Prevalence and characteristics of South African treatment-seeking patients with substance use disorder and co-occurring attention-deficit/hyperactivity disorder

ABSTRACT

Background

Attention-Deficit/Hyperactivity Disorder (ADHD) constitutes a significant risk factor for the development of Substance Use Disorders (SUDs). Individuals with both conditions use more substances, and the pattern of substance use seems to differ between individuals with and without ADHD.

Research aim and objectives

To establish the prevalence of ADHD symptoms in adult South African treatment-seeking patients with SUD, and the pattern of substance use and presence of previous ADHD diagnoses and pharmacotherapy.

Methods

Adult patients (N = 360) were recruited from rehabilitation facilities and screened using the ADHD Self-Report Scale Symptom Checklist (ASRS-v1.1). Questions included demographics, substance consumption and current/historical use of ADHD-indicated medication.

Results

A third (36.0%) of patients with SUD screened positive for ADHD – 14.6% had been diagnosed with ADHD prior to admission, and indicated pharmacotherapy, while 68.5% of those screened positive were not hitherto diagnosed with ADHD (p < 0.001). A statistical difference was found for polysubstance use with the ADHD group significantly being treated more frequently for use of more than one substance (p = 0.04).

Conclusions and implications

High rates of untreated and unrecognized ADHD were found among treatment-seeking SUD patients. Preventative strategies are crucial to reduce substance use and the development of SUD in individuals affected by ADHD.

KEYWORDS:

• Adult
• ASRS
• Attention-Deficit/Hyperactivity Disorder (ADHD)
• prevalence
• polysubstance
• Substance Use Disorder (SUD)

Article highlights

• ADHD symptomology is highly prevalent in South African adult patients treated for substance abuse.

• The findings of the study indicate that ADHD is underdiagnosed in the South African treatment-seeking population.

• Patients with ADHD symptoms are associated with poly-substance use.

• The ASRS is a valuable instrument and it is recommended that it should be incorporated into standard intake assessment protocols.

• Confirmation of ADHD diagnosis will have an impact on the pharmacotherapeutic approaches of the rehabilitation treatment.

• These strategies will have a positive impact on public mental health and addiction service provisions in South Africa.

Authors’ contribution

C. Coetzee. was the primary researcher and responsible for the drafting and preparation of the article. A. Meyer. was responsible for the conceptualisation and editing of the manuscript, analysis and interpretation of the data, and she was the main supervisor for the PhD study (of which this manuscript forms part). I. Truter. was responsible for editing and final approval of the version to be published, and she was the co-supervisor for the PhD study (of which this manuscript forms part).

Acknowledgments

The authors would like to express their thanks to Dr Geurt van de Glind, the project leader of The International Collaboration on ADHD and Substance Abuse (ICASA) foundation.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This research was funded by the National Research Foundation (NRF) Thuthuka Grant, South Africa. (117948)