The association between substance use and attention-deficit/hyperactivity disorder and borderline personality disorder in undergraduate students: An exploratory study

Abstract

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) and borderline personality disorder (BPD) are psychiatric conditions commonly associated with impulsivity and substance use. Both disorders are linked to substance use (SU), which includes patterns of consumption of substances such as alcohol, tobacco, and illicit drugs. Objective: The primary objective is to examine the association between SU and the presence of ADHD and BPD traits among undergraduate students in Eastern Odisha. Additionally, this study aims to estimate the prevalence of ADHD, BPD, SU, and impulsivity within this population; investigate the patterns and types of substances commonly used by students; and evaluate the relationship between impulsivity traits and ADHD, BPD, and SU. Methods: A cross-sectional study was conducted involving 887 undergraduate students aged 18–26 at a university in Bhubaneswar, Eastern Odisha. Participants completed standardized instruments, including the Adult ADHD Self-Report Scale (ASRS-v1.1), the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD), the Barratt Impulsiveness Scale (BIS-11), and the DSM-5 criteria for substance use disorder (SUD). Associations were analyzed using Chi-square tests and odds ratios. Results: The findings indicated a prevalence of ADHD at 3%, BPD at 5%, and SU at 18%. Impulsivity was highly prevalent, reported in 71% of individuals with ADHD, 64% with BPD, and 51% with SU. ADHD was significantly associated with substance use disorder (SUD) (OR = 10.57, 95% CI: 4.68–23.83), with 68% of individuals with ADHD screening positive for SUD (P < 0.001). Similarly, BPD was significantly correlated with SU (OR = 4.54, 95% CI: 2.44–8.43; P < 0.001). Substance use patterns differed between ADHD and BPD, with tobacco and cannabis most strongly linked to BPD, while alcohol showed modest diagnostic specificity. Conclusion: The current study found that substance use was prevalent among undergraduates, with strong associations observed between ADHD and SU, as well as between BPD and SU. These findings highlight distinct SU patterns linked to each disorder. Impulsivity was identified as a common underlying factor across ADHD, BPD, and SU.