Positive and negative aspects of substance use and treatment goals among substance use disorder patients with and without attention deficit hyperactivity disorder: A qualitative study

Figures & data

Table 1. Examples of the coding process. Interviews on the Positive and Negative Aspects of Substance Use and Treatment Goals

Research question	Substance	Meaning unit	Code	Sub-category	Category
Positive aspects of SU
	Alcohol	I sleep very well	It gives good sleep quality	Physical health	Self-regulation
	Amphetamine	It keeps me from doing harmful/impulsive things	It helps stopping unwanted behavior	Behavior	Self-regulation
	Benzodiazepines	I feel pleasure when used in combination with heroin	It gives pleasure	-	The rewarding effects
Negative aspects of SU
	Alcohol	I might experience depression. It may be strengthened by alcohol	It gives/strengthens negative mood	Feelings	Consequences
	Cannabis	It results in a deteriorated memory and concentration	It worsens memory and concentration	Reasoning/ thoughts	Consequences
SU-related treatment goals
	Amphetamine	I want to quit amphetamine use completely	Total abstinence		Total abstinence
	Amphetamine	Stop using if I get assessment and medication for ADHD	Abstaining from SU if receiving assessment and medication for ADHD		Conditional Abstinence
	Alcohol	Drink for example once a month without getting drunk	Reduce in frequency and amount of SU		Substance reduction
	Cannabis	Avoid using cannabis	No clear SU-related goal		Unspecified

Note. SU: Substance use

Table 2. Sociodemographic and clinical characteristics

	SUD+ADHD	%	SUD-ADHD	%	Statistic	p
	N = 12		N = 10
Age M (SD)	39 (8.5)		33.5 (10.0)		U = 1.42	.156
Mdn (range)	40.5 (21)		35.0 (28)
Age of Substance use initiation M (SD)	13.3 (3.0)		13.4 (1.3)		U = 0.07	.939
Mdn (range)	14.0 (11)		13.0 (4)
AUDIT M (SD)	15.5 (12.7)		21.6 (15.0)		U = 1.18	.234
Mdn (range)	11.5 (33)		22.5 (40)
DUDIT M (SD)	20.3 (16.8)		28.1 (16.8)		U = 1.16	.246
Mdn (range)	23.5 (41)		36 (43)
Males		83		60	ᵪ^2 = 1.50	.348
Not living with partner		75		80	ᵪ^2 = 2.31	.315
Previous SUD treatment:		75		80	ᵪ^2 = 3.58	.310
–Inpatient		75		60
–Outpatient		–		20
–None		–		20
Previous treatment for mental health problems ͣ		70		83	ᵪ^2 = 0.55	.624
Other mental disorders—current:		25		30
–Schizophrenia		8		–
–Affective disorders		8		–
–Anxiety disorders		8		10
–Eating disorders		–		10
–Personality disorders		–		10
Previous SUD treatment
SUD diagnoses:
–Alcohol		50		50
–Opioids		17		20
–Cannabis		17		50
–Benzodiazepines		17		20
–Amphetamines		50		70
Number of self-reported substances of abuse:					ᵪ^2 = 1.21	.271
–One substance		41.7		20
–Two or more substances		58.3		80
Frequency of self-reported substances of abuse:					ᵪ^2 = 1.15	.886
–Alcohol		66.6		60
–Amphetamines		50.0		70
–Cannabis		33.3		50
–Benzodiazepines		25.0		20
–Opioids		16.6		10
*p ≤ 0.05, two-tailed.

Sociodemographic and clinical characteristics of SUD patients with (N = 12) and without ADHD (N = 10)

Note. N can vary slightly. SUD: Substance Use Disorder; ADHD: Attention Deficit Hyperactivity Disorder

SD: Standard deviation; AUDIT: Alcohol Use Disorder Identification Test; DUDIT: Drug Use Disorder Identification Test. U: Mann-Whitney U test; ᵪ²: chi-squared test.

ͣ Unspecified if inpatient or outpatient.

Table 3. Description and frequency endorsement of the self-reported Positive and Negative Aspects of Substance Use in SUD patients with (N = 12) and without ADHD (N = 10)

Positive Aspects of Substance Use	SUD+ADHD	SUD-ADHD
	N = 12	N = 10
	%	%
Self-regulation:
Physical health. Substance use is perceived to improve the physical discomfort at a basic physical level. Sometimes the substances are perceived to alleviate the discomfort caused by other substances.	8	60
Behavior. Substance use is perceived to help redirecting unwanted behavior, as well as completing, performing or coping with demanding activities and situations, and increasing productivity.	58	20
Feelings. Substance use is perceived to mitigate negative feelings of anxiety, lack of motivation, increasing feelings of well-being.	83	100
Reasoning/thoughts. Substance use is perceived to improve positive thinking. Additionally, improving cognitive abilities and limiting excessive thinking.	66	50
The rewarding effects:	25	40
Substance use in order to enjoy the euphoric effects: Such an experience does not involve a self-regulatory function, but rather involves hedonistic purposes.
Negative Aspects of Substance Use
Consequences:
Physical health. Substance use is perceived to result in a deteriorated physical health, including problems with blood pressure, sleep, decreased appetite and increased physical pain.	42	100
Behavior. Substance use is perceived to give rise to unwanted behavior such as aggression, passivity, or lack of control of substance consumption. These negative actions conflict with the individual’s true intentions.	50	60
Feelings. Substance use is perceived to give rise to or strengthen negative feelings, such as anxiety, depressed mood, irritation or even numbness.	50	80
Reasoning/thoughts. Substance use is perceived to have consequences such as mental exhaustion, remorse, disorientation and bad memory.	83	90

Note. SUD: Substance Use Disorder; ADHD: Attention Deficit Hyperactivity Disorder.

Figure 1. Frequency of total abstinence goals concerning amphetamines, alcohol and cannabis.

Table

Please describe the substances you have used most frequently in the past 12 months
Substance of use	Is your substance use considered to be problematic (by yourself?/others?)	What are the positive aspects?	What are the negative aspects?
1.
2.
3.

Table

Please determine the treatment goal(s) specified by type of substance that you consider as problematic.			Next evaluation date:
Substance of use	What are your treatment goals?	Strategies
		Concrete plan of action	Your strengths?	Challenges/obstacles for change?
1.	1.	WHAT CAN YOU DO?: 1.
		WHAT DO YOU NEED FROM THOSE AROUND YOU?: 1.

Table

			Next evaluation date:
Domain	Description of your current situation and treatment goal (wanted situation)	Action plan	Your strengths?	Challenges/obstacles for change?
1.	What is your current situation?:	What can you do?: 1.
	What is your treatment goal?	What do you need from those arund you?: 1.

Table

Treatment goal category	SUD+ADHD			SUD-ADHD
	Substances ♦ n = 23	%		Substances ♦ n = 21	%
Total abstinence ͣ	6	26.1		10	47.6
Conditional abstinenceᵇ	4	17.4		1	4.8
Reduced use ͨ	5	21.7		2	9.5
Unspecified ͩ	8	34.7		8	38.1

Note. SUD: Substance Use Disorder; ADHD: Attention Deficit Hyperactivity Disorder.

♦ Across all substances reported by participants.

ͣ Clear statements of wanting to abstain completely from substance use. Total abstinence was sometimes limited to one specific substance, when multiple substances were involved.

ᵇ Quit substance use or refrain from illegal use, on the condition of starting up, changing or increasing psychopharmacological treatment dosage, such as central stimulant medication or other prescribed habit-forming medication.

ͨ Usage reduced in frequency and amount, compared to the consumption before entering SUD treatment.

ͩ Vague statements of avoiding substance use or indirectly related to substance use.