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Published in: BMC Psychiatry 1/2012

Open Access 01-12-2012 | Research article

Rates of undiagnosed attention deficit hyperactivity disorder in London drug and alcohol detoxification units

Authors: Zoe Huntley, Stefanos Maltezos, Charlotte Williams, Alun Morinan, Amy Hammon, David Ball, E Jane Marshall, Francis Keaney, Susan Young, Patrik Bolton, Karen Glaser, Raoul Howe-Forbes, Jonna Kuntsi, Kiriakos Xenitidis, Declan Murphy, Philip J Asherson

Published in: BMC Psychiatry | Issue 1/2012

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Abstract

Background

ADHD is a common childhood onset mental health disorder that persists into adulthood in two-thirds of cases. One of the most prevalent and impairing comorbidities of ADHD in adults are substance use disorders. We estimate rates of ADHD in patients with substance abuse disorders and delineate impairment in the co-morbid group.

Method

Screening for ADHD followed by a research diagnostic interview in people attending in-patient drug and alcohol detoxification units.

Results

We estimated prevalence of undiagnosed ADHD within substance use disorder in-patients in South London around 12%. Those individuals with substance use disorders and ADHD had significantly higher self-rated impairments across several domains of daily life; and higher rates of substance abuse and alcohol consumption, suicide attempts, and depression recorded in their case records.

Conclusions

This study demonstrates the high rates of untreated ADHD within substance use disorder populations and the association of ADHD in such patients with greater levels of impairment. These are likely to be a source of additional impairment to patients and represent an increased burden on clinical services.
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Literature
1.
go back to reference Ford T, Goodman R, Meltzer H: The british child and adolescent mental health survey 1999: the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry. 2003, 42: 1203-11. 10.1097/00004583-200310000-00011.CrossRefPubMed Ford T, Goodman R, Meltzer H: The british child and adolescent mental health survey 1999: the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry. 2003, 42: 1203-11. 10.1097/00004583-200310000-00011.CrossRefPubMed
2.
go back to reference Simon V, Czobor P, Balint S, Meszaros A, Bitter I: Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry. 2009, 194: 204-11. 10.1192/bjp.bp.107.048827.CrossRefPubMed Simon V, Czobor P, Balint S, Meszaros A, Bitter I: Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry. 2009, 194: 204-11. 10.1192/bjp.bp.107.048827.CrossRefPubMed
3.
go back to reference McCarthy S, Asherson P, Coghill D, Hollis C, Murray M, Potts L, Sayal K, de Soysa R, Taylor E, Williams T, Wong IC: Attention-deficit hyperactivity disorder: treatment discontinuation in adolescents and young adults. Br J Psychiatry. 2009, 194: 273-7. 10.1192/bjp.bp.107.045245.CrossRefPubMed McCarthy S, Asherson P, Coghill D, Hollis C, Murray M, Potts L, Sayal K, de Soysa R, Taylor E, Williams T, Wong IC: Attention-deficit hyperactivity disorder: treatment discontinuation in adolescents and young adults. Br J Psychiatry. 2009, 194: 273-7. 10.1192/bjp.bp.107.045245.CrossRefPubMed
4.
go back to reference Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, De Girolamo G, Haro JM, Karam EG, Lara C, Lepine JP, Ormel J, Posada-Villa J, Zaslavsky AM, Jin R: Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry. 2007, 190: 402-9. 10.1192/bjp.bp.106.034389.CrossRefPubMed Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, De Girolamo G, Haro JM, Karam EG, Lara C, Lepine JP, Ormel J, Posada-Villa J, Zaslavsky AM, Jin R: Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry. 2007, 190: 402-9. 10.1192/bjp.bp.106.034389.CrossRefPubMed
5.
go back to reference Kessler RC, Adler LA, Barkley R, Biederman J, Conners CK, Faraone SV, Greenhill LL, Jaeger S, Secnik K, Spencer T, Ustun TB, Zaslavsky AM: Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry. 2005, 57: 1442-51. 10.1016/j.biopsych.2005.04.001.CrossRefPubMedPubMedCentral Kessler RC, Adler LA, Barkley R, Biederman J, Conners CK, Faraone SV, Greenhill LL, Jaeger S, Secnik K, Spencer T, Ustun TB, Zaslavsky AM: Patterns and predictors of attention-deficit/hyperactivity disorder persistence into adulthood: results from the national comorbidity survey replication. Biol Psychiatry. 2005, 57: 1442-51. 10.1016/j.biopsych.2005.04.001.CrossRefPubMedPubMedCentral
6.
go back to reference Kessler RC, Adler LE, Ames M, Barkley RA, Birnbaum H, Greenberg P, Johnston JA, Spencer T, Ustun TB: The prevalence and effects of adult attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. J Occup Environ Med. 2005, 47: 565-572. 10.1097/01.jom.0000166863.33541.39.CrossRefPubMed Kessler RC, Adler LE, Ames M, Barkley RA, Birnbaum H, Greenberg P, Johnston JA, Spencer T, Ustun TB: The prevalence and effects of adult attention deficit/hyperactivity disorder on work performance in a nationally representative sample of workers. J Occup Environ Med. 2005, 47: 565-572. 10.1097/01.jom.0000166863.33541.39.CrossRefPubMed
7.
go back to reference Kooij JJS, Aeckerlin LP, Buitelaar JK: Functioning, comorbidity and treatment of 141 adults with attention deficit hyperactivity disorder (ADHD) at a Psychiatric Outpatients' Department. [Dutch]. Ned Tijdschr Geneeskd. 2001, 145: 1498-1501.PubMed Kooij JJS, Aeckerlin LP, Buitelaar JK: Functioning, comorbidity and treatment of 141 adults with attention deficit hyperactivity disorder (ADHD) at a Psychiatric Outpatients' Department. [Dutch]. Ned Tijdschr Geneeskd. 2001, 145: 1498-1501.PubMed
8.
go back to reference Faraone SV, Wilens TE, Petty C, Antshel K, Spencer T, Biederman J: Substance use among ADHD adults: implications of late onset and subthreshold diagnoses. Am J Addict. 2007, 1 (16): 24-32. quiz 33–4CrossRef Faraone SV, Wilens TE, Petty C, Antshel K, Spencer T, Biederman J: Substance use among ADHD adults: implications of late onset and subthreshold diagnoses. Am J Addict. 2007, 1 (16): 24-32. quiz 33–4CrossRef
9.
go back to reference Sobanski E: Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci. 2006, 256 (Suppl 1): i26-31.CrossRefPubMed Sobanski E: Psychiatric comorbidity in adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci. 2006, 256 (Suppl 1): i26-31.CrossRefPubMed
10.
go back to reference Upadhyaya HP: Substance use disorders in children and adolescents with attention-deficit/hyperactivity disorder: implications for treatment and the role of the primary care physician. Primary care companion to the Journal of clinical psychiatry. 2008, 10: 211-21. 10.4088/PCC.v10n0306.CrossRefPubMedPubMedCentral Upadhyaya HP: Substance use disorders in children and adolescents with attention-deficit/hyperactivity disorder: implications for treatment and the role of the primary care physician. Primary care companion to the Journal of clinical psychiatry. 2008, 10: 211-21. 10.4088/PCC.v10n0306.CrossRefPubMedPubMedCentral
11.
go back to reference Sizoo B, van den Brink W, Koeter M, Gorissen van Eenige M, van Wijngaarden-Cremers P, van der Gaag RJ: Treatment seeking adults with autism or ADHD and co-morbid substance use disorder: prevalence, risk factors and functional disability. Drug Alcohol Depend. 2010, 107: 44-50. 10.1016/j.drugalcdep.2009.09.003.CrossRefPubMed Sizoo B, van den Brink W, Koeter M, Gorissen van Eenige M, van Wijngaarden-Cremers P, van der Gaag RJ: Treatment seeking adults with autism or ADHD and co-morbid substance use disorder: prevalence, risk factors and functional disability. Drug Alcohol Depend. 2010, 107: 44-50. 10.1016/j.drugalcdep.2009.09.003.CrossRefPubMed
12.
go back to reference Sullivan MA: Rudnik-Levin F Attention deficit/hyperactivity disorder and substance abuse. Diagnostic and therapeutic considerations. Ann N Y Acad Sci. 2001, 931: 251-70.CrossRefPubMed Sullivan MA: Rudnik-Levin F Attention deficit/hyperactivity disorder and substance abuse. Diagnostic and therapeutic considerations. Ann N Y Acad Sci. 2001, 931: 251-70.CrossRefPubMed
13.
go back to reference Modestin J, Matutat B, Wurmle O: Antecedents of opioid dependence and personality disorder: attention-deficit/hyperactivity disorder and conduct disorder. Eur Arch Psychiatry Clin Neurosci. 2001, 251: 42-7. 10.1007/s004060170067.CrossRefPubMed Modestin J, Matutat B, Wurmle O: Antecedents of opioid dependence and personality disorder: attention-deficit/hyperactivity disorder and conduct disorder. Eur Arch Psychiatry Clin Neurosci. 2001, 251: 42-7. 10.1007/s004060170067.CrossRefPubMed
14.
go back to reference Ohlmeier MD, Peters K, Te Wildt BT, Zedler M, Ziegenbein M, Wiese B, Emrich HM: Schneider U (2008) Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD). Alcohol and alcoholism (Oxford, Oxfordshire). 2008, 43: 300-400. 10.1093/alcalc/agn014.CrossRef Ohlmeier MD, Peters K, Te Wildt BT, Zedler M, Ziegenbein M, Wiese B, Emrich HM: Schneider U (2008) Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD). Alcohol and alcoholism (Oxford, Oxfordshire). 2008, 43: 300-400. 10.1093/alcalc/agn014.CrossRef
15.
go back to reference Wilson JJ, Levin FR: Attention-deficit/hyperactivity disorder and early-onset substance use disorders. J Child Adolesc Psychopharmacol. 2005, 15: 751-63. 10.1089/cap.2005.15.751.CrossRefPubMed Wilson JJ, Levin FR: Attention-deficit/hyperactivity disorder and early-onset substance use disorders. J Child Adolesc Psychopharmacol. 2005, 15: 751-63. 10.1089/cap.2005.15.751.CrossRefPubMed
17.
18.
go back to reference Liu J, Yu B, Orozco-Cabal L, Grigoriadis DE, Rivier J, Vale WW, Shinnick-Gallagher P, Gallagher JP: Chronic cocaine administration switches corticotropin-releasing factor2 receptor-mediated depression to facilitation of glutamatergic transmission in the lateral septum. J Neurosci. 2005, 25: 577-83. 10.1523/JNEUROSCI.4196-04.2005.CrossRefPubMed Liu J, Yu B, Orozco-Cabal L, Grigoriadis DE, Rivier J, Vale WW, Shinnick-Gallagher P, Gallagher JP: Chronic cocaine administration switches corticotropin-releasing factor2 receptor-mediated depression to facilitation of glutamatergic transmission in the lateral septum. J Neurosci. 2005, 25: 577-83. 10.1523/JNEUROSCI.4196-04.2005.CrossRefPubMed
19.
go back to reference Carpentier PJ, de Jong CA, Dijkstra BA, Verbrugge CA, Krabbe PF: A controlled trial of methylphenidate in adults with attention deficit/hyperactivity disorder and substance use disorders. Addiction. 2005, 100: 1868-74. 10.1111/j.1360-0443.2005.01272.x.CrossRefPubMed Carpentier PJ, de Jong CA, Dijkstra BA, Verbrugge CA, Krabbe PF: A controlled trial of methylphenidate in adults with attention deficit/hyperactivity disorder and substance use disorders. Addiction. 2005, 100: 1868-74. 10.1111/j.1360-0443.2005.01272.x.CrossRefPubMed
20.
go back to reference Barkley RA, Fischer M, Smallish L, Fletcher K: The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol. 2002, 111: 279-289.CrossRefPubMed Barkley RA, Fischer M, Smallish L, Fletcher K: The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol. 2002, 111: 279-289.CrossRefPubMed
21.
go back to reference Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E: The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001, 31: 5-17. 10.1023/A:1005653411471.CrossRefPubMed Baron-Cohen S, Wheelwright S, Skinner R, Martin J, Clubley E: The autism-spectrum quotient (AQ): evidence from Asperger syndrome/high-functioning autism, males and females, scientists and mathematicians. J Autism Dev Disord. 2001, 31: 5-17. 10.1023/A:1005653411471.CrossRefPubMed
22.
go back to reference Lord C, Rutter M, DiLavore PC, Risi S: ADOS, Autism diagnostic observation schedule. 1999, WPS, Los Angeles: Manual Lord C, Rutter M, DiLavore PC, Risi S: ADOS, Autism diagnostic observation schedule. 1999, WPS, Los Angeles: Manual
23.
go back to reference Kooij JJS, Adult ADHD: Diagnostic assessment and treatment. 2012, Springer, 3 Kooij JJS, Adult ADHD: Diagnostic assessment and treatment. 2012, Springer, 3
24.
go back to reference Goodman D, Faraone SV, Adler LA, Dirks B, Hamdani M, Weisler R: Interpreting ADHD rating scale scores: linking ADHD rating scale scores and CGI levels in two randomized controlled trials of lisdexamfetamine dimesylate in ADHD. Primary Psychiatry. 2010, 17: 44-52. Goodman D, Faraone SV, Adler LA, Dirks B, Hamdani M, Weisler R: Interpreting ADHD rating scale scores: linking ADHD rating scale scores and CGI levels in two randomized controlled trials of lisdexamfetamine dimesylate in ADHD. Primary Psychiatry. 2010, 17: 44-52.
25.
go back to reference Reimherr FW, Marchant BK, Strong RE, Hedges DW, Adler L, Spencer TJ, West SA, Soni P: Emotional dysregulation in adult ADHD and response to atomoxetine. Biol Psychiatry. 2005, 58: 125-31. 10.1016/j.biopsych.2005.04.040.CrossRefPubMed Reimherr FW, Marchant BK, Strong RE, Hedges DW, Adler L, Spencer TJ, West SA, Soni P: Emotional dysregulation in adult ADHD and response to atomoxetine. Biol Psychiatry. 2005, 58: 125-31. 10.1016/j.biopsych.2005.04.040.CrossRefPubMed
26.
go back to reference Reimherr FW, Williams ED, Strong RE, Mestas R, Soni P, Marchant BK: A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. J Clin Psychiatry. 2007, 68: 93-101. 10.4088/JCP.v68n0113.CrossRefPubMed Reimherr FW, Williams ED, Strong RE, Mestas R, Soni P, Marchant BK: A double-blind, placebo-controlled, crossover study of osmotic release oral system methylphenidate in adults with ADHD with assessment of oppositional and emotional dimensions of the disorder. J Clin Psychiatry. 2007, 68: 93-101. 10.4088/JCP.v68n0113.CrossRefPubMed
27.
go back to reference Rosler M, Fischer R, Ammer R, Ose C, Retz W: A randomised, placebo-controlled, 24-week, study of low-dose extended-release methylphenidate in adults with attention-deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci. 2009, 259: 120-9. 10.1007/s00406-008-0845-4.CrossRefPubMed Rosler M, Fischer R, Ammer R, Ose C, Retz W: A randomised, placebo-controlled, 24-week, study of low-dose extended-release methylphenidate in adults with attention-deficit/hyperactivity disorder. Eur Arch Psychiatry Clin Neurosci. 2009, 259: 120-9. 10.1007/s00406-008-0845-4.CrossRefPubMed
28.
go back to reference Skirrow C, McLoughlin G, Kuntsi J, Asherson P: Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Rev Neurother. 2009, 9: 489-503. 10.1586/ern.09.2.CrossRefPubMed Skirrow C, McLoughlin G, Kuntsi J, Asherson P: Behavioral, neurocognitive and treatment overlap between attention-deficit/hyperactivity disorder and mood instability. Expert Rev Neurother. 2009, 9: 489-503. 10.1586/ern.09.2.CrossRefPubMed
29.
go back to reference Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM: The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006, 163: 716-23. 10.1176/appi.ajp.163.4.716.CrossRefPubMedPubMedCentral Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM: The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006, 163: 716-23. 10.1176/appi.ajp.163.4.716.CrossRefPubMedPubMedCentral
30.
go back to reference Bell AS: A Critical Review of ADHD Diagnostic Criteria: What to Address in the DSM-V. J Atten Disord. 2010, 15: 3-10.CrossRefPubMed Bell AS: A Critical Review of ADHD Diagnostic Criteria: What to Address in the DSM-V. J Atten Disord. 2010, 15: 3-10.CrossRefPubMed
31.
go back to reference Kooij JJ, Buitelaar JK, van den Oord EJ, Furer JW, Rijnders CA, Hodiamont PP: Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med. 2005, 35: 817-27. 10.1017/S003329170400337X.CrossRefPubMed Kooij JJ, Buitelaar JK, van den Oord EJ, Furer JW, Rijnders CA, Hodiamont PP: Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med. 2005, 35: 817-27. 10.1017/S003329170400337X.CrossRefPubMed
32.
go back to reference Keedwell PA, Poon L, Papadopoulos AS, Marshall EJ, Checkley SA: Salivary cortisol measurements during a medically assisted alcohol withdrawal. Addict Biol. 2001, 6: 247-256. 10.1080/13556210120056580.CrossRefPubMed Keedwell PA, Poon L, Papadopoulos AS, Marshall EJ, Checkley SA: Salivary cortisol measurements during a medically assisted alcohol withdrawal. Addict Biol. 2001, 6: 247-256. 10.1080/13556210120056580.CrossRefPubMed
Metadata
Title
Rates of undiagnosed attention deficit hyperactivity disorder in London drug and alcohol detoxification units
Authors
Zoe Huntley
Stefanos Maltezos
Charlotte Williams
Alun Morinan
Amy Hammon
David Ball
E Jane Marshall
Francis Keaney
Susan Young
Patrik Bolton
Karen Glaser
Raoul Howe-Forbes
Jonna Kuntsi
Kiriakos Xenitidis
Declan Murphy
Philip J Asherson
Publication date
01-12-2012
Publisher
BioMed Central
Published in
BMC Psychiatry / Issue 1/2012
Electronic ISSN: 1471-244X
DOI
https://doi.org/10.1186/1471-244X-12-223

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