Relationships of attention-deficit hyperactivity disorder with defense styles and harm avoidance among male inpatients with alcohol use disorder

INTRODUCTION: Patients with alcohol use disorder (AUD) use immature defense styles, and AUD is related with adult attention-deficit hyperactivity disorder (ADHD). Harm avoidance (HA) is related with both AUD and particularly inattentiveness (IN) dimension of ADHD. AIM: The aim of the present study was to evaluate the relationship of defense styles with probable ADHD and severity of ADHD symptoms while controlling the effect of HA among male inpatients with AUD. SETTINGS AND DESIGN: The present study with cross-sectional design was conducted at the Alcohol and Drug Research, Treatment and Training Center (AMATEM) of Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery in Istanbul. STATISTICAL ANALYSIS: Chi-square test, independent samples t-test, multiple logistic and linear regression analyses, and multivariate analysis of covariance (MANCOVA) were used. MATERIALS AND METHODS: Participants (n = 151) were evaluated with the Adult ADHD Self-Report Scale, the Defense Style Questionnaire, and the HA Dimension of the Temperament and Character Inventory. RESULTS: HA (particularly HA-1 [anticipatory worry and pessimism]) and immature defense style (particularly acting out) predicted the presence of probable ADHD. In linear regression analysis, HA (particularly HA-1 and HA-4 [fatigability and asthenia]), high immature (particularly acting out), and low mature defense styles predicted the severity of ADHD symptoms. In MANCOVA, immature defense style predicted both the IN and the hyperactivity/impulsivity (HI) dimensions of ADHD, whereas HA and IN dimension and low mature defense style predicted HI dimension. CONCLUSIONS: These findings suggest that immature defense style (i.e., acting out) is related with both the presence of probable ADHD and severity of ADHD symptoms, together with HA, which must be taken into account while treating patients with ADHD among male populations with AUD.