Objective: This study aims to examine the relationships between AttentionDeficit/Hyperactivity Disorder (ADHD) symptoms, impulsivity, difficulties in emotion
regulation, and addiction severity among patients diagnosed with substance use disorders
receiving inpatient treatment. Additionally, the study investigates the mediating roles of
impulsivity and difficulties in emotion regulation in the relationship between ADHD symptoms
and addiction severity.
Methods: This study was designed as a cross-sectional and correlational research. The sample
consisted of 100 voluntary participants aged between 18 and 60 years who were receiving
inpatient treatment at the AMATEM clinic of NP Brain Hospital and had been diagnosed with
alcohol or substance use disorder according to DSM-5 diagnostic criteria. Data were collected
using the Sociodemographic Information Form, Adult Attention-Deficit/Hyperactivity
Disorder Self-Report Scale (ASRS), UPPS Impulsive Behavior Scale, Difficulties in Emotion
Regulation Scale (DERS), and Addiction Profile Index (API). 2
Pearson correlation analysis was conducted to examine the relationships among variables.
Regression analyses were performed to determine the predictive effect of ADHD symptoms on
addiction severity. Bootstrap-based mediation analyses were used to test the mediating roles of
impulsivity and difficulties in emotion regulation, and a parallel multiple mediation model was
applied to evaluate the relative contribution of each mediator.
Findings: The correlation analysis revealed a significant positive relationship between ADHD
symptoms and addiction severity (r = 0.507, p <0.01). Regression analysis indicated that
ADHD symptoms significantly predicted addiction severity (β = 0.509, p <0.001). Bootstrap
mediation analyses demonstrated that difficulties in emotion regulation fully mediated the
relationship between ADHD symptoms and addiction severity (indirect effect = 0.192; 95% CI
[0.068–0.329]; mediation ratio = 72.68%). Among the impulsivity subdimensions, only
negative urgency showed a significant mediating effect in this relationship. In the parallel
multiple mediation model, when both impulsivity and difficulties in emotion regulation were
included simultaneously, difficulties in emotion regulation emerged as the dominant mediating
mechanism, whereas the indirect effect of impulsivity remained limited.
Conclusion: The findings indicate that ADHD symptoms are strongly associated with
addiction severity in individuals with substance use disorders and that difficulties in emotion
regulation play a central role in explaining this relationship. These results highlight the
importance of routine screening for ADHD symptoms in addiction treatment settings and
emphasize the need to integrate emotion regulation–focused interventions into treatment
programs. Addressing emotion regulation difficulties may enhance treatment outcomes by
reducing addiction severity and improving overall therapeutic effectiveness.