Abstract
Background
It remains unclear if individuals with Tourette syndrome (TS) or chronic tic disorder
(CTD) have an elevated risk of subsequent substance misuse.
Methods
In this population-based cohort study, we investigated the association between ICD
diagnoses of TS/CTD and substance misuse outcomes, accounting for psychiatric comorbidity
and familial factors. The cohort included all individuals living in Sweden at any
time between January 1, 1973, and December 31, 2013. Substance misuse outcomes were
defined as an ICD code of substance use–related disorder or cause of death, or as
a substance use–related criminal conviction in the nationwide registers.
Results
The cohort included 14,277,199 individuals, of whom 7832 had a TS/CTD diagnosis (76.3%
men). TS/CTD was associated with an increased risk of any subsequent substance misuse
outcomes (adjusted hazard ratio [aHR], 3.11; 95% confidence interval [CI], 2.94–3.29),
including alcohol-related disorder (aHR, 3.45; 95% CI, 3.19–3.72), drug-related disorder
(aHR, 6.84; 95% CI, 6.32–7.40), substance-related criminal convictions (aHR, 2.56;
95% CI, 2.36–2.77), and substance-related death (aHR, 2.54; 95% CI, 1.83–3.52). Excluding
psychiatric comorbidities had little effect on the magnitude of the associations,
with the exception of attention-deficit/hyperactivity disorder, which attenuated the
risk of any substance misuse outcomes (aHR, 2.00; 95% CI, 1.82–2.19). The risk of
any substance misuse outcomes in individuals with TS/CTD was substantially attenuated
but remained significant when compared with their unaffected siblings (aHR, 1.74;
95% CI, 1.53–1.97).
Conclusions
TS/CTD were associated with various types of subsequent substance misuse outcomes,
independently of psychiatric comorbidity and familial factors shared between siblings.
Screening for drug and alcohol use should become part of the standard clinical routines,
particularly in patients with comorbid attention-deficit/hyperactivity disorder.
Keywords
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Article info
Publication history
Published online: September 21, 2020
Accepted:
September 16,
2020
Received in revised form:
September 2,
2020
Received:
March 12,
2020
Identification
Copyright
© 2020 Society of Biological Psychiatry.
