Australian & New Zealand Journal of Psychiatry | 2021
Assessment of attention-deficit hyperactivity disorder in people with substance use disorder: Another case of what gets measured gets done
Abstract
International guidelines recommend that attention-deficit hyperactivity disorder (ADHD) be identified and treated in all age groups, with increased focus on subpopulations with a high prevalence of ADHD. One such group is people who seek treatment for substance use disorder (SUD). ADHD doubles the risk of SUD and approximately one in four people with SUD have co-occurring ADHD. Although often complex and challenging, ADHD can be reliably diagnosed during active substance use and is often important for effective treatment of concurrent SUD (Van Emmerik-Van Oortmerssen et al., 2017). Despite this, ADHD is underdiagnosed among adults with SUD. ADHD often complicates the clinical profile and treatment of SUD. ADHD has been associated with increased complexity and chronicity of SUD and decreased SUD treatment efficacy and retention. Furthermore, ADHD among those with SUD can result in high rates of costly substance use–related acute care contacts, poor physical and mental health outcomes, increased contact with the criminal justice system, reduced quality of life, suicidal behaviour and premature mortality (Sciberras et al., in press). Without addressing the underlying impaired executive functioning and impulsivity – both central characteristics of ADHD – those with unidentified ADHD may engage in risk-taking behaviour increasing their risk of poor health and social outcomes, despite receiving treatment for SUD and other mental health disorders. Accordingly, a randomised controlled trial found that treating ADHD symptoms decreased substance use and criminal justice involvement (Konstenius et al., 2014).