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Childhood trauma exposure in substance use disorder patients with and without ADHD

Identifieur interne : 001F57 ( Pmc/Corpus ); précédent : 001F56; suivant : 001F58

Childhood trauma exposure in substance use disorder patients with and without ADHD

Auteurs : Maija Konstenius ; Anders Leifman ; Katelijne Van Emmerik-Van Oortmerssen ; Geurt Van De Glind ; Johan Franck ; Franz Moggi ; Josep Antoni Ramos-Quiroga ; Frances R. Levin ; Pieter Jan Carpentier ; Arvid Skutle ; Eli-Torild Bu ; Sharlene Kaye ; Zsolt Demetrovics ; Csaba Barta ; Marc Auriecomb ; Melina Fatséas ; Brian Johnson ; Stephen V. Faraone ; Steve Allsop ; Susan Carruthers ; Robert A. Schoevers ; Sofie Verspreet ; Geert Dom ; Maarten Wj Koeter ; Wim Van Den Brink

Source :

RBID : PMC:5518307

Abstract

Background

Childhood trauma exposure (CTE) is frequently reported by those with substance use disorders (SUDs). SUDs also frequently co-occur with attention deficit hyperactivity disorder (ADHD).

Objective

To investigate the role of childhood trauma exposure (CTE) in the presence and the persistence of ADHD in treatment seeking SUD patients.

Method

Data was derived from the International ADHD in Substance Use Disorder Prevalence (IASP) study. A structured interview was administered to 1274 treatment-seeking SUD patients aged 18 to 65.

Results

CTE was present in 53.5% of the patients and comorbid adult ADHD in 14.1%. CTE was significantly associated with ADHD: the prevalence of adult ADHD with and without CTE was 19.4% and 8.5% (OR adjusted for age, gender, main substance of abuse, BPD, and ASPD 1.91 [95%CI 1.29–2.81]). CTE was not associated with the severity of adult ADHD or with the persistence of childhood ADHD into adulthood.

Conclusions

CTE is common in SUD patients and associated with adult ADHD but not with the persistence of childhood ADHD into adulthood. These findings suggest that the increased rate of adult ADHD in SUD patients with CTE is not the consequence of a negative effect of CTE on the persistence of childhood ADHD into adulthood, but a direct expression of the high rate of childhood ADHD in SUD patients with CTE.


Url:
DOI: 10.1016/j.addbeh.2016.10.016
PubMed: 27816036
PubMed Central: 5518307

Links to Exploration step

PMC:5518307

Le document en format XML

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<name sortKey="Kaye, Sharlene" sort="Kaye, Sharlene" uniqKey="Kaye S" first="Sharlene" last="Kaye">Sharlene Kaye</name>
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<name sortKey="Demetrovics, Zsolt" sort="Demetrovics, Zsolt" uniqKey="Demetrovics Z" first="Zsolt" last="Demetrovics">Zsolt Demetrovics</name>
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<nlm:aff id="A16">Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA</nlm:aff>
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<nlm:aff id="A16">Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA</nlm:aff>
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<title xml:lang="en" level="a" type="main">Childhood trauma exposure in substance use disorder patients with and without ADHD</title>
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<nlm:aff id="A1">Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden</nlm:aff>
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<name sortKey="Leifman, Anders" sort="Leifman, Anders" uniqKey="Leifman A" first="Anders" last="Leifman">Anders Leifman</name>
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<nlm:aff id="A2">Stockholm Center for Dependency Disorders, Sweden</nlm:aff>
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<name sortKey="Van Emmerik Van Oortmerssen, Katelijne" sort="Van Emmerik Van Oortmerssen, Katelijne" uniqKey="Van Emmerik Van Oortmerssen K" first="Katelijne" last="Van Emmerik-Van Oortmerssen">Katelijne Van Emmerik-Van Oortmerssen</name>
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<nlm:aff id="A3">Arkin, Amsterdam, The Netherlands</nlm:aff>
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<nlm:aff id="A4">Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands</nlm:aff>
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<name sortKey="Van De Glind, Geurt" sort="Van De Glind, Geurt" uniqKey="Van De Glind G" first="Geurt" last="Van De Glind">Geurt Van De Glind</name>
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<nlm:aff id="A4">Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands</nlm:aff>
</affiliation>
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<name sortKey="Franck, Johan" sort="Franck, Johan" uniqKey="Franck J" first="Johan" last="Franck">Johan Franck</name>
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<nlm:aff id="A1">Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden</nlm:aff>
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<name sortKey="Moggi, Franz" sort="Moggi, Franz" uniqKey="Moggi F" first="Franz" last="Moggi">Franz Moggi</name>
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<nlm:aff id="A5">University Hospital of Psychiatry, University of Bern, Bern, Switzerland</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A6">Department of Psychology, University of Fribourg, Fribourg, Switzerland</nlm:aff>
</affiliation>
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<name sortKey="Ramos Quiroga, Josep Antoni" sort="Ramos Quiroga, Josep Antoni" uniqKey="Ramos Quiroga J" first="Josep Antoni" last="Ramos-Quiroga">Josep Antoni Ramos-Quiroga</name>
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<nlm:aff id="A7">Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Spain</nlm:aff>
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<name sortKey="Levin, Frances R" sort="Levin, Frances R" uniqKey="Levin F" first="Frances R" last="Levin">Frances R. Levin</name>
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<nlm:aff id="A8">Columbia University/the New York State Psychiatric Institute, New York, USA</nlm:aff>
</affiliation>
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<name sortKey="Carpentier, Pieter Jan" sort="Carpentier, Pieter Jan" uniqKey="Carpentier P" first="Pieter Jan" last="Carpentier">Pieter Jan Carpentier</name>
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<nlm:aff id="A9">Reinier van Arkel groep,'s-Hertogenbosch, The Netherlands</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Skutle, Arvid" sort="Skutle, Arvid" uniqKey="Skutle A" first="Arvid" last="Skutle">Arvid Skutle</name>
<affiliation>
<nlm:aff id="A10">Bergen Clinics Foundation, Bergen, Norway</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Bu, Eli Torild" sort="Bu, Eli Torild" uniqKey="Bu E" first="Eli-Torild" last="Bu">Eli-Torild Bu</name>
<affiliation>
<nlm:aff id="A10">Bergen Clinics Foundation, Bergen, Norway</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Kaye, Sharlene" sort="Kaye, Sharlene" uniqKey="Kaye S" first="Sharlene" last="Kaye">Sharlene Kaye</name>
<affiliation>
<nlm:aff id="A11">National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Demetrovics, Zsolt" sort="Demetrovics, Zsolt" uniqKey="Demetrovics Z" first="Zsolt" last="Demetrovics">Zsolt Demetrovics</name>
<affiliation>
<nlm:aff id="A12">Institute of Psychology, Eötvös Loránd University, Budapest, Hungary</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Barta, Csaba" sort="Barta, Csaba" uniqKey="Barta C" first="Csaba" last="Barta">Csaba Barta</name>
<affiliation>
<nlm:aff id="A13">Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Auriecomb, Marc" sort="Auriecomb, Marc" uniqKey="Auriecomb M" first="Marc" last="Auriecomb">Marc Auriecomb</name>
<affiliation>
<nlm:aff id="A14">Laboratoire de psychiatrie Département d'addictologie, Université de Bordeaux, France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Fatseas, Melina" sort="Fatseas, Melina" uniqKey="Fatseas M" first="Melina" last="Fatséas">Melina Fatséas</name>
<affiliation>
<nlm:aff id="A14">Laboratoire de psychiatrie Département d'addictologie, Université de Bordeaux, France</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Johnson, Brian" sort="Johnson, Brian" uniqKey="Johnson B" first="Brian" last="Johnson">Brian Johnson</name>
<affiliation>
<nlm:aff id="A15">Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A16">Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Faraone, Stephen V" sort="Faraone, Stephen V" uniqKey="Faraone S" first="Stephen V" last="Faraone">Stephen V. Faraone</name>
<affiliation>
<nlm:aff id="A15">Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA</nlm:aff>
</affiliation>
<affiliation>
<nlm:aff id="A16">Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Allsop, Steve" sort="Allsop, Steve" uniqKey="Allsop S" first="Steve" last="Allsop">Steve Allsop</name>
<affiliation>
<nlm:aff id="A17">National Drug Research Institute, Curtin University of Technology, Perth, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Carruthers, Susan" sort="Carruthers, Susan" uniqKey="Carruthers S" first="Susan" last="Carruthers">Susan Carruthers</name>
<affiliation>
<nlm:aff id="A17">National Drug Research Institute, Curtin University of Technology, Perth, Australia</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Schoevers, Robert A" sort="Schoevers, Robert A" uniqKey="Schoevers R" first="Robert A" last="Schoevers">Robert A. Schoevers</name>
<affiliation>
<nlm:aff id="A18">Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Verspreet, Sofie" sort="Verspreet, Sofie" uniqKey="Verspreet S" first="Sofie" last="Verspreet">Sofie Verspreet</name>
<affiliation>
<nlm:aff id="A19">Collaborative Antwerp Psychiatry Research Institute (CAPRI, UA), PC Alexian Brothers, Boechout, Belgium</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Dom, Geert" sort="Dom, Geert" uniqKey="Dom G" first="Geert" last="Dom">Geert Dom</name>
<affiliation>
<nlm:aff id="A19">Collaborative Antwerp Psychiatry Research Institute (CAPRI, UA), PC Alexian Brothers, Boechout, Belgium</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Koeter, Maarten Wj" sort="Koeter, Maarten Wj" uniqKey="Koeter M" first="Maarten Wj" last="Koeter">Maarten Wj Koeter</name>
<affiliation>
<nlm:aff id="A4">Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands</nlm:aff>
</affiliation>
</author>
<author>
<name sortKey="Van Den Brink, Wim" sort="Van Den Brink, Wim" uniqKey="Van Den Brink W" first="Wim" last="Van Den Brink">Wim Van Den Brink</name>
<affiliation>
<nlm:aff id="A4">Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands</nlm:aff>
</affiliation>
</author>
</analytic>
<series>
<title level="j">Addictive behaviors</title>
<idno type="ISSN">0306-4603</idno>
<idno type="eISSN">1873-6327</idno>
<imprint>
<date when="2016">2016</date>
</imprint>
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<div type="abstract" xml:lang="en">
<sec id="S1">
<title>Background</title>
<p id="P1">Childhood trauma exposure (CTE) is frequently reported by those with substance use disorders (SUDs). SUDs also frequently co-occur with attention deficit hyperactivity disorder (ADHD).</p>
</sec>
<sec id="S2">
<title>Objective</title>
<p id="P2">To investigate the role of childhood trauma exposure (CTE) in the presence and the persistence of ADHD in treatment seeking SUD patients.</p>
</sec>
<sec id="S3">
<title>Method</title>
<p id="P3">Data was derived from the International ADHD in Substance Use Disorder Prevalence (IASP) study. A structured interview was administered to 1274 treatment-seeking SUD patients aged 18 to 65.</p>
</sec>
<sec id="S4">
<title>Results</title>
<p id="P4">CTE was present in 53.5% of the patients and comorbid adult ADHD in 14.1%. CTE was significantly associated with ADHD: the prevalence of adult ADHD with and without CTE was 19.4% and 8.5% (OR adjusted for age, gender, main substance of abuse, BPD, and ASPD 1.91 [95%CI 1.29–2.81]). CTE was not associated with the severity of adult ADHD or with the persistence of childhood ADHD into adulthood.</p>
</sec>
<sec id="S5">
<title>Conclusions</title>
<p id="P5">CTE is common in SUD patients and associated with adult ADHD but not with the persistence of childhood ADHD into adulthood. These findings suggest that the increased rate of adult ADHD in SUD patients with CTE is not the consequence of a negative effect of CTE on the persistence of childhood ADHD into adulthood, but a direct expression of the high rate of childhood ADHD in SUD patients with CTE.</p>
</sec>
</div>
</front>
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<journal-id journal-id-type="nlm-journal-id">7603486</journal-id>
<journal-id journal-id-type="pubmed-jr-id">244</journal-id>
<journal-id journal-id-type="nlm-ta">Addict Behav</journal-id>
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<xref ref-type="aff" rid="A1">a</xref>
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<name>
<surname>Leifman</surname>
<given-names>Anders</given-names>
</name>
<xref ref-type="aff" rid="A2">b</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>van Emmerik-van Oortmerssen</surname>
<given-names>Katelijne</given-names>
</name>
<xref ref-type="aff" rid="A3">c</xref>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>van de Glind</surname>
<given-names>Geurt</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Franck</surname>
<given-names>Johan</given-names>
</name>
<xref ref-type="aff" rid="A1">a</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Moggi</surname>
<given-names>Franz</given-names>
</name>
<xref ref-type="aff" rid="A5">e</xref>
<xref ref-type="aff" rid="A6">f</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Ramos-Quiroga</surname>
<given-names>Josep Antoni</given-names>
</name>
<xref ref-type="aff" rid="A7">g</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Levin</surname>
<given-names>Frances R</given-names>
</name>
<xref ref-type="aff" rid="A8">h</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Carpentier</surname>
<given-names>Pieter Jan</given-names>
</name>
<xref ref-type="aff" rid="A9">i</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Skutle</surname>
<given-names>Arvid</given-names>
</name>
<xref ref-type="aff" rid="A10">j</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Bu</surname>
<given-names>Eli-Torild</given-names>
</name>
<xref ref-type="aff" rid="A10">j</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kaye</surname>
<given-names>Sharlene</given-names>
</name>
<xref ref-type="aff" rid="A11">k</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Demetrovics</surname>
<given-names>Zsolt</given-names>
</name>
<xref ref-type="aff" rid="A12">l</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Barta</surname>
<given-names>Csaba</given-names>
</name>
<xref ref-type="aff" rid="A13">m</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Auriecomb</surname>
<given-names>Marc</given-names>
</name>
<xref ref-type="aff" rid="A14">n</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Fatséas</surname>
<given-names>Melina</given-names>
</name>
<xref ref-type="aff" rid="A14">n</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Johnson</surname>
<given-names>Brian</given-names>
</name>
<xref ref-type="aff" rid="A15">o</xref>
<xref ref-type="aff" rid="A16">p</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Faraone</surname>
<given-names>Stephen V</given-names>
</name>
<xref ref-type="aff" rid="A15">o</xref>
<xref ref-type="aff" rid="A16">p</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Allsop</surname>
<given-names>Steve</given-names>
</name>
<xref ref-type="aff" rid="A17">q</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Carruthers</surname>
<given-names>Susan</given-names>
</name>
<xref ref-type="aff" rid="A17">q</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Schoevers</surname>
<given-names>Robert A</given-names>
</name>
<xref ref-type="aff" rid="A18">r</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Verspreet</surname>
<given-names>Sofie</given-names>
</name>
<xref ref-type="aff" rid="A19">s</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Dom</surname>
<given-names>Geert</given-names>
</name>
<xref ref-type="aff" rid="A19">s</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Koeter</surname>
<given-names>Maarten WJ</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
<contrib contrib-type="author">
<name>
<surname>van den Brink</surname>
<given-names>Wim</given-names>
</name>
<xref ref-type="aff" rid="A4">d</xref>
</contrib>
</contrib-group>
<aff id="A1">
<label>a</label>
Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden</aff>
<aff id="A2">
<label>b</label>
Stockholm Center for Dependency Disorders, Sweden</aff>
<aff id="A3">
<label>c</label>
Arkin, Amsterdam, The Netherlands</aff>
<aff id="A4">
<label>d</label>
Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands</aff>
<aff id="A5">
<label>e</label>
University Hospital of Psychiatry, University of Bern, Bern, Switzerland</aff>
<aff id="A6">
<label>f</label>
Department of Psychology, University of Fribourg, Fribourg, Switzerland</aff>
<aff id="A7">
<label>g</label>
Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry, Spain</aff>
<aff id="A8">
<label>h</label>
Columbia University/the New York State Psychiatric Institute, New York, USA</aff>
<aff id="A9">
<label>i</label>
Reinier van Arkel groep,'s-Hertogenbosch, The Netherlands</aff>
<aff id="A10">
<label>j</label>
Bergen Clinics Foundation, Bergen, Norway</aff>
<aff id="A11">
<label>k</label>
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia</aff>
<aff id="A12">
<label>l</label>
Institute of Psychology, Eötvös Loránd University, Budapest, Hungary</aff>
<aff id="A13">
<label>m</label>
Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary</aff>
<aff id="A14">
<label>n</label>
Laboratoire de psychiatrie Département d'addictologie, Université de Bordeaux, France</aff>
<aff id="A15">
<label>o</label>
Department of Psychiatry, SUNY Upstate Medical University, Syracuse, NY, USA</aff>
<aff id="A16">
<label>p</label>
Department of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA</aff>
<aff id="A17">
<label>q</label>
National Drug Research Institute, Curtin University of Technology, Perth, Australia</aff>
<aff id="A18">
<label>r</label>
Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands</aff>
<aff id="A19">
<label>s</label>
Collaborative Antwerp Psychiatry Research Institute (CAPRI, UA), PC Alexian Brothers, Boechout, Belgium</aff>
<author-notes>
<corresp id="FN1">
<label>*</label>
Corresponding author at: Karolinska Solna R5:01, 17176 Stockholm, Sweden.
<email>maija.konstenius@ki.se</email>
(M. Konstenius)</corresp>
</author-notes>
<pub-date pub-type="nihms-submitted">
<day>25</day>
<month>5</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="epub">
<day>24</day>
<month>10</month>
<year>2016</year>
</pub-date>
<pub-date pub-type="ppub">
<month>2</month>
<year>2017</year>
</pub-date>
<pub-date pub-type="pmc-release">
<day>20</day>
<month>7</month>
<year>2017</year>
</pub-date>
<volume>65</volume>
<fpage>118</fpage>
<lpage>124</lpage>
<pmc-comment>elocation-id from pubmed: 10.1016/j.addbeh.2016.10.016</pmc-comment>
<abstract>
<sec id="S1">
<title>Background</title>
<p id="P1">Childhood trauma exposure (CTE) is frequently reported by those with substance use disorders (SUDs). SUDs also frequently co-occur with attention deficit hyperactivity disorder (ADHD).</p>
</sec>
<sec id="S2">
<title>Objective</title>
<p id="P2">To investigate the role of childhood trauma exposure (CTE) in the presence and the persistence of ADHD in treatment seeking SUD patients.</p>
</sec>
<sec id="S3">
<title>Method</title>
<p id="P3">Data was derived from the International ADHD in Substance Use Disorder Prevalence (IASP) study. A structured interview was administered to 1274 treatment-seeking SUD patients aged 18 to 65.</p>
</sec>
<sec id="S4">
<title>Results</title>
<p id="P4">CTE was present in 53.5% of the patients and comorbid adult ADHD in 14.1%. CTE was significantly associated with ADHD: the prevalence of adult ADHD with and without CTE was 19.4% and 8.5% (OR adjusted for age, gender, main substance of abuse, BPD, and ASPD 1.91 [95%CI 1.29–2.81]). CTE was not associated with the severity of adult ADHD or with the persistence of childhood ADHD into adulthood.</p>
</sec>
<sec id="S5">
<title>Conclusions</title>
<p id="P5">CTE is common in SUD patients and associated with adult ADHD but not with the persistence of childhood ADHD into adulthood. These findings suggest that the increased rate of adult ADHD in SUD patients with CTE is not the consequence of a negative effect of CTE on the persistence of childhood ADHD into adulthood, but a direct expression of the high rate of childhood ADHD in SUD patients with CTE.</p>
</sec>
</abstract>
<kwd-group>
<kwd>Childhood trauma</kwd>
<kwd>Substance use disorders</kwd>
<kwd>Comorbidity</kwd>
<kwd>ADHD</kwd>
</kwd-group>
</article-meta>
</front>
</pmc>
</record>

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