An exploration of the relationship between ADHD symptomology, recreational drug use and fatty acid deficiency in a normal population.

Dionne Angela Donnelly Module: PSYC340 - Research Project Word Count: 4840 Scored: 79

Abstract Research has shown there is a relationship between increased attention-deficit/hyperactivity disorder (ADHD) symptoms and increased fatty acid deficiency symptoms (FADS). Research also indicates a relationship between increased ADHD symptoms and increased levels of drug use. There may also be a relationship between FADS and increased drug use. These relationships were tested using three scales; the Wender Utah rating scale (WURS), a FADS scale created by the researcher and a drugs scale. The questionnaire was distributed to an opportunity sample of 90 undergraduate students (aged 18-38) from the North West of England. The scores were tested using Pearsons correlatory analysis. It was found that there was no significant relationship between ADHD and FADS, nor ADHD and increased drug use. Neither was there a significant relationship between FADS and drug use. Post hoc tests found significant relationships between cigarette smoking and age, cannabis use and age, and cannabis and cigarette smoking. Future research should be aimed at creating a more detailed, discriminatory and reliable measure of FADS, and investigating the effect of drugs on appetite and therefore fatty acid intake.

Introduction Research into attention-deficit/hyperactivity disorder (ADHD) has exposed a link between increased ADHD symptoms and deficient levels of essential fatty acids (characterised by fatty acid deficiency symptoms; FADS), and between increased ADHD symptoms and increased use of drugs. To date there has been little research into whether there is a link between drug use and FADS. This study aimed to investigate these potential relationships within a normal population.

This was done using three scales, the scores of which were tested for any correlations between ADHD and FADS, ADHD and drug use, and FADS and drug use.

Attention Deficit/Hyperactivity Disorder (ADHD) is commonly viewed as a childhood disorder. This is reflected in the DSM-IV-TR diagnostic criteria (Shifrin, Proctor & Prevatt, 2010). However, symptoms persist into adulthood in up to 70 per cent of cases (Cormier, 2008; see also, Sinn & Bryan, 2007). These symptoms include developmentally inappropriate levels of inattention (American Psychiatric Association, 1994, Cited in DuPaul, et al., 2001) which presents itself as procrastination, overreaction to frustration, poor motivation and timemanagement difficulties (Davidson, 2008; see also, Biederman, 2005).

The highest ADHD prevalence rates are found in countries with a larger average income (such as the UK) than those countries with a smaller income (Fayyad et al., 2007). ADHD symptoms are 2-3 times more likely to be found in males than females (Davids et al., 2005; Sinn & Bryan, 2007; Wender, Wolf & Wasserstein, 2001). In the US, adult prevalence rates vary between 3 and 5 per cent (Kessler et al., 2006) with similar levels found in other Western countries (Faraone, Sergeant, Gillberg & Biederman, 2003). However, a more recent meta-analysis found the prevalence rate to be lower, at 2.5 per cent (Simon, Czobor, Blint, Mszros & Bitter, 2009). Differences in prevalence estimates are thought to be due to the lack of a standardised measure of adult ADHD (Kessler et al., 2006). Symptoms of ADHD can also be found in the normal population, at a sub-diagnosis level (Paloyelis, Asherson, & Kuntsi, 2009). This means that a

huge number of people may be affected by such symptoms but do not receive help in coping with them because they do not surpass the threshold for diagnosis.

The above adult prevalence rates may be so low due to problems with the diagnostic criteria; the criteria for childhood diagnosis may be too strict or developmentally inappropriate to be used for adults (Davidson, 2008). So, reduction of symptoms in adulthood could either be due to remission or decreased measurement sensitivity (ibid; see also Clure et al., 1999). It is for such reasons that adult scales have been created. The majority of these scales involve the adult selfreporting on their symptoms (Jackson & Farrugia, 1997, cited in DuPaul et al., 2001). One scale which utilises such self-report is the Wender Utah Rating Scale (WURS). This scale has been reliably found to be sensitive in detecting ADHD (McCann, Scheele, Ward & Roy-Byrne, 2000). The scale asks questions relating to the symptoms noted above, such as ...do you put things off, procrastinate? (Question 23, see Appendix 3). Therefore this scale was used in this study as it is able to assess adult symptoms in a more developmentally appropriate way than other scales.

ADHD has been found to be comorbid with many other psychological disorders (Sharp, McQuillin & Gurling, 2009; see also, Carroll & Rounsaville, 1993; Milte, Sinn & Howe, 2009; Spencer et al., 2010), such as dyslexia and dyspraxia (Richardson, 2004). One of the most studied comorbid relationships is with substance use disorders (SUDs) (McAweeny, Rogers, Huddleston, Moore & Gentle, 2010). It has been found that individuals who are substance abusers are considerably more likely to have comorbid ADHD (Biederman, 2005; see also, Barkley, Fischer, Smallish, & Fletcher, 2004; Davids et al., 2005; Milte, Sinn & Howe, 2009). 3

Some estimations state that the risk of developing a substance use disorder in those with ADHD is double that for the normal population (Wilens, 2006), with one particular study estimating it to be 35-55 per cent (Wilens et al., 2007). This number is only for those who are actually diagnosed with ADHD and SUD, not those who display sub-diagnosis symptoms. Therefore it is important to study how these two variables interact, i.e. if they relate to one another in a normal population, not just at extreme levels.

The relationship between ADHD and drug use has been found to be a bi-directional one (Wilens et al., 2007) and this is further complicated by the fact that some symptoms of ADHD are similar to those seen in SUDs, including, but not limited to, restlessness, poor response inhibition and impulsivity (McAweeny et al., 2010) and impaired social functioning (Sullivan & Rudnik-Levin, 2001). If symptoms of either ADHD or SUD are not recognised, or one is mistaken for the other, peoples quality of life can be reduced (Wilens & Fusillo, 2007). Therefore, it is important to highlight that there is an interaction between these variables and one may exacerbate or attenuate the other.

Burke, Loeber, & Lahey (2001) found that 78 per cent of participants with ADHD reported smoking cigarettes or cannabis, drinking alcohol or taking other drugs (see also, Lambert & Hartsough, 1998). Those with ADHD and SUD are usually younger and have received less formal education (McAweeny et al., 2010). This may pose a problem for the current study as the participants are all university students, so it is likely they will present with fewer symptoms. In general, there is a dearth of systematic information about how ADHD symptomology is 4

expressed in adults (Clure et al., 1999), and more particularly in the university population (DuPaul et al., 2001). This study will help add to this information by presenting data about the extent of ADHD symptoms found in this population.

When symptoms are below the level necessary for diagnosis, despite causing problems for the individual, they are often left untreated. Consequently, increased drug use in those with ADHD symptoms may be seen as an attempt to self-medicate (Carroll & Rounsaville, 1993; Lambert & Hartsough, 1998; Sullivan & Rudnik-Levin, 2001; Wilens & Fusillo, 2007). This is chiefly believed because only a quarter of subjects with ADHD report using drugs for their high (Wilens et al., 2007). Similarly, smoking (which does not result in a high and is proven to be detrimental to health) is also closely linked to ADHD; 41-42 per cent of the adult ADHD population smoke, compared to 26 per cent of the adult population (Kollins, McClernan, Fuemmeler, 2005). The more ADHD symptoms reported, the greater the cigarette consumption (ibid.). Specifically, the symptom of inattention has been found to lead to a two times greater risk for cigarette smoking (Burke et al., 2001; see also Lambert & Hartsough, 1998). Smoking has been found to improve attention and arousal (Sullivan & Rudnik-Levin, 2001), effects which may be desirable for the individual attempting to cope with ADHD symptoms (Pomerlau, Downey, Stelson & Pomerlau, 1995; Wilens & Fusillo, 2007). Evidence which lends support to this is that treatment for ADHD with stimulant medication is a protective factor for future smoking (Wilens, 2006). ADHD symptoms can also hinder attempts to quit (Sullivan & RudnikLevin, 2001). The conclusions drawn from this research is that there is a clear relationship between increased ADHD symptoms and increased risk of smoking cigarettes

Research has also shown that those with ADHD are significantly more likely to use cannabis (McAweeny et al., 2010), with many users reporting that it improved their feelings of internal restlessness (Wilens & Fusillo, 2007). Furthermore, between 17 and 45 per cent of adults with ADHD are alcohol abusers or are alcohol dependent (Wilens & Fusillo, 2007). Alcohol may be also be used to reduce arousal and anxiety (Sullivan & Rudnik-Levin, 2001). In contrast to the above findings, a longitudinal follow-up study by Fischer et al. (cited in Barkley, 2002) found that there was no increased risk of SUDs in those with ADHD. Such a finding is thought to be the exception to the rule as the majority of longitudinal research has similar findings to the crosssectional studies outlined above (Davids et al., 2005).

SUDs are not the only variable claimed to be closely related to ADHD. There is an abundance of research into the relationship between ADHD and essential fatty acids (Omega-3 and Omega-6) (Soh, Walter, Baur & Collins, 2009). Essential fatty acids play a critical role in human brain development (Richardson, 2004) but are not manufactured by the body; they can only be acquired through our diet (Singh, 2005; Sinn & Bran, 2007; Suvarna, 2008; see also, Horrocks & Yeo, 1999). The evidence that ADHD is related to suboptimal levels of fatty acids is compelling (Sinn, 2008), and it is believed that they may be the cause of or lead to worsened ADHD (Ross, Seguin & Sieswarda, 2007; Singh, 2005). Omega-3 is found in oily fish and several green leafy vegetables, nuts and seed oils (Suvarna, 2008; see also, Richardson, 2004; Sinn & Bryan, 2007). Omega-6 is much more abundant in modern Western diets, because it is found in most vegetable oils and meat and dairy products. Conversion of one fatty acid (alpha-

linolenic acid - ALA) into omega-3 can also be inhibited by the presence of saturated fats, and poor amounts of vitamins and minerals (Tomlinson, Wilkinson & Wilkinson, 2009). Therefore poor diet is likely to lead to the FADS noted above. Adult inattention has been found to be improved by Omega-3 supplementation (Fontani et al., 2005). However, most effects of supplementation on ADHD symptoms have been found to be small (Ross et al., 2007) or inconclusive (Tomlinson et al., 2009). It could be that individuals with ADHD have higher Omega-3 requirements (Soh et al. 2009). It could also be that there are other macronutrients involved that we have not discovered the role of yet (Sinn & Bryan, 2007). As the research in this area is far from conclusive, further investigations such as the current study are required to help understand the nature of the relationship.

Pelsser et al. (2009) found that children with ADHD who were placed on an elimination diet for 5 weeks no longer met the criteria for ADHD diagnosis. This shows that good diet is associated with decreased ADHD symptoms. Indicators of deficient levels of essential fatty acids (FADS) have been linked to ADHD and include dry skin and hair, brittle nails (Richardson, 2004; Suvarna, 2008) excessive thirst and urination (Tomlinson et al., 2009) and follicular keratoses (Milte, Sinn & Howe, 2009). However, one study found no correlation between signs of FADS and symptoms of ADHD (Sinn, 2007). Those from a poorer socio-economic status (in highincome societies - see above), often have poor diet quality (Kirby, Woodward, Jackson, Wang & Crawford, 2010). Most modern Western diets are higher in energy-dense refined grains, added fats and sugars (increased Omega-6), and lower in low energy-dense fish and vegetables (decreased omega-3) (Darmon & Drewnowski, 2008). Such diets indicate an increased Omega-6 to Omega-3 ratio (which has been found to be up to 20:1 - Richardson, 2004). It is still unclear 7

whether it is the absolute levels of Omega-3 and Omega-6 that matter or if the ratio is more important (Busch, 2007). Colter, Cutler, and Meckling (2008; Milte et al., 2009) found that those with ADHD had higher total and saturated fat intake, but lower body fat mass than controls. In addition, it has been found that reports of dietary intake do reflect the levels of essential fatty acid present (Kirby et al., 2010). This shows that a FADS scale can be appropriately used to indicate approximate levels of fatty acid.

Despite the clear link between ADHD and increased drug use, and ADHD and FADS, there is very little research pertaining to whether there is a distinct relationship between FADS and drug use. There is some evidence which suggests there could be links, but these variables have not been explicitly linked and studied. For example, those who have quit smoking increase their intake of polyunsaturated fatty acids (Strickland & Graves, 1992). In addition to lack of vitamins and minerals, conversion of ALA into omega-3 is also reduced by ingestion of alcohol and cigarette smoking (Tomlinson et al., 2009). Cannabis promotes appetite (the munchies) (Budney & Lile, 2009), especially for energy-dense and sweet foods (Kirkham, 2009; see also, Farrimond, Mercier, Whalley & Williams, 2011; Kirkham, 2008) and particularly when smoked chronically (Cotal et al., 2003). Smokers have lower body weight than non-smokers, as nicotine is an appetite suppressant (Jo, Talmage & Role, 2002), and therefore less overall calories are ingested (Chen et al., 2005). Once smoking ceases, there is often significant weight gain (Jo et al., 2002). So, this link between smoking cigarettes/cannabis and changes in appetite could have consequences for ADHD symptoms. As this area has not really been studied, a preliminary investigation into whether there could be a significant positive relationship may be beneficial.

On the basis of the above research, several hypotheses were generated. The first was that there would be a positive relationship between WURS score and FADS score. The second was that there would be a positive relationship between WURS score and increased cigarette smoking, increased cannabis use and increased alcohol intake. Finally, it was hypothesised that there would be a positive relationship between FADS and smoking (both cigarettes and cannabis). These hypotheses were tested using the questionnaires outlined in the Methods section below.

Method Participants Opportunity sampling was used to obtain 90 undergraduate students from the North West of England. Participants were aged between 18 and 38 (M = 20.88, SD = 3.33). Of these participants, 39 were male, and 51 were female. All participants received the same version of the questionnaire.

Design This study was a cross-sectional correlational survey. For the first hypothesis, the predictor variable (PV) was score on the WURS scale, the outcome variables (OV) was the FADS score. For the second hypothesis the PV was WURS score, and the OVs were the cannabis, alcohol and cigarettes scores. For the final hypothesis, PV was score on the FADS scale and the OVs were the cannabis, alcohol and cigarettes scores. 9

Stimuli A WURS scale comprising 30 Likert-type questions was used as it is a sensitive measure of adult ADHD (McCann, Scheele, Ward, & Roy-Byrne, 2000). A higher score on this scale was indicative of a greater number of ADHD-related symptoms (Mackin & Horner, 2005). A drugs questionnaire consisting of 7 questions was also used. The questions including in the analysis were those relating to amount and frequency of alcohol use (49-51), and the number of cigarettes (52) and cannabis joints smoked (53). This resulted in separate alcohol, cigarette and cannabis scores. The FADS questionnaire was created by the researcher and comprised 16 Likert-type questions, these questions focused on diet as this is our only source of fatty acids (Suvarna, 2008) and reports of diet have been found to be a good indicator of fatty acid levels (Kirby, Woodward, Jackson, Wang & Crawford, 2010). The questions included references to several symptoms which have been identified by research into FADS, including excessive thirst/urination (Tomlinson, Wilkinson & Wilkinson, 2009), dry skin and brittle nails (Richardson, 2004). It consisted of 11 positive (a higher score indicated FADS) and 5 negative items (a lower score indicated FADS).

Procedure The WURS, FADs and drugs scales were all combined into one questionnaire consisting of 53 questions (see Appendix 3). A pilot study using this questionnaire was conducted on 10 participants. Participants found the scales easy to understand and complete, so the scale was left unchanged for the study proper. The questionnaire was distributed to an opportunity sample of 10

students in the North West of England. Participants were informed of the purpose of the study and given instructions via a Participant Information sheet (see Appendix 1), which also assured them of their anonymity and confidentiality. Once this was read and any questions were answered the participants were then asked to fill out a consent form confirming their willingness to participate in the study (see Appendix 2). Once the data was collected it was inputted and analysed using the PASW 18 Statistics program (see Appendices 4-8). As the data was normally distributed (see Appendices 5 and 6), a Pearsons product-moment correlation coefficient test was conducted, which assessed the relationships between the WURS scores and the FADS, alcohol, cigarette and cannabis scores respectively. Post-hoc tests (also Pearsons) were conducted on interactions between drug use and age (see Appendix 8).

Results The questionnaire outlined above generated separate scores for WURS, FADS, and cigarette, alcohol and cannabis use in order to assess the nature of the relationship between these variables. In addition, age and gender were also recorded. The average age of the participants was 20.88 (SD = 3.33). The average WURS score was 55.82 (SD = 12.48), this appears to be quite a low average score as the minimum score was 30, and the maximum was 120, indicating that the overall level of ADHD symptoms present in the sample was low. The average FADS score (minimum: 16; maximum: 64) was 36.58 (SD = 6.1), indicating that the number of FADS symptoms were low and overall participants consumed a reasonably healthy diet. In relation to the drugs scores, 16 participants smoked cannabis. Of these participants the average number of joints smoked was 5 (SD = 4.95). Only 7 participants never drank alcohol. The average alcohol

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score was 8.57 (SD = 3.12), where 2 was the minimum and 15 was the maximum possible score. 21 participants were cigarette smokers, and the average number of cigarettes they smoked was 28.52 per week (SD = 23.91) (see Table 1). Table 1: Descriptive statistics mean scores for each variable. Age 20.88 (3.33) WURS FADS Cannabis 55.82 (12.48) 36.58 (6.1) 5 (4.95) Alcohol 8.57 (3.12) Cigarettes 28.52 (23.91)

Mean (SD)

As the WURS scores were normally distributed the data was analysed using Pearsons productmoment correlatory analysis. Pearsons analysis showed that there was no significant correlation between WURS and FADS scores [N = 90, r = -0.017, p = 0.438 (one-tailed)] as can be seen in Figure 1. As is visible from the scatter plot, they two variables appear to share no relationship within this sample; they are widely spread around the line of best fit. Therefore, the first hypothesis, that there would be a significant positive relationship between WURS score and FADS score was rejected. There was no significant correlation between WURS score and cannabis use [N = 90, r = -0.027, p= 0.399 (one-tailed)] (see Figure 2). The plot shows that the majority of participants did not report using cannabis, and for those that did, it was seemingly unrelated to the presence of ADHD symptoms. Furthermore, there was no significant correlation between WURS score and alcohol use [N = 90, r = 0.108, p= 0.156 (one-tailed)] (see Figure 3), the scores are widely spread out on the plot. Despite this, this was the strongest relationship found between WURS score and either FADS or drug use. Finally, there was no significant correlation between WURS score and cigarette smoking [N = 90, r = 0.067, p = 0.265 (onetailed)] (see Figure 4). The plot shows that the majority of participants did not smoke cigarettes and the cigarette scores are clearly unrelated to WURS score. Consequently, the second

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hypothesis, that there would be a significant positive relationship between WURS score and drugs scores was also rejected.

Figure 1: The non-significant relationship between WURS and FADS.

Figure 2: The non-significant relationship between WURS and cannabis.

Figure 3: The non-significant relationship between WURS score and alcohol score.

Figure 4: The non-significant relationship between WURS score and cigarette smoking.

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There was also no significant relationship found between FADS score and cannabis use [N = 90, r = -0.075, p= 0.243 (one-tailed)] (see Figure 5). Once more, the scores were quite widely spread above the line of best fit. Also, there was a non-significant relationship between FADS and cigarette smoking [N = 90, r = 0.14, p= 0.094 (one-tailed)] (see Figure 6). This means that the final hypothesis, that there would be a positive relationship between FADS and smoking (cigarettes/cannabis) was also rejected.

Figure 5: The non-significant relationship between FADS and cannabis.

Figure 6: The non-significant relationship between FADS and cigarette smoking.

Post hoc Pearsons tests found several significant results. The first was a positive relationship between age and cannabis use [N = 90, r = 0.368, p= 0.001 (one-tailed)] (see Figure 7). The second was a positive relationship between age and cigarette smoking [N = 90, r = 0.213, p = 14

0.022 (one-tailed)] (see Figure 8). Thirdly and finally, there was a positive relationship between cannabis use and cigarette smoking [N = 90, r = 0.551, p= 0.001 (one-tailed)] (see Figure 9).

Figure 7: The significant positive relationship between age and cannabis use.

Figure 8: The significant positive relationship between age and cigarette smoking.

Figure 9: The significant positive relationship between cannabis use and cigarette smoking.

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Discussion All three hypotheses were rejected. The relationship between WURs score and FADS score was found to be non-significant. This indicated that there was no evidence of a relationship between increased number of ADHD symptoms and deficient levels of essential fatty acids in this sample. This is in contradiction to the majority of evidence in this area, such as the studies by Sinn (2008), Ross et al. (2007) and Singh (2005) which show a clear relationship between ADHD and essential fatty acids. However, it does support the study by Sinn (2007) which found no correlation between FADS and ADHD symptoms.

It is difficult to compare the results of research into adult ADHD due to the wide variety of scales available, as the official diagnostic criteria for ADHD are based on it being a childhood disorder (Shifrin et al., 2010) (for example, use of a different scale within this study may have yielded a different result). Therefore, attempts should be made to create a standardised way of measuring adult ADHD, in order to make recognition of symptoms, diagnosis and comparison easier and more reliable (Davidson, 2008; see also, Clure et al., 1999) and more developmentally appropriate. For example, to ensure that all scales recognise the adult symptoms identified by Davidson (2008). However, for the present study, as the WURS has previously been found to be a good measure of ADHD symptoms (McCann et al., 2000) the lack of a significant relationship may be due to issues with the FADS scale. The symptoms outlined by Milte et al. (2009), Richardson (2004), Suvarna (2008), and Tomlinson et al. (2009) which were included in the FADS scale are almost certainly indicators of deficient levels of essential fatty acids. For future reference, a better scale may have asked more in depth questions regarding these symptoms, in

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order to assess the relationship between individual symptoms of FADS and ADHD. Furthermore, an updated FADS questionnaire would do better to have the more speculatory questions, regarding diet quality, in a separate scale as the speculatory nature of the questions may have affected the overall power of the FADS scale to identify potential FADS symptoms. For example, despite the findings of Darmon & Drewnowski (2008) and Kirby et al. (2010) poor diet may not lead to FADS in everyone, there may be other factors involved. Also, any new way of assessing FADS should be refined and tested on those who have been diagnosed with FADS and/or ADHD in order to test its discriminatory power. Accordingly, this does not mean that research into the relationship between ADHD and FADS should be disregarded, but should be refined.

It was also found that the relationships between WURS score and alcohol, cannabis and cigarette smoking were non-significant. The lack of any significant findings between the above variables is surprising in light of the weight of evidence, including the research by Biederman (2005), Barkley et al. (2004), and Milte et al. (2009), which states that SUDS and ADHD are significantly correlated. However, research does state that ADHD only leads to an increased risk of substance use (and vice versa) (Wilens, 2006; Wilens et al., 2006). It may be that this risk only appears above a certain threshold of symptoms and is not a problem for the normal population.

Another potential reason for the lack of significant relationships is that ADHD symptoms are 2-3 times more common in boys (Davids et al., 2005; Sinn & Bryan, 2007; Wender et al., 2001) and 17

males were under-represented in the sample (due to using an opportunity sample). It may also be due to the sample being from the university population, as those most likely to show symptoms of ADHD are those with a lower level of education (McAweeny et al., 2010). It is possible that participants may have found ways other than drug use to compensate for or mask their symptoms. Also, university students are often from more affluent backgrounds (Forsyth & Furlong, 2010), meaning they are more likely to have a healthy diet (as seen in the relatively low average FADS score found). Therefore, a methodological flaw in this study is that a random, more representative sample may have increased the likelihood of a significant result being found between the variables. However, this study does add information to the shortage of information of ADHD in the university population that was described by DuPaul et al. (2001).

A further methodological issue that may have affected the results is that it involved participants self-reporting (like the majority of adult ADHD scales - Jackson & Farrugia, 1997, cited in DuPaul et al., 2001) on potential ADHD symptoms, their personality, diet and drug use. It is possible that participants may not have wanted to present themselves unfavourably when answering such sensitive questions (Kessler et al., 2006). Future research, as well as using selfreports, could involve physiological data and reports from friends and family members on participants personality, diet and drug use in order to gain more realistic and reliable data.

Despite these factors which may have reduced the likelihood of a significant result, the study was conducted in the UK, a Western, higher-income country, therefore it was expected that more symptoms would be present (based on the findings presented in Fayyad et al., 2007). However, 18

WURS scores did vary quite widely (from 32 to 99) so it does show that there is a continuum of symptoms that present themselves below the threshold of diagnosis as postulated by Paloyelis et al. (2009). Hopefully this study has helped to show that ADHD symptoms do exist on a continuum and it is not only 2.5-5 per cent of the population (as described by Faraone et al., 2003; Kessler et al., 2006; Simon et al., 2009) who are affected by such symptoms. Further research could involve the use of semi-structured interviews to assess how individuals who do display a number of ADHD-like symptoms cope with them on a day-to-day basis, this could be then used to help those who are diagnosed with ADHD to cope with their symptoms without using prescribed drugs or self-medicating (which data suggests is what those who are not diagnosed do; Carroll & Rounsaville, 1993; Lambert & Hartsough, 1998; Sullivan & RudnikLevin, 2001; and Wilens & Fusillo, 2007).

This study also established that there was not a significant relationship between FADS and drug use. This is unsurprising as these hypotheses were based on limited amounts of data and were of a more exploratory nature. The lack of an effect of drug use on FADS could possibly be due to the balancing out of cigarettes appetite suppressing (Jo et al., 2002, Strickland & Graves, 1992) with cannabiss appetite increasing (Budney & Lile, 2009; see also, Kirkham 2008; 2009) properties (as cigarette smoking and cannabis use were significantly correlated). However, such a proposition needs further investigation.

The post-hoc tests uncovered several significant relationships. The first was slight positive correlation between cigarette smoking and age. The second was a similar relationship between 19

cannabis use and age. The third was a moderate relationship between cannabis use and cigarette smoking. These results could be used as a basis for future research surrounding drug use and age, or to support/refute findings in this area of research.

To conclude, it was found that there was a no relationship between ADHD and FADS, and no relationship between ADHD and drug use. This contradicts the majority of research surrounding ADHD, drug use and FADS. It was also found that there was no relationship between FADS and drug use. Post hoc tests found significant relationships between cigarette smoking and age, cannabis use and age, and cigarette smoking and cannabis use, respectively. The implications of this are that the evidence surrounding these variables is still highly inconclusive and deserve more consideration. Future research should be aimed at creating a more detailed, discriminatory and reliable measure of FADS, and investigating the effect of drugs on appetite and therefore fatty acid intake.

References Barkley, R. A. (2002). Major life activity and health outcomes associated with attentiondeficit/hyperactivity disorder. Journal of Clinical Psychiatry, 63(12), 10-15. Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2004). Young adult follow-up of hyperactive children: Antisocial activities and drug use. Journal of Child Psychology and Psychiatry, 42(2), 195-211.

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Biederman, J. (2005). Attention-deficit/hyperactivity disorder: A selective overview. Biological Psychiatry, 57, 1215-1220. Budney, A. J. & Lile, J. A. (2009). Moving beyond the cannabis controversy into the world of the cannabinoids. International Review of Psychiatry, 21(2), 91-95. Burke, J. D., Loeber, R., & Lahey, B. B. (2001). Which aspects of ADHD are associated with tobacco use in early adolescence? Journal of Child Psychology and Psychiatry, 42(4), 493-502. Busch, B. (2007). Polyunsaturated fatty acid supplementation for ADHD? Fishy, fascinating, and far from clear. Journal of Development & Behavioral Pediatrics, 28(2), 139-144. Carroll, K. M., & Rounsaville, B. J. (1993). History and significance of childhood attention deficit disorder in treatment-seeking cocaine abusers. Comprehensive Psychiatry, 34(2), 75-82. Chen, H. C., Vlahos, R., Bozinovskil, S., Jones, J., Anderson, G. P., & Morris, M. J. (2005). Effect of short-term cigarette smoke exposure on body weight, appetite and brain neuropeptide Y in mice. Neuropsychopharmacology, 30, 713-719. Clure, C. C., Brady, K. T., Saladin, M. E., Johnson, D., Waid, R., & Rittenbury, M. (1999). Attention-deficit/hyperactivity disorder and substance use: Symptom pattern and drug choice. American Journal of Drug and Alcohol Abuse, 25(3), 441-448. Colter, A. L., Cutler, C., & Meckling, K. A. (2008). Fatty acid status and behavioural symptoms of attention deficit hyperactivity disorder in adolescents: A case-control study. Nutrition Journal, 7, 1-11. 21

Cormier, E. (2008). Attention deficit/hyperactivity disorder: A review and update. Journal of Pediatric Nursing, 23(5), 345-357. Cotal, D., Marsicano, G., Lutz, B., Vicennati, V., Stallal, G. K., Pasquali, R., & Pagotto, U. (2003). Endogenous cannabinoid system as a modulator of food intake. International Journal of Obesity, 27, 289-301. Darmon, N., & Drewnowski, A. (2008). Does social class predict diet quality? The American Journal of Clinical Nutrition, 87, 11071117. Davids, E., von Bnau, U., Specka, M., Fischer, B., Scherbaum, N., & Gastpar, M. (2005). History of attention-deficit hyperactivity disorder symptoms and opioid dependence: A controlled study. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 29, 291-296. Davidson, M. A. (2008). ADHD in adults: A review of the literature. Journal of Attention Disorders, 11, 628-641. DuPaul, G. J., Schaughency, E. A., Weyandt, L. L., Tripp, G., Kiesner, J., Ota, K., & Stanish, H. (2001). Self-report of ADHD symptoms in university students: Cross-gender and crossnational prevalence. Journal of Learning Disabilities, 34, 370-379. Faraone S. V., Sergeant, J., Gillberg, C., Biederman, J. (2003). The worldwide prevalence of ADHD: Is it an American condition? World Psychiatry, 2, 104 113. Farrimond, J. A., Mercier, M. S., Whalley, B. J., & Williams, C. M. (2011). Cannabis sativa and the endogenous cannabinoid system: Therapeutic potential for appetite regulation. Phytotherapy Research, 25, 170-188. 22

Fayyad, J., de Graaf, R., Kessler, R., Alsonso, J., Angermeyer, M., Demyttenaere, K., de Girolamo, G., Haro, J. M., Karam, E. G., Lara, C., Lepine, J. P., Ormel, J., Posada-Villa, J., Zaslavsky, A. M., & Jin, R. (2007). Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. British Journal of Psychiatry, 190, 402-409. Fontani, G., Corradeschi, F., Felici, A., Alfatti, F., Migliorini, S., & Lodi. L. (2005) Cognitive and physiological effects of Omega-3 polyunsaturated fatty acid supplementation in healthy subjects. European Journal of Clinical Investigation, 35, 691-699. Forsyth, A. & Furlong, A. (2010). Access to higher education and disadvantaged young people. British Educational Research Journal, 29(2), 205-225. Horrocks, L. A. & Yeo, Y. K. (1999). Health benefits of docosahexaenoic acid (DHA). Pharmacological Research, 40(3), 211-225. Jo, Y-H., Talmage, D. A., & Role, L. W. (2002). Nicotinic receptor-mediated effects on appetite and food intake. Journal of Neurobiology, 53(4), 618-632. Kessler, R. C., Adler, L. Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Ustun, T. B., Walters, E. E., & Zaslavsky, A. M. (2006). Prevalence and correlates of adult ADHD in the United States. Results from National Comorbidity Survey Replication. American Journal of Psychiatry, 163, 716-723. Kirby, A., Woodward, A., Jackson, S., Wang, Y., & Crawford, M. A. (2010). Childrens learning and behaviour and the association with cheek cell polyunsaturated fatty acid levels. Research in Developmental Disabilities, 31, 731742.

23

Kirkham, T. C. (2008). Endocannabinoids and the neurochemistry of gluttony. Journal of Neuroendocrinology, 20, 1099-1100. Kirkham, T. C. (2009). Cannabinoids and appetite: Food craving and food pleasure. International Review of Psychiatry, 21(2), 163-171. Kollins, S. H., McClernon, J., & Fuemmler, B. F. (2005). Association between smoking and attention-deficit/hyperactivity disorder symptoms in a population-based sample of young adults. Archives of General Psychiatry, 62, 1142-1147. Lambert, N. M., & Hartsough, C. S. (1998). Prospective study of tobacco smoking and substance dependencies among samples of ADHD and non-ADHD participants. Journal of Learning Disabilities, 31, 533-544. Mackin, R. S. & Horner, M. D. (2005). Relationship of the Wender Utah Rating Scale to objective measures of attention. Comprehensive Psychiatry; 46(6), 468-471. McAweeny, M., Rogers, N. L., Huddleston, C., Moore, D., & Gentle, J. P. (2010). Symptom prevalence of ADHD in a community residential substance abuse treatment program. Journal of Attention Disorders, 13, 601-608. McCann, B. S., Scheele, L., Ward, N, & Roy-Byrne, P. (2000). Discriminant validity of the Wender Utah Rating Scale for attention-deficit/hyperactivity disorder in adults. Journal of Neuropsychiatry & Clinical Neurosciences, 12, 240-245. Milte, C. M., Sinn, N., & Howe, P. R. C. (2009). Polyunsaturated fatty acid status in attention deficit hyperactivity disorder, depression, and Alzheimers disease: Towards an Omega-3 index for mental health? Nutrition Reviews, 67(10), 573-590. 24

Paloyelis, Y., Asherson, P. & Kuntsi, J. (2009). Are ADHD symptoms associated with delay aversion or choice impulsivity? A general population study. Journal of the American Academy of Child and Adolescent Psychiatry, 48(8), 837-846. Pelsser, L. M. J., Frankena, K.,Toorman, J., Savelkoul, H. F. J., Pereira, R. R., & Buitelaar, J. K. (2009). A randomised controlled trial into the effects of food on ADHD. European Child & Adolescent Psychiatry, 18, 12-19. Pomerlau, O. F., Downey, K. K., Stelson, F. W., & Pomerlau, C. S. (1995). Cigarette smoking in adult patients diagnosed with attention deficit hyperactivity disorder. Journal of Substance Abuse, 7, 373-378. Richardson, A. J. (2004). Long-chain polyunsaturated fatty acids in childhood developmental and psychiatric disorders. Lipids, 39(12), 1215-1222. Ross, B. M., Seguin, J., & Sieswarda, L. E. (2007). Omega-3 fatty acid as treatment for mental illness: Which disorder and which fatty acid? Lipids in Health and Disease, 6, 21-39. Shifrin, J. G., Proctor, B. E., & Prevatt, F. F. (2010). Work performance differences between college students with and without ADHD. Journal of Attention Disorders, 13, 489-496. Simon, V., Czobor, P., Blint, S., Mszros, A., & Bitter, I. (2009). Prevalence and correlates of adult attention-deficit hyperactivity disorder: Meta-analysis. The British Journal of Psychiatry, 194, 204-211. Singh, M. (2005). Essential fatty acids, DHA and human brain. Indian Journal of Pediatrics, 72, 239-242.

25

Sinn, N. (2007). Physical fatty acid deficiency signs in children with ADHD symptoms. Prostaglandins, Leukotrienes and Essential Acids, 77(2), 109-115. Sinn, N. (2008). Nutritional and dietary influences on attention deficit hyperactivity disorder. Nutrition Reviews, 66(10), 558-568. Sinn, N. & Bryan, J. B. (2007). Effect of supplementation with polyunsaturated fatty acids and micronutrients on learning and behavior problems associated with child ADHD. Journal of Developmental and Behavioral Pediatrics, 28, 82-91. Soh, N., Walter, G., Baur, L., & Collins, C. (2009). Nutrition, mood and behavior: A review. Acta Neuropsychiatrica, 21, 214-227. Spencer, T. J., Adler, L. A., Qiao, M., Saylor, K. E., Brown, T. E., Holdnack, J. A., & Schuh K. A. (2010). Validation of the Adult ADHD Investigator Symptom Rating Scale (AISRS). Journal of Attention Disorders, 14, 57-68. Strickland, D. & Graves, K. (1992). Smoking status and dietary fats. Preventive Medicine, 21(2), 228-236. Sullivan, M. A., & Rudnik-Levin, F. (2001). Attention/deficit/hyperactivity disorder and substance abuse. Diagnostic and therapeutic considerations. Annals of the New York Academy of Sciences, 931, 251-270. Suvarna, B. S. (2008). Secrets of Omega-3 oil. Kathmandu University Medical Journal, 6(3), 406-411. Tomlinson, D., Wilkinson, H. & Wilkinson, P. (2009). Diet and mental health in children. Child and Adolescent Mental Health, 14(3), 148155. 26

Wender, P. H., Wolf, L. E., & Wasserstein, J. (2001). Adults with ADHD. An overview. Annals of the New York Academy of Sciences, 931, 1-16. Wilens, T. E. (2006). Attention deficit hyperactivity disorder and substance use disorders. American Journal of Psychiatry, 163(12), 2059-2063. Wilens, T. E., & Fusillo, S. (2007). When ADHD and substance use disorders intersect: Relationship and treatment implications. Current Psychiatry Reports, 9, 408-414. Wilens, T. E., Adamson, J., Sgambati, S., Whitley, J., Santry, A., Monuteaux, M. C., & Biederman, J. (2007). Do individuals with ADHD self-medicate with cigarettes and substances of abuse? Results from a controlled family study of ADHD. The American Journal on Addictions, 16, 14-23.

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Appendix

28

Appendix 1: Participant information sheet

PARTICIPANT INFORMATION SHEET

Title of Study: An Exploration of the Relationship between ADHD Symptomology, Recreational Drug Use and Fatty Acid Deficiency in a Normal Population. Researcher(s): Dionne Donnelly Principal Investigator: Dr Judith Smith You are being invited to participate in a research study. Before you decide whether to participate, it is important for you to understand why the research is being done and what it will involve. Please take time to read the following information carefully and feel free to ask us if you would like more information or if there is anything you do not understand. Please also feel free to discuss this with friends and the researcher if you wish. We would like to stress that you do not have to accept this invitation and should only agree to take part if you want to. Thank you for reading this.

Past research has indicated that most people exhibit at least some of the symptoms/characteristics of Attention Deficit Hyperactivity Disorder (ADHD). The ADHD questionnaire used in this study provides a score indicating the level of ADHD symptomology, which can then be ranked in terms of severity only within this sample. This study aims to investigate the relationship between ADHD symptomology, recreational drug/alcohol use and fatty acid deficiency. Research has shown that individuals diagnosed with ADHD are more likely to use recreational drugs and to show signs of fatty acid (omega-3) deficiency. This study will also indicate if there is a relationship between degree of drug use and fatty acid deficiency symptoms. This research may have serious implications for the diagnosis of ADHD, and for drug intervention programmes. You will be asked to complete questionnaires which will assess levels of the following: ADHD symptoms Recreational drug/alcohol use Fatty acid deficiency symptoms 29

Altogether the questionnaires consist of 53 questions and should take you approx. 15-20 minutes to complete. Please answer all questions as accurately as possible. If you should experience any discomfort or disadvantage as part of the research please tell the researcher (s) immediately. If you are unhappy with any aspect of the study, or if there is a problem. Please feel free to let us know by contacting the Principal Investigator, Dr Judith Smith on 0151 794 2951 (judis@liv.ac.uk) and we will try to help. If you remain unhappy or have a complaint which you feel you cannot come to us with, then you should contact the Research Governance Officer on 0151 794 8290 (ethics@liv.ac.uk). When contacting the Research Governance Officer, please provide details of the name or description of the study (so that it can be identified), the researcher(s) involved, and the details of the complaint you wish to make. All information collected will be used only for the purpose of the research and will be kept confidential. Data will be anonymised and only the Researcher(s) and the Principal Investigator will have access to the data. You are welcome to apply to the Principal Investigator, Dr Judith Smith, for a summary of the results of the study. You may withdraw from the study at any time, without explanation and if you so wish your data will be removed from the study and destroyed. If you have any further questions please contact the Principal Investigator: Dr Judith A. Smith School Of Psychology University of Liverpool Eleanor Rathbone Building Bedford Street Liverpool L69 7ZA Tel: 0151-794-2951 e-mail: judis@liv.ac.uk

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Appendix 2: Consent form

CONSENT FORM Title of Study: An Exploration of the Relationship between ADHD Symptomology, Recreational Drug Use and Fatty Acid Deficiency in a Normal Population. Researcher: Dionne Donnelly Principal Investigator: Dr Judith Smith Please initial box 1. I confirm that I have read and have understood the information sheet dated October 2007, for the above study. I have had the opportunity to consider the information, ask questions and have had these answered satisfactorily.

2. I understand that my participation is voluntary and that I am free to withdraw at any time without giving any reason, without my rights being affected. 3. I understand that, under the Data Protection Act, I can at any time ask for access to the information I provide and I can also request the destruction of that information if I wish. 4. I agree to take part in the above study.

Participant Name

Date

Signature

Researcher

Date

Signature

The contact details of lead Researcher (Principal Investigator) are: Dr Judith A. Smith, School Of Psychology, University of Liverpool, Eleanor Rathbone Building, Bedford Street, Liverpool, L69 7ZA. Tel: 0151-794-2951 e-mail: judis@liv.ac.uk 31

Appendix 3: Questionnaire Wender Utah Rating Scale For each question, please tick the box that you think best matches you:
Not at all or rarely 1. Do you have difficulty with concentrating, mind wandering and distractability? 2. Do people complain that you dont pay attention to them when theyre talking? 3. Do you have difficulty keeping your mind on reading materials? 4. Are you forgetful and lose or misplace things like car keys, purse, wallet etc? 5. Are you fidgety? 6. Do you drum with your fingers, kick or tap with your foot? 7. Are you restless, cant sit still, always on the go? 8. Do you talk too much? Do other people feel you talk too much? 9. Do you have difficulty relaxing? 10. Do you have trouble sitting still through a movie or TV show? Do you get up from the table immediately after dinner? 11. Do you have a short fuse or a low boiling point? 12. Are you irritable? 13. Do you keep your anger in? 14. When you are angry do you lose control verbally? 15. When you are angry do you lose control physically? 16. Are you (or have you been) depressed, sad, blue, down in the dumps? Do you have periods when you get excited, flying, going too fast? 17. Does your mood change up and down like a roller coaster? 18. Do you feel down on yourself, self-critical, have low self-esteem? 19. Do you over-react to pressure? Do you feel easily stressed, flustered, hassled, depressed, angry? 20. Do you have problems with overstimulation or going too fast? 21. Do you make mountains out of molehills, or blow things up out of proportion? 22. Do you have trouble planning/organising your time/money/work? 23. Do you have problems starting difficult projects, or do you put things off, procrastinate? 24. Have you had problems because of saying or doing things before youve thought things out? Somewhat or sometimes Quite a bit Very often

32

25. Do you interrupt others when they are talking? 26. Do you make impetuous decisions, based on angry feelings? 27. Are you reckless? 28. Do others regard you or do you regard yourself as impatient, for example, while driving, with children or others? 29. Do you act first and think later, for example do you impulse buy? 30. Do you have trouble sticking to things once started, or do you jump from one task to another before finishing the first?

FADS Symptomology Scale How much would you say you agree with each of these statements?
Not at all or rarely 31. I get thirsty. 32. I need to urinate more than other people. 33. My hair is dry. 34. My skin is dry. 35. My nails are soft and/or brittle. 36. I suffer from dandruff. 37. I get raised red bumps that appear on my skin. 38. I have a healthy balanced diet. 39. I eat oily fish (such as fresh [not tinned] tuna, kippers etc). 40. I eat dark, leafy vegetables (such as spinach and green cabbage). 41. People have expressed concern over my diet. 42. I eat nuts and/or seeds. 43. I eat fast food (such as pizzas and take-aways). 44. I eat meals containing a meat product. 45. I consume dairy products. 46. I take omega-3/omega-6 supplement capsules. Somewhat or sometimes Quite a bit Very often

33

And finally, please answer the following questions regarding drug use:
47. Which of the following drugs have you used at least once? Amphetamine Tranquillisers Magic Mushrooms Heroin Naloxone Ketamine Ecstasy Crack Poppers (Please circle your answers) Cocaine LSD None Cannabis Glue/Solvents

48. Which of the following drugs do you currently use, or have used in the past, on a fairly regular basis ? (Please circle your answers) Amphetamine Tranquillisers Magic Mushrooms Heroin Naloxone Ketamine Ecstasy Crack Poppers Cocaine LSD None Cannabis Glue/Solvents

49. How often do you have a drink containing alcohol? Never Monthly or less Two to four times a month Two to three times a week Four or more times a week

50. How many drinks containing alcohol do you have on a typical day when you are drinking? 1 or 2 3 or 4 5 or 6 7 to 9 10 or more

51. How often do you have six or more drinks on one occasion? Never Less than monthly Monthly Weekly Daily or almost daily

52. If you smoke, please estimate how many cigarettes you typically smoke in a week: ___________ 53. If you use cannabis, please estimate how many joints you typically smoke in a week: ___________

Thank you very much for taking part in this study. Your time and effort is much appreciated.

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Appendix 4: Raw Data.

PP

Age

Gender

WURS

FADS

Cann.

Alc.

Cig.

PP

Age

Gender

WURS

FADS

Cann.

Alc.

Cig.

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49

18 20 21 21 21 18 20 19 19 19 20 19 18 18 18 21 18 19 21 19 20 18 19 19 30 38 21 28 23 18 25 20 18 27 19 20 20 20 20 21 21 24 18 20 20 21 19 20 21

Female Female Female Female Female Male Female Female Female Male Male Female Male Female Female Female Female Female Male Female Female Female Female Female Female Female Male Male Male Female Female Female Female Male Female Female Female Male Male Male Male Male Male Female Female Female Male Female Female

68 62 52 60 52 56 56 64 73 54 41 42 32 58 34 67 49 48 54 33 49 48 52 42 50 70 40 61 39 64 58 53 51 56 53 47 55 41 49 68 46 42 71 50 78 65 57 52 89

36 29 50 44 34 37 34 37 42 37 36 26 38 42 28 32 42 39 38 31 41 38 33 32 53 25 34 36 38 32 34 44 45 40 39 36 29 34 30 39 34 39 39 33 39 39 39 45 35

0 0 0 0 0 0 0 0 2 0 3 0 0 0 0 5 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 7 0 5 0 0 1 0 0 0 0 0 0 0 0 0 0

10 6 9 9 6 14 11 12 9 11 12 10 7 11 4 12 11 4 12 7 9 10 12 11 6 7 2 11 7 6 11 12 11 12 8 9 6 12 6 8 9 12 10 12 12 12 13 10 12

0 0 0 0 0 0 10 0 70 0 0 0 0 0 0 40 0 0 20 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 5 0 0 30 10 0 70 0 0 0 0 0 45 0

50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90

24 20 21 20 19 19 19 20 20 20 20 20 19 18 30 26 20 18 19 23 18 25 29 19 21 23 23 19 20 25 19 18 24 22 19 19 18 19 26 23 20

Male Male Female Female Male Male Male Male Female Female Female Female Female Female Female Male Female Male Male Male Male Male Male Male Female Female Female Male Male Male Female Female Female Male Male Male Male Male Male Female Female

52 64 77 71 36 43 99 59 46 67 87 52 50 48 46 62 63 57 58 63 72 58 45 87 67 51 56 55 60 48 39 54 57 56 49 42 48 51 56 54 68

34 37 36 39 33 42 37 34 34 31 36 33 48 41 35 51 36 36 48 39 28 23 34 29 36 38 35 42 47 41 50 46 34 30 27 29 31 34 25 29 38

0 0 0 0 0 0 0 0 0 0 0 0 0 0 21 5 10 0 0 0 0 7 2 0 0 0 3 1 0 0 0 0 0 0 0 0 1 0 4 0 3

8 9 13 12 9 2 11 10 12 2 2 2 8 10 6 10 12 5 8 7 5 9 12 6 2 9 11 10 5 8 2 9 4 9 4 5 6 8 10 8 6

0 0 0 0 0 0 12 0 0 0 0 0 0 0 70 70 30 20 0 0 0 20 10 0 0 0 5 0 0 0 0 10 10 0 0 0 0 0 0 0 40

Key: WURS: Score on WURS scale. FADS: Score on FADS scale. Cann.: Cannabis score. Alc.: Alcohol score. Cig.: Cigarette score.

35

200528625

C800

PSYC340

Appendix 5: Histogram showing normal distribution of WURS scores.

Appendix 6: Histogram showing normal distribution of WURS scores.

36

200528625 Appendix 7: Descriptive Statistics

C800

PSYC340

Gender WURS FADS Age Cannabis Alcohol Cigarettes Valid N

N 90 90 90 90 90 90 90 90

Mean 1.57 55.82 36.58 20.88 5 8.57 28.52

SD .498 12.477 6.100 3.328 4.95 3.123 23.91

Appendix 8: Pearsons Correlations

Age
Pearson Correlation 1 90 -.059 .289 90 .032 .383 90 -.086 .210 90 .368** .000 90 .029 .391 90 .213* .022 90

Gender
-.059 .289 90 1 90 .090 .198 90 .102 .170 90 .030 .391 90 .001 .497 90 -.006 .478 90

WURS
.032 .383 90 .090 .198 90 1 90 -.017 .438 90 -.027 .399 90 .108 .156 90 .067 .265 90

FADS
-.086 .210 90 .102 .170 90 -.017 .438 90 1 90 -.075 .243 90 .115 .141 90 .140 .094 90

Cannabis
.368
**

Alcohol
.029 .391 90 .001 .497 90 .108 .156 90 .115 .141 90 .069 .259 90 1 90 .079 .230 90

Cigarettes
.213* .022 90 -.006 .478 90 .067 .265 90 .140 .094 90 .551** .000 90 .079 .230 90 1 90

Age

Sig. (1-tailed) N Pearson Correlation Sig. (1-tailed) N Pearson Correlation Sig. (1-tailed) N Pearson Correlation Sig. (1-tailed) N Pearson Correlation Sig. (1-tailed) N Pearson Correlation Sig. (1-tailed) N Pearson Correlation Sig. (1-tailed) N

.000 90 .030 .391 90 -.027 .399 90 -.075 .243 90 1 90 .069 .259 90 .551** .000 90

Gender

WURS

FADS

Cannabis

Alcohol

Cigarettes

**. Correlation is significant at the 0.01 level (1-tailed). *. Correlation is significant at the 0.05 level (1-tailed).

37