title: Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria.
abstract: BACKGROUND
  Available studies vary in their estimated prevalence of attention deficit/hyperactivity disorder (ADHD) in substance use disorder (SUD) patients, ranging from 2 to 83%. A better understanding of the possible reasons for this variability and the effect of the change from DSM-IV to DSM-5 is needed.
  
  
  METHODS
  A two stage international multi-center, cross-sectional study in 10 countries, among patients form inpatient and outpatient addiction treatment centers for alcohol and/or drug use disorder patients. A total of 3558 treatment seeking SUD patients were screened for adult ADHD. A subsample of 1276 subjects, both screen positive and screen negative patients, participated in a structured diagnostic interview.
  
  
  RESULTS
  Prevalence of DSM-IV and DSM-5 adult ADHD varied for DSM-IV from 5.4% (CI 95%: 2.4-8.3) for Hungary to 31.3% (CI 95%:25.2-37.5) for Norway and for DSM-5 from 7.6% (CI 95%: 4.1-11.1) for Hungary to 32.6% (CI 95%: 26.4-38.8) for Norway. Using the same assessment procedures in all countries and centers resulted in substantial reduction of the variability in the prevalence of adult ADHD reported in previous studies among SUD patients (2-83%→5.4-31.3%). The remaining variability was partly explained by primary substance of abuse and by country (Nordic versus non-Nordic countries). Prevalence estimates for DSM-5 were slightly higher than for DSM-IV.
  
  
  CONCLUSIONS
  Given the generally high prevalence of adult ADHD, all treatment seeking SUD patients should be screened and, after a confirmed diagnosis, treated for ADHD since the literature indicates poor prognoses of SUD in treatment seeking SUD patients with ADHD.
authors.affiliation: Trimbos-instituut and ICASA Foundation, Utrecht, The Netherlands; Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. Electronic address: gglind@trimbos.nl.
authors.forename: Geurt
authors.initials: G
authors.lastname: van de Glind
authors.affiliation: Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Maija
authors.initials: M
authors.lastname: Konstenius
authors.affiliation: Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Maarten W J
authors.initials: MWJ
authors.lastname: Koeter
authors.affiliation: Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Arkin Mental Health and Addiction Treatment Center, Amsterdam, The Netherlands; Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Katelijne
authors.initials: K
authors.lastname: van Emmerik-van Oortmerssen
authors.affiliation: Reinier van Arkel groep, 's-Hertogenbosch, The Netherlands.
authors.forename: Pieter-Jan
authors.initials: PJ
authors.lastname: Carpentier
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
authors.forename: Sharlene
authors.initials: S
authors.lastname: Kaye
authors.affiliation: National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia; Melbourne School of Population and Global Health, University of Melbourne, Australia.
authors.forename: Louisa
authors.initials: L
authors.lastname: Degenhardt
authors.affiliation: Bergen Clinics Foundation, Bergen, Norway.
authors.forename: Arvid
authors.initials: A
authors.lastname: Skutle
authors.affiliation: Department of Clinical Neuroscience, Division of Psychiatry, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Franck
authors.affiliation: Bergen Clinics Foundation, Bergen, Norway.
authors.forename: Eli-Torild
authors.initials: ET
authors.lastname: Bu
authors.affiliation: University Hospital of Psychiatry Bern and Department of Psychology, University of Fribourg, Fribourg, Switzerland.
authors.forename: Franz
authors.initials: F
authors.lastname: Moggi
authors.affiliation: Collaborative Antwerp Psychiatry Research Institute (CAPRI, UA), PC Alexian Brothers, Boechout, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Dom
authors.affiliation: Collaborative Antwerp Psychiatry Research Institute (CAPRI, UA), PC Alexian Brothers, Boechout, Belgium.
authors.forename: Sofie
authors.initials: S
authors.lastname: Verspreet
authors.affiliation: Institute of Psychology, Eötvös Loránd University, Budapest, Hungary.
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Demetrovics
authors.affiliation: Institute of Psychology, Eötvös Loránd University, Budapest, Hungary; Nyírő Gyula Hospital Drug Outpatient and Prevention Center, Budapest, Hungary.
authors.forename: Máté
authors.initials: M
authors.lastname: Kapitány-Fövény
authors.affiliation: Laboratoire de psychiatrie, Sanpsy CNRS USR 3413, Université de Bordeaux, and Département d'addictologie, CH Ch. Perrens/CHU de Bordeaux, Bordeaux, France.
authors.forename: Melina
authors.initials: M
authors.lastname: Fatséas
authors.affiliation: Laboratoire de psychiatrie, Sanpsy CNRS USR 3413, Université de Bordeaux, and Département d'addictologie, CH Ch. Perrens/CHU de Bordeaux, Bordeaux, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Auriacombe
authors.affiliation: Østfold Hospital Trust, Department for Substance Abuse Treatment, Norway.
authors.forename: Arild
authors.initials: A
authors.lastname: Schillinger
authors.affiliation: Østfold Hospital Trust, Department for Substance Abuse Treatment, Norway.
authors.forename: Merete
authors.initials: M
authors.lastname: Møller
authors.affiliation: Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Johnson
authors.affiliation: Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
authors.forename: Stephen V
authors.initials: SV
authors.lastname: Faraone
authors.affiliation: Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Spain.
authors.forename: J Antoni
authors.initials: JA
authors.lastname: Ramos-Quiroga
authors.affiliation: Servei de Psiquiatria, Hospital Universitari Vall d'Hebron, CIBERSAM, Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Casas
authors.affiliation: National Drug Research Institute/Curtin University of Technology, Perth, Australia.
authors.forename: Steve
authors.initials: S
authors.lastname: Allsop
authors.affiliation: National Drug Research Institute/Curtin University of Technology, Perth, Australia.
authors.forename: Susan
authors.initials: S
authors.lastname: Carruthers
authors.affiliation: Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Schoevers
authors.affiliation: Stockholm Centre for Dependency Disorders, Sweden.
authors.forename: Sara
authors.initials: S
authors.lastname: Wallhed
authors.affiliation: Institute of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary.
authors.forename: Csaba
authors.initials: C
authors.lastname: Barta
authors.affiliation: Alcohol Treatment Research, Kirchlindach and Ellikon, Switzerland.
authors.forename: Peter
authors.initials: P
authors.lastname: Alleman
authors.affiliation: Columbia University/New York State Psychiatric Institute, New York City, NY, USA.
authors.forename: Frances R
authors.initials: FR
authors.lastname: Levin
authors.affiliation: Amsterdam Institute for Addiction Research, Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Wim
authors.initials: W
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mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D003430:Cross-Sectional Studies; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D038622:Internationality; D008137:Longitudinal Studies; D008297:Male; D015995:Prevalence; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome
keywords: Adults; Attention deficit hyperactivity disorder; DSM-5; Prevalence; Substance use disorder