(24) Prevalence of ADHD in Adults Seeking Methadone Treatment for Opioid Use Disorder

Background & Introduction: The global prevalence of adult attention-deficit/hyperactivity disorder (ADHD) is less than 3%, increasing to over 20% in patients with opioid use disorder (OUD).[1,2] Comorbid psychiatric condition history has been shown to negatively impact OUD treatment outcomes, yet most individuals, especially with ADHD, remain undertreated.[3,4,5] Evidence also shows an association between ADHD and comparatively worse methadone treatment outcomes in patients with OUD.[5,6,7] Despite these findings, no specific guidelines exist for managing patients with both ADHD and OUD, indicating the need for further research on evidence-driven treatment strategies in this high-risk population.[8] This project’s purpose is to characterize the prevalence of screening positive for ADHD in patients seeking treatment for OUD at an opioid treatment program (OTP).

Methods: We surveyed patients seeking methadone treatment during intake appointments. Each patient completed a survey with demographic information and two screening instruments for ADHD -- the ADHD Self-Report Scale Version 1.1 (ASRS v1.1) and ADHD Self-Report Scale for DSM-5 (ASRS-5).

The ASRS v1.1 consists of two parts: Part A (six questions) and Part B (12 questions). Respondents indicate how often a symptom occurred in the previous six months. Answers include: never, rarely, sometimes, often, very often. A positive answer is a response of “sometimes,” “often,” or “very often” for questions one through three, and “often” or “very often” for questions four through six. A patient screens positive for ADHD if they endorse four or more questions in Part A at a positive threshold.

The ASRS-5 is more recent and shorter form – only six questions total. Similarly, respondents indicate how often a symptom occurred in the prior six months by answering: never, rarely, sometimes, often, or very often. Each answer is converted to a numerical score from 0 to 4, respectively (never=0 and very often=4). The final score is the sum of each response. A patient screens positive for ADHD if they score 14 or higher (out of 24 maximum points).

Results: We surveyed 68 patients with severe OUD at a Denver-area methadone clinic during intake appointments from 10/1/2023-02/28/2024. Respondents identified as 37% male, 37% female, and 26% did not indicate their gender. Ages ranges included 18 through 64, with 40% of respondents being aged 35 to 44. Over half of patients did not identify their race or ethnicity, though of those who did respond, 40% were White and 31% were not Hispanic or Latino. All patients completed both the ASRS-5 and ASRS v1.1 during their intake appointment. Using the ASRS-5 screener, 53% of patients screened negative for ADHD and 47% screened positive. Using the ASRS v1.1 screener, 51% of patients screened negative for ADHD and 49% screened positive. Only one respondent was categorized differently between both screeners.

Conclusion & Discussion: Our results showed that nearly half of patients seeking methadone for OUD screened positive for ADHD. The prevalence was similar across screening tools (ASRS v1.1 and ASRS-5). As such, we plan to adopt the ASRS-5 for future screenings in clinical practice due to its brevity and known validity in patients with substance use disorders.[10] Our findings demonstrate a significantly higher prevalence of ADHD in patients seeking OUD treatment, compared to the general population. This raises concerns about undiagnosed ADHD in this population. With the prevalence established, the authors plan to conduct a chart review to evaluate additional medical history for these patients, including previous or current treatments for ADHD, stimulant use disorders, and to assess outcomes in the methadone treatment program. A particularly important outcome will be retention in care, which has been shown to reduce mortality risk in this population.[9] To improve the efficiency of future screenings, the ASRS-5 could be modified to include a question regarding current ADHD treatment status.

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