CADDRA Expert Series 2, Session 1: Diagnosing of ADHD in the Setting of Substance Use Disorders

1. Recognize the prevalence of ADHD and common psychiatric comorbidities among individuals in the general and substance use disorder treatment population.
2. Identify the factors that might complicate making a diagnosis of ADHD in substance-using populations.
3. List strategies to help determine the presence of ADHD in the setting of other psychiatric comorbidities

ADHD is a widely prevalent disorder in children, adolescents, and adults. Potential etiologies to explain the overrepresentation of substance use and substance use disorders among youths and adults will be reviewed as well as implications for primary and secondary prevention. Various screeners may help identify individuals for potential ADHD and the utility of these screeners in SUD populations will be discussed. Further, once a patient screens positive for ADHD, there are several validated structured interviews that can be applied to systematically diagnose ADHD among those with SUD. However, even with a careful assessment, the presence of a comorbid substance use disorder (SUD) in addition to other psychiatric comorbidities make it more difficult to diagnose ADHD in adults. There are numerous factors that can lead to both underdiagnosis and overdiagnosis of ADHD among those with and without additional SUD. Notably, focusing on the age criterion may lead to underdiagnose and undertreatment of ADHD in adults and may be even more likely among those with SUDs. Alternatively, interviewing individuals while they are intoxicated, or acute withdrawal may lead to overdiagnosis and unnecessary treatment among active substance users. Strategies to determine whether the psychiatric symptoms are consistent with ADHD, better explained by other psychiatric disorders or is likely to be multiple co-occurring disorders will be discussed. In sum, the importance of diagnosing youths and adults with ADHD cannot be overstated since treatment of ADHD may alter the course of morbidity and mortality among those comorbid SUD.

Dr. Frances Levin:

Frances Rudnick Levin, MD is the Kennedy-Leavy Professor of Psychiatry at Columbia University and the Chief of the Division on Substance Use Disorders at NYSPI/CUIMC. Dr. Levin, working with Columbia University faculty, inaugurated the university-wide Center for Healing of Opioid and Other Substance Use Disorders: Enhancing Intervention Development and Implementation (CHOSEN) in 2020 and serves as one of the senior Directors. She is the Principal Investigator several NIH grants including a long-standing T32 Substance Abuse Research Fellowship. Her current research interests include pharmacologic interventions for opioid, cocaine and marijuana use disorders, and treatments targeting adults with substance use disorders and attention-deficit hyperactivity disorder (ADHD). She is a past President of the American Academy of Addiction Psychiatry and past Chair of the APA Council on Addiction Psychiatry.

CADDRA – Canadian ADHD Resource Alliance has been approved by the College of Family Physicians, the Royal College of Physicians and Surgeons of Canada and the Canadian Psychological Association to offer 1.25 continuing education credits for this session.  CADDRA maintains responsibility for the program.

Participation in a discussion forum is required to claim full credits.