Clin Psychopharmacol Neurosci 2018; 16(3): 267-275  
Serial Progression from Attention-Deficit/Hyperactivity Disorder to Alcohol Use Disorder: Serial Multiple Mediated Effects of Externalizing Disorders and Depression
Jung Min Jo, Sung Doo Won
Department of Clinical Psychology, Keyo Medical Foundation Keyo Mental Hospital, Uiwang, Korea
Correspondence to: Sung Doo Won, PhD
Department of Clinical Psychology, Keyo Medical Foundation Keyo Mental Hospital, 15 Ojeon-ro, Uiwang 16062, Korea
Tel: +82-31-452-4110, Fax: +82-31-452-4110
Received: April 13, 2017; Revised: May 16, 2017; Accepted: June 1, 2017; Published online: August 31, 2018.
© The Korean College of Neuropsychopharmacology. All rights reserved.

This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Objective: Externalizing disorders such as attention-deficit/hyperactivity disorder (ADHD), conduct disorder and antisocial personality disorder, as well as depression are common comorbidities in alcohol use disorder (AUD). The current study focused on the temporal relationship between the onsets of these disorders and AUD, and investigated the serial multiple mediator model of externalizing disorders (e.g., ADHD) and depression on AUD.
Methods: We analyzed the mediated effects of the Adult ADHD Self-Report Scale (ASRS), the Barratt Impulsiveness Scale motor (BIS_M) and the Beck Depression Inventory (BDI) on Korean version of the Alcohol Dependence Scale (ADS_K) using the multiple-step multiple mediation procedure regression analysis. In addition, we comparatively analyzed different clinical characteristics in relation to conduct problems.
Results: The multiple-step multiple mediation procedure found the serial multiple mediated effects of the BIS_M and the BDI on the relationship between the ASRS and the ADS_K. Also, the group with conduct problem was significantly high in ADHD symptoms, depression, anxiety, impulsivity, legal problems and alcohol-related problems, compared to the group without conduct problems.
Conclusion: To sum up, the results of this study show that ADHD symptoms in childhood could exert significant effects on the severity of AUD in adulthood, and both disorders might be mediated by the externalizing disorders characterized by the core feature of motor impulsivity, and depression serially. Thus, the treatment of preceding disorders in accordance with developmental stages is an overarching clinical component for preventing the subsequent development of AUD and for its treatment.
Keywords: Attention deficit disorder with hyperactivity; Depression; Externalizing disorder; Alcohol use disorder; Impulsive behavior; Conduct disorder.

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