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

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.

Keywords: Adult ADHD self-report scale; Attention-deficit/hyperactivity disorder symptoms; Injecting substance use; Opioid substitution treatment; Substance-related disorders.

Fig. 1

Timeline of data collection of the study sample. OAT: Opioid agonist therapy; ASRS: The adult ADHD self-report scale, version 1.1. ¹⁾ Assessment visit: ASRS, part A, question 3, ASRS, part B, question 9, substance use, injecting substance use, sociodemographic factors. ²⁾ A total of 323 of the 701 patients completed the assessment visits twice or thrice during the study period. The remaining 378 patients had completed one assessment visit at the end of March 2022. ³⁾ Of the 701 patients who had completed at least one assessment visit, 225 patients participated in an extended interview during the period from November 2019 to March 2022. Extended interview: ASRS, part A, and information on registered mental disorder diagnoses from medical records

Fig. 2

Distribution of responses to the ASRS–memory and –attention at baseline. ASRS: The adult ADHD self-report scale version 1.1. The responses to the ASRS–memory (ASRS, part A, question 3, n = 701) and –attention (ASRS, part B, question 9, n = 666), presented on a Likert scale ranging from never to very often. ASRS, part A, question 3: How often do you have problems remembering appointments or obligations?. ASRS, part B, question 9: How often do you have difficulty concentrating on what people say to you, even when they are speaking to you directly? Affirmative answers of “sometimes,” “often,” or “very often” on the scale serves as symptoms over the standard cut-off for these two questions

Fig. 3

Distribution of responses to the ASRS, part A (n = 225). Q: Question; ASRS: The adult ADHD self-report scale version 1.1. The responses to the ASRS, part A, presented on a Likert scale ranging from never to very often. Q1: “Trouble wrapping up final details”; Q2: “Difficulties with organization”; Q3: “Problems remembering appointments”; Q4: “Delays in getting started task”; Q5: “Squirm with your hands or feet”; Q6: “Compelled to do things”