Transitions and Motivations for Substance Misuse in Prison Inmates With ADHD and Conduct Disorder: Validation of a New Instrument

ABSTRACT

Objective: There is a reasonable theoretical base for understanding the possible causes and motivations behind substance misuse and its dependency. There is a need for a reliable and valid measure that delineates the markers of substance use from its initiation and identifies different motivations for drug use transitioning, maintenance, and dependency. We addressed this gap in the United Kingdom by examining and validating the Substance Transitions in Addiction Rating Scale (STARS). Methods: For this review, 390 male prisoners were screened for conduct disorder and assessed with a clinical diagnostic interview for attention deficit/hyperactivity disorder (ADHD). They completed the four STARS subscales regarding their substance use. Exploratory structural equation modeling was performed to assess the STARS structure and to derive factors to assess validity against ADHD and conduct disorder diagnostic categories. Results: Each of the subscales produced meaningful and reliable factors that supported the self-medication and behavioral disinhibition hypotheses of substance use motivation. The findings robustly show that ADHD is significantly associated with the need for coping as a way of managing primary and comorbid symptoms, but not conduct disorder. The findings were strongest for the combined ADHD type. Discussion: STARS has a great potential to further the understanding of the motivation behind substance use and its dependency in different populations.

KEYWORDS:

• Drug dependence
• motivations
• ADHD
• conduct disorder
• transitions
• self-medication

Acknowledgments

We are grateful to the Scottish Prison Service and staff at Porterfield Inverness Prison for their support of the study. This study was funded by Shire Pharmaceutical Development Limited. Shire Pharmaceutical Development Ltd. had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; the preparation, review, or approval of the manuscript; or the decision to submit the manuscript for publication. The research was supported by the National Institute for Health Research (NIHR) Imperial Biomedical Research Centre. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health.

Disclosures

Susan Young has received honoraria for consultancy, travel, educational talks and/or research from Janssen, Eli Lilly, and/or Shire. All other authors have no conflicts of interest.

Funding

This study was funded by Shire Pharmaceutical Development Limited.