Is Highly Comorbid With Adult ADHD in Alcohol Use Disorder Inpatients.

Objective: Increasing number of studies show an association between adult ADHD (a-ADHD) and posttraumatic stress disorder (PTSD). We explored this association in alcohol use disorder (AUD) inpatients. Method: In total, 551 inpatients cross-sectionally completed self-administered questionnaires regarding sociodemographics, lifetime trauma exposure, PTSD Checklist for DSM-5, Adult ADHD Self-Report Scale (ASRS), and Wender Utah Rating Scale (WURS). We considered self-reported a-ADHD when ASRS and WURS had significant scores. Results: Prevalence for a-ADHD was 20%. PTSD prevalence was higher in a-ADHD patients (84% vs. 40%; p < .001). They also were younger (p < .001) and women (p = .015). Adult ADHD was associated with more traumatic events, and symptoms were correlated with PTSD severity. After adjusting for age, gender and marital status, PTSD severity was associated with a-ADHD. Conclusion: Our study confirms that a-ADHD is associated with PTSD in AUD inpatients, and thus, may represent a specific subpopulation. Future studies should explore implication of this dual diagnosis on AUD and treatment outcome.

Childhood Trauma Predicts Less Remission from PTSD among Patients with Co-Occurring Alcohol Use Disorder and PTSD.

Post-traumatic stress disorder (PTSD) is highly prevalent among patients hospitalized for an alcohol use disorder (AUD). Hospitalization can improve PTSD and AUD outcomes in some but not all patients, but we lack data on the baseline predictors of PTSD non-remission. This study aimed to determine the baseline risk factors for non-remitted PTSD in patients hospitalized for an AUD. Of 298 AUD inpatients recruited in a rehabilitation center (Le Courbat, France), we included 91 AUD inpatients with a co-occurring PTSD and a longitudinal assessment at baseline (T1) and before discharge (T2: 8 weeks later). Patients were assessed for PTSD diagnosis/severity (PCL-5=PTSD Checklist for DSM-5), different types of trauma including childhood trauma (LEC-5=Life Events Checklist for DSM-5/CTQ-SF=Childhood Trauma Questionnaire, Short-Form), and AUD diagnosis/severity (clinical interview/AUDIT=Alcohol Use Disorders Identification Test). Rate of PTSD remission between T1 and T2 was 74.1%. Non-remitted PTSD at T2 was associated with a history of childhood trauma (physical, emotional or sexual abuse, physical negligence), but not with other types of trauma experienced, nor baseline PTSD or AUD severity. Among patients hospitalized for an AUD with co-occurring PTSD, PTSD remission was more strongly related to the existence of childhood trauma than to AUD or PTSD severity at admission. These patients should be systematically screened for childhood trauma in order to tailor evidence-based interventions.

Posttraumatic Stress Disorder Is a Risk Factor for Multiple Addictions in Police Officers Hospitalized for Alcohol.

BACKGROUND: In police officers, posttraumatic stress disorder (PTSD) is associated with alcohol use disorder (AUD), but we lack data on the association between PTSD and other substance-related and addictive disorders. OBJECTIVES: We assessed whether PTSD could be a risk factor for different substance-related and addictive disorders in police officers, including alcohol, tobacco, cannabis, and gambling. METHOD: This cross-sectional study included all police officers admitted consecutively for alcohol to an inpatient ward dedicated to police officers (Le Courbat rehabilitation center, France; n= 133). Each patient completed self-administered questionnaires that assessed lifetime exposure to potentially traumatic events (Life Event Checklist for DSM-5), PTSD severity and diagnosis (PTSD Checklist for DSM-5), AUD severity (Alcohol Use Disorder Identification Test [AUDIT]), tobacco dependence (Fagerström test for Nicotine Dependence), cannabis dependence (Cannabis Abuse Screening test), and gambling disorder (Canadian Problem Gambling Index). RESULTS: Mean AUDIT score was 23.7 ± 8.0; 66.2% had an AUDIT score ≥20. Our sample comprised a high prevalence for PTSD (38.3%) and for substance-related and addictive disorders: tobacco dependence (68.4%), cannabis dependence (3.8%), and pathological gambling (3%). Patients with PTSD experienced higher lifetime exposure to traumatic experiences: physical assault, severe human suffering, sudden accidental death of another person, and other types of stressful events/experiences. In multiple linear regressions adjusted for age, sex, and marital status, PTSD was a significant predictor of the severity of AUD and tobacco use disorder, but not of the severity of cannabis use disorder nor gambling disorder. CONCLUSIONS: PTSD is common in police officers hospitalized for alcohol and associated with a higher severity of some addictive disorders (alcohol/tobacco). PTSD and its comorbid addictive disorders should be systematically screened and treated in this population.

[A comparison of self-esteem in alcohol-dependent women and women who have become abstinent, against a control group]. / Comparaison de l'estime de soi de femmes alcoolo-dépendantes et de femmes devenues abstinentes, par rapport à un groupe témoin.

INTRODUCTION: Women's addiction to alcohol remains a taboo subject, whereas one third of alcohol-dependent people are female. Social representations concerning them are very unfavorable. Their alcoholism is usually accompanied by strong feelings of guilt, depreciation and lowered self-esteem. There is little existing work about self-esteem in women who have become abstinent. This study's goal is to compare the self-esteem of women who are alcohol-dependent and the self-esteem of women who have become abstinent in various domains (social, familial, professional). METHODS: The sample contained 71 women divided into three groups: 31 alcohol-dependent women (average age of 44.9); 20 alcohol-dependent women who had become abstinent for at least two months (average age of 44.7) and 20 women who formed the control group (average age of 44.4). The material was put together from the Self-Esteem Inventory (SEI, adult version of Coopersmith 1981). It includes 58 items divided into four sub-categories (general self-esteem, social, familial and professional) and a scale for falsehoods. The SEI was self-administered. The statistics were produced entirely with non-parametric tests: Mann-Whitley U Test for the comparison of two independent samples and Kruskal-Wallis Anova for the comparison of three independent samples. RESULTS: A significant difference was found for general self-esteem (P=0.001), familial (P=0.01) and professional (P=0.03) between the three groups of women (alcohol-dependent, alcohol-dependent who had become abstinent and women from the control group). There was no statistical difference for social self-esteem or the lying scale. There was a difference between alcohol-dependent women and the control group in general self-esteem (P=0.0001), familial self-esteem (P=0.01) and professional self-esteem (P=0.002), as well as between women who had become abstinent and women from the control group in general self-esteem (P=0.02), familial self-esteem (P=0.005) and professional self-esteem (P=0.07; ns). No difference was found between alcohol-dependent women and women who had become abstinent. CONCLUSION: This study has shown evidence that general, familial and professional self-esteem drops in alcohol-dependent women and in women who had become abstinent compared to a general population. There was no proof of any difference of self-esteem in women who had become abstinent and alcohol-dependent women, although abstinent women seemed to have better general and professional self-esteem while their familial self-esteem seemed to be lower. This study begs the question about self-esteem in women who have become abstinent suggests that self-esteem should be integrated into their treatment.