Attention Deficit Hyperactivity Disorder Symptoms are Common in Patients in Opioid Maintenance Treatment

Abstract

Introduction and Aims: Knowledge of attention deficit hyperactivity disorder (ADHD) symptoms among patients in opioid maintenance treatment (OMT) is important for treatment optimization and yet limited. We investigated the prevalence of ADHD symptoms, and factors associated with high ADHD symptom burden in a group of Norwegian OMT patients. Methods: We interviewed individuals entering OMT across Norway in 2 steps between 2012 and 2016. ADHD symptoms were measured by the Adult ADHD Self-Report Scale (ASRS; n = 175). We compared 2 groups of individuals who scored above or below the clinical cutoff score. Mental distress was measured with the General Symptom Index (GSI) of the Hopkin’s Symptom Check-List-25. Results: A total of 33% of the OMT patients screened positively for ADHD on the ASRS. Participants who scored above the clinical cutoff were younger, and reported more severe substance use and mental distress. When controlling for other significant variables in a logistic regression analysis, scoring above cutoff on the ASRS was associated with higher GSI (OR 1.61; 95% CI 1.03–2.50) and use of stimulants (OR 2.55; 1.13–5.76). Conclusions: ADHD symptoms were common in these OMT patients. High ADHD symptom burden was associated with higher mental distress and use of stimulants. This underlines a need of more systematic focus on ADHD in OMT to plan treatment accordingly.

Ten Years of Experience With Buprenorphine in a Private Psychiatric Outpatient Practice

“…Of note were the high prevalence of major depressive disorder (31%), ADHD (27%), and generalized anxiety disorder (23%) compared with general population estimates of 7%, 11%, and 3%, respectively 14 . Similarly high rates of these diagnoses in the opioid use disorder population have been reported by others 15‐18 . Most patients in this study reported that their comorbid psychiatric disorders played a significant role in their opioid dependence, as their psychiatric symptoms were greatly ameliorated by opioids.…”

Attention Deficit Hyperactivity Disorder among Clients Diagnosed with a Substance Use Disorder in the Therapeutic Communities: Prevalence and Psychiatric Comorbidity

“…The prevalence estimates may differ according to the type of substance used and the subpopulations or treatment modality. For example, the following populations of patients in opioid maintenance treatment (OMT) were screened positively for ADHD: in Norway, 33% of OMT patients [5], in Austria, in 50% of children and 17% of adults of the mainly male prison inmates in OMT [6], and in Italy, 11.2% of OMT patients [7]. In the methamphetamine-using population of one hospital’s psychiatric center, the prevalence of the ADHD diagnosis went up to 55.6% [8].…”

Levels of Impulsivity, Hyperactivity, and Inattention and the Association with Mental Health and Substance Use Severity in Opioid-Dependent Patients Seeking Treatment with Extended-Release Naltrexone

“…It was recommended by Kessler et al [ 19 ] as an initial screening tool for ADHD and has been used, to some extent, in populations with SUDs [ 19 , 20 , 21 ]. The scoring method is similar to that of the full version, with the summed score ranging from 0–6, and a score ≥ 4 is considered to be a likely positive screen for ADHD [ 3 , 4 , 22 ]. Compared to the 18-item version, which was validated in a representative community sample, Daigree et al [ 20 ] reported a much higher sensitivity (87.5%) and much lower specificity (68.6%) for the 6-item scale in a population with SUDs [ 20 ].…”

“…A high prevalence of psychiatric comorbidity, mental distress, and attention deficit hyperactivity disorder (ADHD) has been observed in a number of patient populations with substance use disorder (SUD) [ 1 , 2 ]. However, knowledge of the impact of ADHD symptomatology as a co-occurring condition among opioid-dependent patients enrolled in opioid maintenance treatment (OMT) is sparse [ 3 , 4 ]. The core symptoms of ADHD are impulsivity, hyperactivity, and inattention (IHI) and difficulties performing executive functions.…”