Attention-deficit/hyperactivity disorder (ADHD) symptoms and their relation to diagnosed ADHD, sociodemographic characteristics, and substance use among patients receiving opioid agonist therapy: a Norwegian cohort study

BMC Psychiatry · 7 authors, 5 centres

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TL;DR

This cohort study of 701 patients on opioid agonist therapy found that over half scored above cutoffs on self-reported ADHD symptom scales for memory and attention.

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A Norwegian cohort study of 701 patients receiving opioid agonist therapy used the ADHD Self-Report Scale (ASRS) to assess symptoms. At baseline, 61% scored above the cutoff for memory symptoms and 53% for attention symptoms. Ordinal regression analyses showed frequent cannabis use was associated with higher memory (OR 1.7) and attention (OR 1.7) scores at baseline, and frequent stimulant use was associated with higher memory scores (OR 1.8). In a subsample of 225 patients, 45% screened positive for ADHD on the ASRS screener, but only 13% had a registered ADHD diagnosis. The authors note symptoms were relatively stable over time and suggest the ASRS screener may be useful for identifying patients needing further ADHD assessment, but emphasize the need for improved diagnostic methods due to overlapping symptoms with substance use and other mental disorders. Limitations include reliance on self-report, potential recall bias, and the use of a retrospective diagnosis from medical records.

STUDY TYPE

cohort

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psychiatry

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ORIGINAL PAPER

PMC10308780

Attention-deficit/hyperactivity disorder (ADHD) symptoms and their relation to diagnosed ADHD, sociodemographic characteristics, and substance use among patients receiving opioid agonist therapy: a Norwegian cohort study

BMC Psychiatry

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ABSTRACT

Background Attention-deficit/hyperactivity disorder (ADHD) symptoms may challenge sufficient treatment of substance use and mental disorders. The literature on the extent of such symptoms among patients receiving opioid agonist therapy (OAT) is scarce. This study examined ADHD symptoms using the ADHD self-report scale (ASRS) and the association between the ‘ASRS–memory’ and ‘ASRS–attention’ scores and substance use and sociodemographic characteristics among patients receiving OAT. Methods We used data from assessment visits of a cohort of patients in Norway. In total, 701 patients were included from May 2017 to March 2022. All patients responded at least once to two ASRS questions assessing memory and attention, respectively. Ordinal regression analyses were performed to investigate whether the two obtained scores were associated with age, sex, frequent substance use, injecting use, housing status, and educational attainment at baseline, i.e., the first assessment, and over time. The results are presented as odds ratios (OR) with 95% confidence intervals (CI). Additionally, a subsample of 225 patients completed an extended interview, including the ASRS–screener and collection of registered mental disorder diagnoses from the medical records. Standard cutoffs were used to define the presence of each ASRS symptom or a positive ASRS–screener (‘ASRS–positive’). Results At baseline, 428 (61%) and 307 (53%) patients scored over the cutoffs on the ‘ASRS–memory’ and ‘ASRS–attention,’ respectively. Frequent cannabis use was associated with higher ‘ASRS–memory’ (OR: 1.7, 95% CI: 1.1–2.6) and ‘ASRS–attention’ (1.7, 1.1–2.5) scores compared with less or no use at baseline, though reduced score on the ‘ASRS–memory’ over time (0.7, 0.6–1.0). At baseline, frequent stimulant use (1.8, 1.0–3.2) and low educational attainment (0.1, 0.0–0.8) were associated with higher ‘ASRS–memory’ scores. In the subsample fulfilling the ASRS–screener, 45% of the patients were ‘ASRS–positive,’ of whom 13% with a registered ADHD diagnosis. Conclusions Our findings illustrate a relationship between the ASRS–memory and –attention scores and frequent cannabis and stimulant use. Furthermore, nearly half of the subsample was ‘ASRS–positive.’ Patients receiving OAT might benefit from being further assessed for ADHD, but improved diagnostic methods are required. Supplementary Information The online version contains supplementary material available at 10.1186/s12888-023-04980-w.

CITATION EXPORT

Jørn Henrik Vold, Anne Halmøy, Fatemeh Chalabianloo et al.. Attention-deficit/hyperactivity disorder (ADHD) symptoms and their relation to diagnosed ADHD, sociodemographic characteristics, and substance use among patients receiving opioid agonist therapy: a Norwegian cohort study. BMC Psychiatry. (2023). https://doi.org/10.1186/s12888-023-04980-w

AUTHORS

7 · 5 CENTRES

Jørn Henrik Vold, Anne Halmøy, Fatemeh Chalabianloo, Marianne Cook Pierron, Else-Marie Løberg, Kjell Arne Johansson, Lars Thore Fadnes

1grid.412008.f0000 0000 9753 1393Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies Vei 65, N-5021 Bergen, Norway
2grid.7914.b0000 0004 1936 7443Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
3grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
4grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway
5grid.7914.b0000 0004 1936 7443Department of Clinical Psychology, University of Bergen, Bergen, Norway