Objective: Attention-deficit hyperactivity disorder (ADHD) often coincides with substance abuse and delinquency. A sample of opioid-maintained inmates was assessed for symptoms of ADHD, substance abuse history, types of offense, psychiatric comorbidities, and psychopharmacological treatment using a standardized battery of instruments. Method: Adult inmates (n = 133, mean age 35.7 years, 21.8% female) in opioid-maintenance therapy (OMT) were administered the Adult ADHD self-report scale, Wender Utah Rating Scale, Mini International Neuropsychiatric Interview, -European Addiction Severity Index. Results: Fifty percent screened positive for childhood and 17% for adult ADHD, four (3.1%) received ADHD medication. Inmates with ADHD symptom status were significantly younger at first substance abuse, reported more drug overdoses, longer duration of cocaine and prescribed medication abuse and more in- and outpatient treatments (all p < 0.05). For all inmates in OMT a high rate of psychiatric comorbidities was observed (78.9%). Conclusion: There is a need for assessment of ADHD and other psychiatric comorbidities in OMT prisoners. Evidence-based treatment should be routinely provided.

1.
Butler T, Andrews G, Allnutt S, Sakashita C, Smith NE, Basson J: Mental disorders in Australian prisoners: a comparison with a community sample. Aust N Z J Psychiatry 2006; 40: 272–276.
2.
Indig D, Topp L, Ross B, Mamoon H, Border B, Kumar S, McNamara M: 2009 Inmate Health Survey: Key findings report, Sydney, Justice Health, 2010.
3.
Dolan K, Wirtz AL, Moazen B, Ndeffo-Mbah M, Galvani A, Kinner SA, Courtney R, McKee M, Amon JJ, Maher L, Hellard M, Beyrer C, Altice FL: Global burden of HIV, viral hepatitis, and tuberculosis in prisoners and detainees. Lancet 2016; 388: 1089–1102.
4.
Ginsberg Y, Långström N, Larsson H, Lindefors N: Long-term treatment outcome in adult male prisoners with attention-deficit/hyperactivity disorder: three-year naturalistic follow-up of a 52-week methylphenidate trial. J Clin Psychopharmacol 2015; 35: 535–543.
5.
Young S, Goodwin E: Attention-deficit/hyperactivity disorder in persistent criminal offenders: the need for specialist treatment programs. Expert Rev Neurother 2010; 10: 1497–1500.
6.
Young S, Moss D, Sedgwick O, Fridman M, Hodgkins P: A meta-analysis of the prevalence of attention deficit hyperactivity disorder in incarcerated populations. Psychol Med 2015; 45: 247–258.
7.
Simon V, Czobor P, Bálint S, Mészáros A, Bitter I: Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry 2009; 194: 204–211.
8.
Rösler M, Retz W, Yaqoobi K, Burg E, Retz-Junginger P: Attention deficit/hyperactivity disorder in female offenders: prevalence, psychiatric comorbidity and psychosocial implications. Eur Arch Psychiatry Clin Neurosci 2009; 259: 98–105.
9.
Young S, Gudjonsson G, Wells J, Ashershon P, Theobald D, Oliver B, Scott C, Mooney A: Attention deficit hyperactivity disorder and critical incidents in a Scottish prison population. Pers Individ Dif 2009; 46: 265–269.
10.
Young S, Wells J, Gudjonsson GH: Predictors of offending among prisoners: the role of attention-deficit hyperactivity disorder and substance use. J Psychopharmacol 2011; 25: 1524–1532.
11.
Mohr-Jensen C, Steinhausen HC: A meta-analysis and systematic review of the risks associated with childhood attention-deficit hyperactivity disorder on long-term outcome of arrests, convictions, and incarcerations. Clin Psychol Rev 2016; 48: 32–42.
12.
Rasmussen K, Almvik R, Levander S: Attention deficit hyperactivity disorder, reading disability, and personality disorders in a prison population. J Am Acad Psychiatry Law 2001; 29: 186–193.
13.
González RA, Vélez-Pastrana MC, Ruiz Varcárcel JJ, Levin FR, Albizu-García CE: Childhood ADHD symptoms are associated with lifetime and current illicit substance-use disorders and in-site health risk behaviors in a representative sample of Latino prison inmates. J Atten Disord 2015; 19: 301–312.
14.
Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA: The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007; 164: 942–948.
15.
Piñeiro-Dieguez B, Balanzá-Martínez V, García-García P, Soler-López B; CAT Study Group: Psychiatric comorbidity at the time of diagnosis in adults with ADHD: the CAT study. J Atten Disord 2016; 20: 1066–1075.
16.
Capusan AJ, Bendtsen P, Marteinsdottir I, Larsson H: Comorbidity of adult ADHD and its subtypes with substance use disorder in a large population-based epidemiological study. J Atten Disord 2016, Epub ahead of print.
17.
Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM: The prevalence and correlates of adult ADHD in the United States: results from the national comorbidity survey replication. Am J Psychiatry 2006; 163: 716–723.
18.
Dunne EM, Hearn LE, Rose JJ, Latimer WW: ADHD as a risk factor for early onset and heightened adult problem severity of illicit substance use: an accelerated gateway model. Addict Behav 2014; 39: 1755–1758.
19.
Upadhyaya HP: Managing attention-deficit/hyperactivity disorder in the presence of substance use disorder. J Clin Psychiatry 2007; 68(suppl 11): 23–30.
20.
Wilens TE: The nature of the relationship between attention-deficit/hyperactivity disorder and substance use. J Clin Psychiatry 2007; 68(suppl 11): 4–8.
21.
Young S, Sedgwick O, Fridman M, Gudjonsson G, Hodgkins P, Lantigua M, González RA: Co-morbid psychiatric disorders among incarcerated ADHD populations: a meta-analysis. Psychol Med 2015; 45: 2499–2510.
22.
Konstenius M, Larsson H, Lundholm L, Philips B, van de Glind G, Jayaram-Lindström N, Franck J: An epidemiological study of ADHD, substance use, and comorbid problems in incarcerated women in Sweden. J Atten Disord 2015; 19: 44–52.
23.
Wilens TE: Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. Psychiatr Clin North Am 2004; 27: 283–301.
24.
Wilens TE: Drug therapy for adults with attention-deficit hyperactivity disorder. Drugs 2003; 63: 2395–2411.
25.
Lichtenstein P, Halldner L, Zetterqvist J, Sjolander A, Serlachius E, Fazel S, Langstrom N, Larsson H: Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med 2012; 367: 2006–2014.
26.
EMCDDA: Legal Frameworks of Opioid Substitution Treatment [Internet]. www.emcdda.europa.eu/html.cfm/index41823EN.html, 2018.
27.
Hedrich D, Farrell M: Opioid maintenance in European prisons: is the treatment gap closing? Addiction 2012; 107: 461–463.
28.
Larney S, Dolan K: A literature review of international implementation of opioid substitution treatment in prisons: equivalence of care? Eur Addict Res 2009; 15: 107–112.
29.
Milloy MJ, Wood E: Withdrawal from methadone in US prisons: cruel and unusual? Lancet 2015; 386: 316–318.
30.
Gaïffas A, Galéra C, Mandon V, Bouvard MP: Attention-deficit/hyperactivity disorder in young French male prisoners. J Forensic Sci 2014; 59: 1016–1019.
31.
Riegler A, Völkl-Kernstock S, Lesch O, Walter H, Skala K: Attention deficit hyperactivity disorder and substance abuse: an investigation in young Austrian males. J Affect Disord 2017; 217: 60–65.
32.
Ginsberg Y, Quintero J, Anand E, Casillas M, Upadhyaya HP: Underdiagnosis of attention-deficit/hyperactivity disorder in adult patients: a review of the literature. Prim Care Companion CNS Disord 2014; 16:pii: PCC.13r01600.
33.
Rhodes JD, Pelham WE, Gnagy EM, Shiffman S, Derefinko KJ, Molina BS: Cigarette smoking and ADHD: an examination of prognostically relevant smoking behaviors among adolescents and young adults. Psychol Addict Behav 2016; 30: 588–600.
34.
Mitchell JT, Howard AL, Belendiuk KA, Kennedy TM, Stehli A, Swanson JM, Hechtman L, Arnold LE, Hoza B, Vitiello B, Lu B, Kollins SH, Molina BS: Cigarette smoking progression among young adults diagnosed with ADHD in childhood: a 16-year longitudinal study of children with and without ADHD. Nicotine Tob Res 2018, Epub ahead of print.
35.
Kleinman NL, Durkin M, Melkonian A, Markosyan K: Incremental employee health benefit costs, absence days, and turnover among employees with ADHD and among employees with children with ADHD. J Occup Environ Med 2009; 51: 1247–1255.
36.
Fletcher JM: The effects of childhood ADHD on adult labor market outcomes. Health Econ 2014; 23: 159–181.
37.
Bauermeister JJ, Shrout PE, Chávez L, Rubio-Stipec M, Ramírez R, Padilla L, Anderson A, García P, Canino G: ADHD and gender: are risks and sequela of ADHD the same for boys and girls? J Child Psychol Psychiatry 2007; 48: 831–839.
38.
Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, De Girolamo G, Haro JM, Karam EG, Lara C, Lépine JP, Ormel J, Posada-Villa J, Zaslavsky AM, Jin R: Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. Br J Psychiatry 2007; 190: 402–409.
39.
Rösler M, Retz W, Retz-Junginger P, Hengesch G, Schneider M, Supprian T, Schwitzgebel P, Pinhard K, Dovi-Akue N, Wender P, Thome J: Prevalence of attention deficit-/hyperactivity disorder (ADHD) and comorbid disorders in young male prison inmates. Eur Arch Psychiatry Clin Neurosci 2004; 254: 365–371.
40.
Hurtig T, Ebeling H, Jokelainen J, Koivumaa-Honkanen H, Taanila A: The association between hospital-treated injuries and ADHD symptoms in childhood and adolescence: a follow-up study in the Northern Finland birth cohort 1986. J Atten Disord 2016; 20: 3–10.
41.
Maloney E, Degenhardt L, Darke S, Nelson EC: Are non-fatal opioid overdoses misclassified suicide attempts? Comparing the associated correlates. Addict Behav 2009; 34: 723–729.
42.
Semple SJ, Patterson TL, Grant I: A comparison of injection and non-injection methamphetamine-using HIV positive men who have sex with men. Drug Alcohol Depend 2004; 76: 203–212.
43.
Perry JL, Carroll ME: The role of impulsive behavior in drug abuse. Psychopharmacology (Berl) 2008; 200: 1–26.
44.
Carpentier PJ, van Gogh MT, Knapen LJ, Buitelaar JK, De Jong CA: Influence of attention deficit hyperactivity disorder and conduct disorder on opioid dependence severity and psychiatric comorbidity in chronic methadone-maintained patients. Eur Addict Res 2011; 17: 10–20.
45.
Fiksdal Abel K, Ravndal E, Clausen T, Bramness JG: Attention deficit hyperactivity disorder symptoms are common in patients in opioid maintenance treatment. Eur Addict Res 2017; 23: 298–305.
46.
Lugoboni F, Levin FR, Pieri MC, Manfredini M, Zamboni L, Somaini L, Gerra G, Gruppo InterSert Collaborazione Scientifica G: Co-occurring attention deficit hyperactivity disorder symptoms in adults affected by heroin dependence: patients characteristics and treatment needs. Psychiatry Res 2017; 250: 210–216.
47.
Liao YT, Chen CY, Ng MH, Huang KY, Shao WC, Lin TY, Chen VC, Gossop M: Depression and severity of substance dependence among heroin dependent patients with ADHD symptoms. Am J Addict 2017; 26: 26–33.
48.
Blacken P, Hendriks V, Pozzi G, Tempesta E, Hartgers C, Koeter M, Uchtenhagen A: European Addiction Severity Index (EuropASI) 5th edition. Athens, EMCCDA, 1994.
49.
Oeberg D, Sallmen B, Kaplan C, McMurphy S, Ackerson T, Krantz L, Turner T: The Addiction Severity Index-Crime Module. Hoever, Karlsvik Rehabilitation Center, 1998.
50.
Brinkley-Rubinstein L, McKenzie M, Macmadu A, Larney S, Zaller N, Dauria E, Rich J: A randomized, open label trial of methadone continuation versus forced withdrawal in a combined US prison and jail: findings at 12 months post-release. Drug Alcohol Depend 2018; 184: 57–63.
51.
Schaub M, Stevens A, Berto D, Hunt N, Kerschl V, McSweeney T, Oeuvray K, Puppo I, Santa Maria A, Trinkl B, Werdenich W, Uchtenhagen A: Comparing outcomes of “voluntary” and “quasi-compulsory” treatment of substance dependence in Europe. Eur Addict Res 2010; 16: 53–60.
52.
Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, Hergueta T, Baker R, Dubar GC: The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 1998; 59: 22–33.
53.
Mir J, Kastner S, Priebe S, Konrad N, Ströhle A, Mundt AP: Treating substance abuse is not enough: comorbidities in consecutively admitted female prisoners. Addict Behav 2015; 46: 25–30.
54.
Ayhan G, Arnal R, Basurko C, About V, Pastre A, Pinganaud E, Sins D, Jehel L, Falissard B, Nacher M: Suicide risk among prisoners in French Guiana: prevalence and predictive factors. BMC Psychiatry 2017; 17: 156.
55.
World Health Organization: Adult ADHD Self-Report Scale (ASRS). https://www.hcp.med.harvard.edu/ncs/asrs.php (German version November 16, 2018).
56.
Kessler RC, Adler L, Ames M, Demler O, Faraone S, Hiripi E, Howes MJ, Jin R, Secnik K, Spencer T, Ustun TB, Walters EE: The world health organization adult ADHD self-report scale (ASRS): a short screening scale for use in the general population. Psychol Med 2005; 35: 245–256.
57.
Moore E, Sunjic S, Kaye S, Archer V, Indig D: Adult ADHD among NSW prisoners: prevalence and psychiatric comorbidity. J Atten Disord 2016; 20: 958–967.
58.
Retz-Junginger P, Retz W, Blocher D, Weijers HG, Trott GE, Wender PH, Rösler M: Wender Utah Rating Scale (WURS-k) Die deutsche Kurzform zur retrospektiven erfassung des hyperkinetischen syndroms bei erwachsenen. Der Nervenarzt 2002; 73: 830–838.
59.
Ward MF, Wender PH, Reimherr FW: The wender utah rating scale: an aid in the retrospective diagnosis of childhood attention deficit hyperactivity disorder. Am J Psychiatry 1993; 150: 885–890.
60.
Matsumoto T, Kamijo A, Yamaguchi A, Iseki E, Hirayasu Y: Childhood histories of attention-deficit hyperactivity disorders in Japanese methamphetamine and inhalant abusers: preliminary report. Psychiatry Clin Neurosci 2005; 59: 102–105.
61.
Retz-Junginger P, Retz W, Blocher D, Stieglitz RD, Georg T, Supprian T, Wender PH, Rösler M: [Reliability and validity of the Wender-Utah-Rating-Scale short form. Retrospective assessment of symptoms for attention deficit/hyperactivity disorder]. Nervenarzt 2003; 74: 987–993.
62.
Cohen J: Statistical Power Analysis for the Behavioral Sciences (ed 2). Hillsdale, Erlbaum, 1988.
63.
Einarsson E, Sigurdsson JF, Gudjonsson GH, Newton AK, Bragason OO: Screening for attention-deficit hyperactivity disorder and co-morbid mental disorders among prison inmates. Nord J Psychiatry 2009; 63: 361–367.
64.
Faraone SV, Biederman J, Spencer T, Mick E, Murray K, Petty C, Adamson JJ, Monuteaux MC: Diagnosing adult attention deficit hyperactivity disorder: are late onset and subthreshold diagnoses valid? Am J Psychiatry 2006; 163: 1720–1729.
65.
Landes SD, London AS: Self-reported ADHD and adult health in the United States. J Atten Disord 2018, Epub ahead of print.
66.
Katzman MA, Bilkey TS, Chokka PR, Fallu A, Klassen LJ: Adult ADHD and comorbid disorders: clinical implications of a dimensional approach. BMC Psychiatry 2017; 17: 302.
67.
Bramness JG, Kornør H: Benzodiazepine prescription for patients in opioid maintenance treatment in Norway. Drug Alcohol Depend 2007; 90: 203–209.
68.
Metz V, Matzenauer C, Kammerer K, Winklbauer B, Ebner N, Radler D, Fischer G: Evaluation of opioid-dependent prisoners in oral opioid maintenance therapy. Heroin Addict Relat Clin Probl 2010; 12: 5–16.
69.
Sobanski E, Brüggemann D, Alm B, Kern S, Deschner M, Schubert T, Philipsen A, Rietschel M: Psychiatric comorbidity and functional impairment in a clinically referred sample of adults with attention-deficit/hyperactivity disorder (ADHD). Eur Arch Psychiatry Clin Neurosci 2007; 257: 371–377.
70.
Chahua M, Sordo L, Barrio G, Domingo-Salvany A, Brugal MT, Molist G, de la Fuente L, Bravo MJ; ITINERE Project Group: Non-fatal opioid overdose and major depression among street-recruited young heroin users. Eur Addict Res 2014; 20: 1–7.
71.
Rodríguez-Cintas L, Daigre C, Braquehais MD, Palma-Alvarez RF, Grau-López L, Ros-Cucurull E, Rodríguez-Martos L, Abad AC, Roncero C: Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res 2018; 262: 440–445.
72.
Bohnert AS, Roeder KM, Ilgen MA: Suicide attempts and overdoses among adults entering addictions treatment: comparing correlates in a U.S. National study. Drug Alcohol Depend 2011; 119: 106–112.
73.
Wynchank D, Bijlenga D, Lamers F, Kooij JJS, Bron TI, Beekman ATF, Penninx B: The association between metabolic syndrome, obesity-related outcomes, and ADHD in adults with comorbid affective disorders. J Atten Disord 2018; 22: 460–471.
74.
Cumyn L, French L, Hechtman L: Comorbidity in adults with attention-deficit hyperactivity disorder. Can J Psychiatry 2009; 54: 673–683.
75.
Black DW, Gunter T, Loveless P, Allen J, Sieleni B: Antisocial personality disorder in incarcerated offenders: psychiatric comorbidity and quality of life. Ann Clin Psychiatry 2010; 22: 113–120.
76.
Griffiths EV, Willis J, Spark MJ: A systematic review of psychotropic drug prescribing for prisoners. Aust N Z J Psychiatry 2012; 46: 407–421.
77.
Luo SX, Levin FR: Towards precision addiction treatment: new findings in co-morbid substance use and attention-deficit hyperactivity disorders. Curr Psychiatry Rep 2017; 19: 14.
78.
Lee SS, Humphreys KL, Flory K, Liu R, Glass K: Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clin Psychol Rev 2011; 31: 328–341.
79.
Khantzian EJ: Addiction as a self-regulation disorder and the role of self-medication. Addiction 2013; 108: 668–679.
80.
Khantzian EJ: The self-medication hypothesis of addictive disorders: focus on heroin and cocaine dependence. Am J Psychiatry 1985; 142: 1259–1264.
81.
Vogel M, Bucher P, Strasser J, Liechti ME, Krähenbühl S, Dürsteler KM: Similar and different? Subjective effects of methylphenidate and cocaine in opioid-maintained patients. J Psychoactive Drugs 2016; 48: 93–100.
82.
Nuijten M, Blanken P, van de Wetering B, Nuijen B, van den Brink W, Hendriks VM: Sustained-release dexamfetamine in the treatment of chronic cocaine-dependent patients on heroin-assisted treatment: a randomised, double-blind, placebo-controlled trial. Lancet 2016; 387: 2226–2234.
83.
Frauger E, Amaslidou D, Spadari M, Allaria-Lapierre V, Braunstein D, Sciortino V, Thirion X, Djezzar S, Micallef J: Patterns of methylphenidate use and assessment of its abuse among the general population and individuals with drug dependence. Eur Addict Res 2016; 22: 119–126.
84.
Turan O: Smoking status and the presence of chronic obstructive pulmonary disease in prison. J Addict Med 2015; 9: 118–122.
85.
Do HP, Nguyen LH, Thi Nguyen NP, Ngo C, Thi Nguyen HL, Le GT, Nguyen LK, Nguyen CT, Tran BX, Le HT, Vu TMT, Phan HTT, Tran TD, Latkin CA, Dunne MP: Factors associated with nicotine dependence during methadone maintenance treatment: findings from a multisite survey in Vietnam. BMJ Open 2017; 7:e015889.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.