Screening for adult attention deficit/hyperactivity disorder in high-dose benzodiazepine dependent patients

Abstract

Screening for ADHD in this type of SUD with this questionnaire is quick and may offer useful information for prognosis and treatment. (Am J Addict 2017;26:610-614).

Association between Adult Attention Deficit/Hyperactivity Disorder and Intravenous Misuse of Opioid and Benzodiazepine in Patients under Opioid Maintenance Treatment: A Cross-Sectional Multicentre Study

“…We confirmed adult ADHD positive screening to be overrepresented in patients under OMT, in that 11.2% of our sample was classified as ADHD+ according to the ASRS-v1.1 Symptom Checklist Part A [43], with women having approximately 1.5 higher adult ADHD positive screening than men. Our estimate, which is 2-4 times higher than ADHD prevalence in the general adult population [28,30], is in keeping with previous reports on SUD patients [31][32][33][34]42]. This estimate is higher than that reported in Taiwan (8%) [46], comparable to that of an international study [32], but smaller than those of some previous studies in European countries on heroin dependent patients (15-33%) [37,38,40].…”

“…They also expand the notion that ADHD is associated with worse outcome in patients under OMT [37,41], being associated with increased likelihood of misusing OMT. ADHD has been suggested to be associated with sequential polydrug use, where early SUD increases the risk for subsequent use of other drugs [42,49]. The association between positivity to adult ADHD screening and misuse of both OMT and BZD by different routes is in accordance with the hypothesis that ADHD should be considered a cross-cultural risk-factor for SUD, unspecific to the used drug [31].…”

“…Other limitations include the cross-sectional design that impeded an estimate of risk of misuse secondary to ADHD, no information on abuse of other substances (e.g., cocaine, alcohol), coexisting psychiatric conditions, conduct disorders, ADHD subtypes (i.e., combined, inattentive, hyperactive/impulsive), executive functions and impulsivity [42], and the absence of a match of the answers to the questionnaire (e.g., ER admissions because of misuse complications) with objective data.…”

“…Adult ADHD has higher prevalence (i.e., 5-46%) in patients with substance use disorder (SUD) than the general population [31][32][33][34] and is considered a risk factor for SUD [35,36]. ADHD is prevalent in patients affected by heroin dependence [37,38], those under OMT [39,40], where it is characterised by greater addiction severity, more comorbid psychopathology and antisocial personality disorders, and worse quality of life [37,41], and in high-dose BZD users [42]. Whether ADHD might be associated with higher misuse rate in patients under OMT has never been explored.…”

Adult Attention-Deficit/Hyperactivity Disorder and Quality of Life in High-Dose Benzodiazepine and Related Z-Drug Users

“…Exploring the presence of adult ADHD may be helpful to improve the treatment and prevent relapses in patients with SUD [21]. The diagnosis of adult ADHD may be complex because of the elaborated and time-consuming diagnostic interview that requires a retrospective investigation of childhood symptoms [27], and different diagnostic criteria across DSM versions might influence estimates of ADHD prevalence [17]. Using a valid ADHD screening tool with good accuracy and short time of application might be useful in a busy clinical setting [17,27].…”