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Young S, Abbasian C, Al-Attar Z, Branney P, Colley B, Cortese S, Cubbin S, Deeley Q, Gudjonsson GH, Hill P, Hollingdale J, Jenden S, Johnson J, Judge D, Lewis A, Mason P, Mukherjee R, Nutt D, Roberts J, Robinson F, Woodhouse E, Cocallis K. Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement. World J Psychiatry 2023; 13:84-112. [PMID: 37033892 PMCID: PMC10075023 DOI: 10.5498/wjp.v13.i3.84] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 02/19/2023] [Accepted: 03/15/2023] [Indexed: 03/17/2023] Open
Abstract
Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.
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Affiliation(s)
- Susan Young
- Department of Psychology, Psychology Services Limited, Croydon CR9 7AE, United Kingdom
- Department of Psychology, Reykjavik University, Reykjavik, Iceland
| | - Cyrus Abbasian
- Psychiatry-UK Limited, Cornwall PL33 9ET, United Kingdom
| | | | - Polly Branney
- ADHD and Autism, Oxford ADHD & Autism Centre, Headington OX3 7BX, United Kingdom
| | - Bill Colley
- CLC Consultancy, Dunkeld PH8 0AY, United Kingdom
| | - Samuele Cortese
- Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
| | - Sally Cubbin
- Adult ADHD, Adult ADHD Clinic Ltd, Oxford OX3 7RP, United Kingdom
| | - Quinton Deeley
- Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London Institute of Psychiatry, London SE5 8AF, United Kingdom
| | - Gisli Hannes Gudjonsson
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Peter Hill
- Department of Psychiatry, University of London, London WC1E 7HU, United Kingdom
| | - Jack Hollingdale
- Department of Psychology, Compass Psychology Services Ltd, London BR1 9DX, United Kingdom
| | | | - Joe Johnson
- Halton and Knowsley Adult ADHD Team, Merseycare NHS Foundation Trust, Winwick WA2 9WA, United Kingdom
| | | | - Alexandra Lewis
- Department of Psychiatry, Fulbourn Hospital, Cambridge CB21 5EF, United Kingdom
| | - Peter Mason
- Department of Psychiatry, Dr Peter Mason ADHD & Psychiatry Services Limited, Liverpool L1 9AR, United Kingdom
| | - Raja Mukherjee
- Adult Neurodevelopmental Service, Horizon House, Epsom KT17 4QJ, United Kingdom
| | - David Nutt
- Department of Psychiatry, Imperial College London, London WS12 0NN, United Kingdom
| | - Jane Roberts
- Service User Representative, Gloucestershire GL1 3NN, United Kingdom
| | - Fiona Robinson
- Drug & Alcohol Services, Surrey & Borders Partnership Trust, Leatherhead KT22 7AD, United Kingdom
| | - Emma Woodhouse
- Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
| | - Kelly Cocallis
- Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington NE63 9JJ, United Kingdom
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Coetzee C, Truter I, Meyer A. Differences in alcohol and cannabis use amongst substance use disorder patients with and without comorbid attention-deficit/hyperactivity disorder. S Afr J Psychiatr 2022; 28:1786. [PMID: 35547103 PMCID: PMC9082225 DOI: 10.4102/sajpsychiatry.v28i0.1786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
Background Substance use disorders (SUDs) continue to be a public health problem. Attention-deficit/hyperactivity disorder (ADHD) is seen as a risk factor for SUD. Prevalence of alcohol and cannabis use amongst adults with SUD and comorbid ADHD impacts both disorders cognitively and behaviourally. Aim Our study aimed to compare alcohol and cannabis use between treatment-seeking SUD patients with ADHD and SUD patients without ADHD symptomatology. Setting Various rehabilitation centres, including the South African National Council on Alcoholism and Drug Dependence (SANCA) Centres, and Private and Provincial Government Substance Abuse Treatment Centres. Methods A cross-sectional study of adults on drug rehabilitation was conducted. Data on socio-demographic information and alcohol and cannabis use from 185 post-detox inpatients were collected. Diagnoses were based on DSM-IV criteria. Attention-deficit/hyperactivity disorder diagnosis was confirmed by the Diagnostic-Interview for ADHD in Adults (DIVA 2.0). SUD+ADHD (n = 52) and SUD-ADHD (n = 128) groups were compared on alcohol and cannabis use as a function of gender. Results No significant differences in the use of alcohol between the SUD+ADHD and SUD-ADHD groups were found. However, the SUD+ADHD group showed increased cannabis consumption. Especially, the SUD+ADHD females showed an earlier age of onset of cannabis use than the SUD-ADHD females and revealed that they use cannabis for a longer period compared with the SUD-ADHD females and SUD+ADHD and SUD-ADHD males. Conclusion The results revealed the relationship between ADHD and cannabis use, especially amongst females with ADHD and reinforce the need to consider ADHD in cannabis use SUD in clinical interventions.
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Affiliation(s)
- Corné Coetzee
- Drug Utilization Research Unit (DURU), Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
- Department of Pharmacy, Faculty of Health Sciences, University of Limpopo, Sovenga, South Africa
| | - Ilse Truter
- Drug Utilization Research Unit (DURU), Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
| | - Anneke Meyer
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Faculty of Health Sciences, Nelson Mandela University, Gqeberha, South Africa
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van de Baan FC, Montanari L, Royuela L, Lemmens PHHM. Prevalence of illicit drug use before imprisonment in Europe: results from a comprehensive literature review. Drugs: Education, Prevention and Policy 2022. [DOI: 10.1080/09687637.2021.1879022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Affiliation(s)
- Frank C. van de Baan
- Public Health Unit, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Linda Montanari
- Public Health Unit, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
| | - Luis Royuela
- Public Health Unit, European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal
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Brandt L, Levin FR, Kraigher D. Impulsive Personality Traits Mediate the Relationship Between Attention-Deficit/Hyperactivity Disorder Symptoms and Psychiatric Comorbidity among Patients with Severe Alcohol Use Disorder. J Dual Diagn 2021; 17:193-206. [PMID: 34313557 PMCID: PMC8452140 DOI: 10.1080/15504263.2021.1944711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Attention-deficit/hyperactivity disorder (ADHD) is an established risk factor for developing alcohol use disorder (AUD), and AUD-ADHD comorbidity is associated with additional psychiatric diagnoses. Several lines of evidence support the role of impulsivity as a pathway of these relationships; however, impulsivity is not a unitary construct. Thus, we sought to explore whether separate aspects of impulsivity may explain the relationship between ADHD symptoms and psychiatric comorbidity among inpatients (N = 136) with AUD. Methods: We assessed ADHD symptoms (childhood ADHD [Wender Utah Rating Scale], adult ADHD [Adult ADHD self-report scale]), health-related quality of life (HRQL; EQ-5D-5L), psychiatric comorbidity (Mini International Neuropsychiatric Interview), and impulsive personality traits (Urgency, Premeditation, Perseverance, Sensation seeking [UPPS] scale). Results: 19% of patients screened positive in the retrospective assessment of childhood ADHD, and 17% for adult ADHD. Participants reported moderate levels of problem severity in the HRQL dimensions, and 65% had ≥1 current psychiatric disorders other than AUD and ADHD. Multiple mediation indicated that there was a significant direct effect of childhood ADHD symptoms on psychiatric comorbidity (β = 0.224, 95% CI [0.080, 1.114]), and indirect effects of both reacting impetuously when experiencing negative emotions (negative urgency; β = 0.999, 95% CI [0.043, 0.461]) and the tendency to not finish tasks (lack of perseverance; β = 0.075, 95% CI [0.002, 0.297]). Conclusions: The subcomponents of impulsivity to react rashly when experiencing negative emotions and the tendency to not persist in activities seem to contribute to the relationship between ADHD symptoms (particularly those in childhood) and psychiatric comorbidity among patients with severe AUD.
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Affiliation(s)
- Laura Brandt
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
| | - Frances R Levin
- Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York, USA.,Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA
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Abstract
OBJECTIVES International studies have reported disproportionately higher rates of Attention Deficit Hyperactivity Disorder (ADHD) among youth and adult offenders across police custody, prison, probation and forensic mental health settings, estimated to fall at around 25%. This review aimed to investigate the presentation and vulnerabilities of this subpopulation of people with ADHD compared to those with ADHD in the general population and consider how this may impact on the approach to assessment and treatment in this population. METHODOLOGY A selective review of the extant literature was conducted to investigate how offenders with ADHD may present differently from their non-ADHD peers in their clinical presentation, criminogenic behaviour and psychological vulnerabilities. RESULTS Nearly all (around 96%) offenders with ADHD have additional comorbid problems, including mood, anxiety, conduct, substance use and personality disorders. Compared with offenders without ADHD, they become involved in the criminal justice system (CJS) at a younger age, have higher rates of recidivism, are more likely to make a false confession, engage in behavioural disturbances in custody, have health risk behaviours and a lower quality of life. Assessing and treating ADHD in this subpopulation may be more complex due to their presentation. CONCLUSIONS Offenders with ADHD are disadvantaged within the system by their ADHD symptoms being unrecognised and/or misunderstood; their diagnosis of ADHD may be missed or misdiagnosed. This is at cost to the individual, from both a health and rehabilitative perspective, as well as more broadly to society.
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Affiliation(s)
- Susan Young
- Psychology Services Limited, London, PO 1735, Croydon, C9 7AE, UK. .,Department of Psychology, Reykjavik University, Reykjavík, Iceland.
| | - Kelly Cocallis
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
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Young S, Woodhouse E. Assessment and treatment of substance use in adults with ADHD: a psychological approach. J Neural Transm (Vienna) 2021; 128:1099-108. [PMID: 33211196 DOI: 10.1007/s00702-020-02277-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022]
Abstract
Over half of young people and adults diagnosed with Attention Deficit Hyperactivity Disorder [ADHD] also have substance use disorder [SUD]. Their use of substances may arise from an attempt to self-medicate and/or to cope with their difficulties. This manuscript reviews key research in the literature and identifies that traditional SUD psychological interventions are an effective treatment for those presenting with a dual diagnosis of ADHD and SUD. However, typically, this is only available to those presenting to specialist SUD services for treatment of harmful use and/or dependency. This misses an opportunity to intervene much earlier, before drug use escalates to these levels. The manuscript aims to provide practical guidance for healthcare practitioners, by detailing a psychological framework for earlier assessment and intervention of problematic drug use in young people and adults with ADHD. Specific techniques are outlined drawing on psychoeducation, motivational interviewing and cognitive behavioural therapy in a phased approach to address factors that motivate initial use of substances and those that maintain use.
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Sadeghpour A, Sadeghi-Bazargani H, Ghaffari-fam S, Salarilak S, Farahbakhsh M, Ekman R, Daemi A. Adult ADHD screening scores and hospitalization due to pedestrian injuries: a case-control study. BMC Psychiatry 2020; 20:444. [PMID: 32912205 PMCID: PMC7488147 DOI: 10.1186/s12888-020-02848-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 08/31/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to investigate the association between adult ADHD screening scores and hospitalization due to pedestrian injuries in a sample of Iranian pedestrians. METHODS Through a case-control study, a case population of 177 pedestrians injured by the vehicles in road traffic crashes were compared with 177 controls who lacked a record of intentional or unintentional injuries enrolled from various wards of Imam Reza University Hospital which is a specialty teaching hospital located in the same city with similar referral level. The cases and controls had an age range of 18-65 years and were matched on gender and age. ADHD symptom profile was assessed using the Persian Self-report Screening Version of the Conner's Adult ADHD Rating Scales (CAARS-S:SV). The association of ADHD screening score and pedestrian injuries was investigated using multiple binary logistic regression to investigate the independent effect of ADHD index score on belonging to case group. Both crude and adjusted odds ratios were reported. RESULTS Men comprised 86.4% of the study subjects. The crude odds ratios for all the four ADHD subscales to be associated with pedestrian injuries were 1.05, 1.08, and 1.04 for the subscales A (attention deficit), B (hyperactivity/impulsiveness) and ADHD index respectively. However, the association for subscale A was not statistically significant with a borderline p-value. The final multivariate analysis showed that variables associated with pedestrian injuries in the road traffic crashes were ADHD Index score (OR = 1.06, 95% CI: 1.01-1.12); economic status (including household income and expenditure capacity); educational level and total walking time per 24 h. CONCLUSIONS Adult ADHD screening score can predict pedestrian injuries leading to hospitalization independently from sex, age, economic status, educational level and pedestrian exposure to traffic environment (average walking time).
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Affiliation(s)
- Alireza Sadeghpour
- grid.412888.f0000 0001 2174 8913Department of Orthopedics, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Homayoun Sadeghi-Bazargani
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Central campus, Golshahr square, Elgoli Ave, Tabriz, 5167846185, Iran.
| | - Saber Ghaffari-fam
- grid.412763.50000 0004 0442 8645School of Nursing of Miyandoab, Urmia University of Medical Sciences, Urmia, Iran
| | - Shaker Salarilak
- grid.459617.80000 0004 0494 2783Department of Public Health, Islamic Azad University of Tabriz, Medical school, Tabriz, Iran
| | - Mostafa Farahbakhsh
- grid.412888.f0000 0001 2174 8913Research Center of Psychiatry and Behavioral Sciences, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Robert Ekman
- grid.5371.00000 0001 0775 6028Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
| | - Amin Daemi
- grid.411746.10000 0004 4911 7066Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
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Vélez-Pastrana MC, González RA, Ramos-Fernández A, Ramírez Padilla RR, Levin FR, Albizu García C. Attention Deficit Hyperactivity Disorder in Prisoners: Increased Substance Use Disorder Severity and Psychiatric Comorbidity. Eur Addict Res 2020; 26:179-190. [PMID: 32615575 DOI: 10.1159/000508829] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 05/18/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD) are overrepresented among incarcerated populations. We examined whether ADHD was associated with increased severity of comorbid SUD and with increased psychiatric comorbidity among prisoners. METHODS Cross-sectional study of 500 randomly selected Latino male prisoners in the Puerto Rico Correctional System using validated diagnostic measures to assess Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) ADHD and SUD diagnosis, antisocial personality disorder (ASP) and borderline personality disorder (BPD), major depression, and generalized anxiety disorder (GAD). We defined SUD severity by symptom count and by presence of at least 2 current SUD diagnoses (polysubstance). RESULTS Participants with ADHD had increased risk for lifetime (p < 0.05) and current (p < 0.01) SUDs, all comorbid psychiatric disorders, and suicidality (p < 0.001). They had more severe SUD, both in number of symptoms and number of SUD (polysubstance) diagnoses (p < 0.01). ADHD was associated with increased psychiatric comorbidity, as participants with ADHD were more likely to have a second diagnosis, and a greater number of comorbid disorders (p < 0.001). ASP, BPD, major depression, and GAD, but not ADHD, were significant predictors of SUD severity in adjusted models. CONCLUSIONS Findings highlight the complex mental health needs of incarcerated populations, where SUD, ADHD, and other psychiatric disorders are prevalent and interrelated.
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Affiliation(s)
- María C Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico, .,Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA,
| | - Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom.,Centre for Psychiatry, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom
| | | | - Rafael R Ramírez Padilla
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Carmen Albizu García
- Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Rio Piedras, Puerto Rico, USA
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González RA, Vélez-Pastrana MC, Blankers M, Bäcker A, Konstenius M, Holtmann M, Levin FR, Noack M, Kaye S, Demetrovics Z, van de Glind G, van den Brink W, Schellekens A. Onset and Severity of Early Disruptive Behavioral Disorders in Treatment-Seeking Substance Use Disorder Patients with and without Attention-Deficit/Hyperactivity Disorder. Eur Addict Res 2020; 26:211-222. [PMID: 32594079 DOI: 10.1159/000508653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 05/13/2020] [Indexed: 11/19/2022]
Abstract
AIMS This study addressed the age of onset of conduct disorder (CD) and oppositional defiant disorder (ODD) in treatment-seeking substance use disorder (SUD) patients with and without adult attention-deficit/hyperactivity disorder (ADHD) and its association with early onset of SUD. METHODS We examined data from the 2nd International ADHD in Substance Use Disorders Prevalence Study, including 400 adults in SUD treatment from Puerto Rico, Hungary, and Australia. ADHD, SUD, and CD/ODD were assessed with the Conners Adult ADHD Diagnostic Interview for DSM-IV, the MINI International Neuropsychiatric Interview, and the K-SADS, respectively. Cox regression analyses modeled time to emergence of CD/ODD separately for SUD patients with and without adult ADHD. Linear regression models examined associations between age of onset of SUD and presence of ADHD and adjusted for sex, age, and country. To assess the mediating role of CD/ODD on the association of ADHD with onset of SUD, adjusted regression models were estimated. RESULTS Treatment-seeking SUD patients with ADHD presented an earlier onset of CD/ODD compared with those without ADHD. CD/ODD symptom loads were higher among the SUD and ADHD group. Age of first substance use and SUD were significantly earlier in SUD patients with ADHD, and these findings remained significant after adjustment for demographics and coexisting CD/ODD. CONCLUSIONS ADHD is associated with earlier onset of SUD as well as with an earlier onset of more frequent and more severe disruptive behavioral disorders. These findings may inform preventive interventions to mitigate adverse consequences of ADHD.
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Affiliation(s)
- Rafael A González
- National Adoption and Fostering Service & National Conduct Problems Team, Michael Rutter Centre, South London and Maudsley NHS Foundation Trust, London, United Kingdom, .,Centre for Psychiatry, Imperial College London, London, United Kingdom,
| | - María C Vélez-Pastrana
- PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico, USA
| | - Matthijs Blankers
- Arkin Mental Health Care, Department of Research, Amsterdam, The Netherlands.,Trimbos institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.,Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Amanda Bäcker
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Maija Konstenius
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Holtmann
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Frances R Levin
- New York State Psychiatric Institute, Columbia University Irving Medical Center, New York, New York, USA
| | - Moritz Noack
- LWL-University Hospital for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany
| | - Sharlene Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Geurt van de Glind
- Radboudumc, Donders Centre for Medical Neuroscience, Department of Psychiatry, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
| | - Wim van den Brink
- Department of Psychiatry, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Arnt Schellekens
- Radboudumc, Donders Centre for Medical Neuroscience, Department of Psychiatry, Nijmegen, The Netherlands.,Nijmegen Institute for Scientist Practitioners in Addiction, Nijmegen, The Netherlands
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Kuzmickaitė J, Leskauskas D, Gylytė O. ADHD-Related Mental Health Issues of Young Adult Male Prisoners in Pravieniškės Correction House-Open Colony (Lithuania). Am J Mens Health 2019; 13:1557988319870974. [PMID: 31426725 PMCID: PMC6702778 DOI: 10.1177/1557988319870974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate mental health issues related to attention-deficit/hyperactivity disorder (ADHD) in young adult male prisoners. The study was performed in the Pravieniškės Correction House-Open Prison Colony and represents the first study on adult ADHD in Lithuania. The sample consisted of 100 young males imprisoned for mild to moderate crimes. ADHD symptoms were assessed using the Adult Self-Report Scale v1.1 (ASRS v1.1) and Wender Utah Rating Scale (WURS) self-rating scales. Related mental health issues were evaluated using the DSM-5 Level 1 Cross-Cutting Symptom Measure, the Personality Inventory for DSM-5, and data from both medical files and offenses-incentives lists. Clinically significant ADHD symptoms were found in 17% of the respondents. Prisoners with ADHD were younger and had shorter incentives lists. Personality traits of negative affect, antagonism, disinhibition, and psychoticism with increased personality dysfunction were more prevalent in the respondents with ADHD. Medical files of prisoners with ADHD more frequently included data on substance abuse, psychiatric diagnoses, and psychopharmacological treatment. None of the respondents had been diagnosed or treated for this disorder. Clinically significant ADHD symptoms were highly prevalent among imprisoned males, but ADHD was not diagnosed or treated correctly. These findings show that the problem of ADHD in young male adults with increased risk for criminal behavior needs recognition by the politicians and professionals responsible for health care in Lithuania in order to better care for prisoners with this psychopathology.
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Affiliation(s)
- Jūratė Kuzmickaitė
- 1 Lithuanian University of Health Sciences Hospital Kauno klinikos (Department of Psychiatry), Kaunas, Lithuania
| | - Darius Leskauskas
- 1 Lithuanian University of Health Sciences Hospital Kauno klinikos (Department of Psychiatry), Kaunas, Lithuania
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Abstract
PURPOSE OF REVIEW To examine recent advances in the understanding of attention deficit hyperactivity disorder (ADHD) among the prison population. RECENT FINDINGS Efforts have been made to develop useful tools for assessing ADHD among prisoners. Prisoners with ADHD demonstrate incremental vulnerability due to comorbid psychiatric disorders, neurodevelopmental disorders and traumatic brain injury. Compared with prisoners without ADHD, prisoners with ADHD become involved in the criminal justice system at a younger age and have higher rates of recidivism in adulthood. Recent studies demonstrate the effectiveness of extended release stimulant medication and psychological interventions. Early identification and treatment of prisoners with ADHD have the potential to demonstrate health economic benefits. Our understanding of ADHD among prisoners continues to develop. However, further research is needed, particularly among neglected groups such as females. Much more attention is needed by the prison service to engender better outcomes for this at-risk population.
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Young S, Gudjonsson G, Chitsabesan P, Colley B, Farrag E, Forrester A, Hollingdale J, Kim K, Lewis A, Maginn S, Mason P, Ryan S, Smith J, Woodhouse E, Asherson P. Identification and treatment of offenders with attention-deficit/hyperactivity disorder in the prison population: a practical approach based upon expert consensus. BMC Psychiatry 2018; 18:281. [PMID: 30180832 PMCID: PMC6122636 DOI: 10.1186/s12888-018-1858-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 08/22/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Around 25% of prisoners meet diagnostic criteria for attention-deficit/hyperactivity disorder (ADHD). Because ADHD is associated with increased recidivism and other functional and behavioural problems, appropriate diagnosis and treatment can be a critical intervention to improve outcomes. While ADHD is a treatable condition, best managed by a combination of medication and psychological treatments, among individuals in the criminal justice system ADHD remains both mis- and under-diagnosed and consequently inadequately treated. We aimed to identify barriers within the prison system that prevent appropriate intervention, and provide a practical approach to identify and treat incarcerated offenders with ADHD. METHODS The United Kingdom ADHD Partnership hosted a consensus meeting to discuss practical interventions for youth (< 18 years) and adult (≥18 years) offenders with ADHD. Experts at the meeting addressed prisoners' needs for effective identification, treatment, and multiagency liaison, and considered the requirement of different approaches based on age or gender. RESULTS The authors developed a consensus statement that offers practical advice to anyone working with prison populations. We identified specific barriers within the prison and criminal justice system such as the lack of adequate: staff and offender awareness of ADHD symptoms and treatments; trained mental health staff; use of appropriate screening and diagnostic tools; appropriate multimodal interventions; care management; supportive services; multiagency liaison; and preparation for prison release. Through discussion, a consensus was reached regarding prisoners' needs, effective identification, treatment and multiagency liaison and considered how this may differ for age and gender. CONCLUSIONS This practical approach based upon expert consensus will inform effective identification and treatment of offenders with ADHD. Appropriate intervention is expected to have a positive impact on the offender and society and lead to increased productivity, decreased resource utilization, and most importantly reduced rates of re-offending. Research is still needed, however, to identify optimal clinical operating models and to monitor their implementation and measure their success. Furthermore, government support will likely be required to effect change in criminal justice and mental health service policies.
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Affiliation(s)
| | - Gisli Gudjonsson
- Institute of Psychiatry, Psychology and Neuroscience, Department of Psychology, King’s College London, London, UK
| | - Prathiba Chitsabesan
- Offender Health Research Network, Division of Psychology and Mental Health and Division of Medicine and Health, University of Manchester, Manchester, UK
| | | | - Emad Farrag
- Sussex Partnership NHS Foundation Trust, Children & Young People’s Service, Tunbridge Wells Kent, UK
| | - Andrew Forrester
- Forensic Psychiatry and Offender Health Research Network, Division of Psychology and Mental Health and Division of Medicine and Health, University of Manchester, Manchester, UK
| | - Jack Hollingdale
- Division of Psychology and Language Science, University College London, London, UK
| | - Keira Kim
- Independent Medical Writer, San Diego, California USA
| | - Alexandra Lewis
- Barnet Enfield & Haringey Mental Health NHS Trust, HMP/YOI Feltham, Feltham, UK
- Health & Justice Central Team, NHS, London, UK
| | - Sarah Maginn
- Kent Prisons, Oxleas NHS Foundation Trust, Dartford, UK
| | - Peter Mason
- Cheshire & Wirral Partnership NHS Foundation Trust, The Stein Centre, St Catherine’s Hospital, Birkenhead, UK
| | - Sarah Ryan
- Tees, Esk & Wear Valley NHS Foundation Trust, HMP Frankland, Durham, UK
| | - Jade Smith
- Humber NHS Foundation Trust, East Yorkshire, London, UK
| | - Emma Woodhouse
- Institute of Psychiatry, Psychology, and Neuroscience, Department of Forensic and Neurodevelopmental Sciences, King’s College London, London, UK
- South London & Maudsley NHS Foundation Trust, National Adult Outpatient Neurodevelopmental Clinic, and National Autism Unit, London, UK
| | - Philip Asherson
- Institute of Psychiatry, Psychology, and Neuroscience, King’s College London, London, UK
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13
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Sommer JL, Mota N, Edmondson D, El-Gabalawy R. Comorbidity in illness-induced posttraumatic stress disorder versus posttraumatic stress disorder due to external events in a nationally representative study. Gen Hosp Psychiatry 2018; 53:88-94. [PMID: 29776731 DOI: 10.1016/j.genhosppsych.2018.02.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 02/03/2018] [Accepted: 02/07/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The current study compared physical and mental health characteristics and quality of life of illness-induced posttraumatic stress disorder (PTSD) versus those with PTSD due to external traumatic events in a population-based sample. METHOD PTSD was assessed with the Alcohol Use Disorder and Associated Disabilities Interview Schedule (AUDADIS-5) using DSM-5 criteria in the 2012-2013 National Epidemiologic Survey on Alcohol and Related Conditions. Participants with past-year PTSD (n = 1779) were categorized into two groups: illness-induced (6.5%) and other trauma-induced PTSD (92.9%) based on index trauma. Group differences in physical health, mental health, and quality of life were estimated using multiple logistic and linear regressions with adjustment for demographics and medical morbidity. RESULTS Compared to PTSD due to external events, illness-induced PTSD had higher rates of life-threatening illness in the past year. Illness-induced PTSD compared to PTSD due to external events was associated with reduced odds of depressive/bipolar disorders and antisocial personality disorder, but increased odds of cannabis use disorder. The groups did not differ on quality of life after accounting for medical morbidity. CONCLUSION Illness-induced PTSD is common among American adults and has a similar impact on quality of life as PTSD due to external events, but may have distinct mental health correlates.
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Affiliation(s)
- Jordana L Sommer
- Department of Psychology, Faculty of Arts, University of Manitoba, United States; Department of Anesthesia & Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Canada
| | - Natalie Mota
- Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada
| | - Donald Edmondson
- Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University Medical Center, United States
| | - Renée El-Gabalawy
- Department of Psychology, Faculty of Arts, University of Manitoba, United States; Department of Anesthesia & Perioperative Medicine, Max Rady College of Medicine, University of Manitoba, Canada; Department of Clinical Health Psychology, Max Rady College of Medicine, University of Manitoba, Canada; Department of Psychiatry, Max Rady College of Medicine, University of Manitoba, Canada.
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