Barriers to implementation of treatment guidelines for ADHD in adults with substance use disorder

The Role of Age in Adult ADHD Quality Care: A Longitudinal Analysis of Electronic Health Record Data

OBJECTIVE

Several studies have shown that Adult ADHD presents differently in younger and older adults. We sought to assess the difference in care between these two groups using previously identified quality measures (QMs).

METHODS

Using electronic health record data, we matched a younger group of ADHD patients to an older group. We then assessed the achievement of the QMs using probit models with and without interaction terms.

RESULTS

The majority of QMs shown an increase in achievement for both groups over time. However, significant differences in quality of care between younger and older adult ADHD patients persisted. By the end of the study period, with the exception of three QMs, younger patients achieved the QMs more.

CONCLUSION

While, in general, the quality of care for adult ADHD increased from 2010 to 2020, there were still differences in care between younger and older adult ADHD patients.

No prescription? No problem: A qualitative study investigating self-medication with novel psychoactive substances (NPS)

BACKGROUND

The proliferation of Novel Psychoactive Substances (NPS) presents a challenge for global drug policy. The ease of online drug purchase and the emergence of the dark web have created new avenues for the growth of NPS. Despite the global nature of this issue, limited research has examined motivations of use. These include perceived safety or convenience, an interest in novel pharmacology and self-exploration. Recent evidence has suggested individuals may be self-medicating with NPS, however this phenomenon has yet to be thoroughly explored. This study aims to investigate the occurrence of NPS self-medication, identify the specific NPS involved, and understand the motivations behind their use.

METHODS

Discussions surrounding self-medication using NPS were collected between October 2022 and February 2023 via a content analysis of a Reddit community. Ninety-three threads, comprising 182,490 words and 5023 comments, were collected and cleaned. A frequency analysis was conducted to identify the NPS discussed, and data was analysed systematically through the process of iterative categorization (IC).

RESULTS

Our study revealed frequent discussions about the self-medication with several NPS, notably etizolam, clonazolam, diclazepam, flualprazolam, 2-FMA, 4F-MPH, 3-FPM and 3-MeO-PCP. Individuals were mainly self-treating ADHD, anxiety and depression. Motivations for choosing NPS included access, cost, legality and a dissatisfaction with conventional healthcare. Substances were often chosen based on a profile of "Functionality" and outcomes varied. The use of clonazolam was highlighted as particularly problematic.

CONCLUSION

The current study provides insight into the phenomenon of self-medication with NPS within an internet demographic, exploring the motivations behind why individuals choose NPS for a variety of disorders. The easy access to NPS and lack of scientific data pose a significant challenge for drug policy. Future policies should focus on improving healthcare providers knowledge of NPS use, removing barriers to adult ADHD diagnosis and rebuilding trust between individuals and addiction services.

Validity of the ADHD module of the Mini International Neuropsychiatric Interview PLUS for screening of adult ADHD in treatment seeking substance use disorder patients: ADHD screening with MINI-Plus

OBJECTIVE

This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion.

METHOD

A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus.

RESULTS

According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60.

CONCLUSION

The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients.

SCIENTIFIC SIGNIFICANCE

On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.

Adult attention-deficit hyperactivity disorders and its correlates in patients with opioid dependence: An exploratory study

BACKGROUND

Adult attention-deficit hyperactivity disorder (ADHD) often remains undiagnosed and undertreated among patients with substance use disorders (SUDs). Research is lacking with regard to adult ADHD in individuals with SUD. The current work was intended to study the prevalence of adult ADHD among individuals with opioid dependence and its correlates, and to assess the attitude of the individuals with adult ADHD toward its treatment.

METHODS

This cross-sectional survey was conducted in 132 consecutive inpatients with opioid-dependence syndrome. Patients were assessed using the Mini International Neuropsychiatric Interview. 5.0, adult ADHD Self-Report Screening Scale, and Maudsley Addiction Profile. Those who screened positive for adult ADHD (ADHD+) were compared with those screened negative (ADHD-) on a number of sociodemographic, substance use, and clinical variable. Furthermore, attitude toward the treatment for ADHD was assessed among the ADHD+ individuals.

RESULTS

About a fifth (n=24, 18.2%) of the patients with opioid dependence screened positive for adult ADHD. One-third of the participants (n=8, 33.3%) were willing for the treatment of any kind, and only a half (n=3) was willing to pay. Earlier age of onset of opioid use (relative risk: 0.01; 95% confidence interval: 0.003, 0.85; P = 0.036) had higher likelihood to ADHD+ status.

CONCLUSION

Despite a high rate of ADHD screen positivity among individuals with opioid dependence, a majority were not willing to receive the treatment. Sensitization of: (1) addiction psychiatrist to routinely screen for ADHD, especially in the presence of certain correlates and (2) patients-caregivers about the potential benefit of treatment in effectively addressing the symptoms of ADHD effectively in this population.

International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder

Adult attention deficit/hyperactivity disorder (ADHD) often co-occurs with substance use disorders (SUD) and is associated with early onset and more severe development of SUD and with reduced treatment effectiveness. Screening tools allow for a good recognition of possible ADHD in adults with SUD and should be used routinely, followed by an ADHD diagnostic process initiated as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, using a combination of pharmaco- and psychotherapy, is recommended. Long-acting methylphenidate, extended-release amphetamines, and atomoxetine with up-titration to higher dosages may be considered in patients unresponsive to standard doses. This paper includes evidence- and consensus-based recommendations developed to provide guidance in the screening, diagnosis and treatment of patients with ADHD-SUD comorbidity.

Relationship of self-mutilative behaviour with history of childhood trauma and adult ADHD symptoms in a sample of inpatients with alcohol use disorder

The aim of the present study was to evaluate relationship of self-mutilative behaviour (SMB) with the severity of childhood trauma and adult attention-deficit/hyperactivity disorder (ADHD) symptoms in a sample of inpatients with alcohol use disorder (AUD). Participants included 188 inpatients with AUD. Participants were evaluated with the Self-mutilative Behaviour Questionnaire, the Childhood Trauma Questionnaire (CTQ-28) and the Adult ADD/ADHD DSM-IV Based Diagnostic Screening and Rating Scale (Adult ADHD Scale). Among inpatients with AUD those who have a history of SMB constituted the SMB group (n = 57, 30.3%), and those without a history of SMB constituted the group without SMB (n = 131, 69.7%). Risk of high ADHD risk was 2.5 times higher among those with SMB. Adult ADHD Scale and CTQ-28 scores were also higher in the group with SMB. In the first backward logistic regression model, the severity of ADHD symptoms predicted the presence of SMB, together with the severity of childhood trauma, whereas in the second model, physical neglect and inattentive (IN) dimension of ADHD predicted the presence of SMB. These findings suggest that the higher severity of physical neglect and adult IN dimension of ADHD may be related to SMB among inpatients with AUD.