Substance Use Disorder Severity Among Patients with and Without ASRS-Based Probable Adult ADHD in Rehabilitation Settings in Nairobi, Kenya
DOI:
https://doi.org/10.59952/aa63mq58Keywords:
Adult Attention-Deficit/Hyperactivity Disorder (Adult ADHD), Substance use disorder (SUD), Substance use severity, Rehabilitation centers, KenyaAbstract
Adult Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occurs with Substance Use Disorders (SUDs) and has been associated with greater substance-related severity. Evidence comparing SUD severity according to ADHD screening status among treatment-seeking adults in Kenya remains limited. A cross-sectional analytical study was conducted among adults aged 18–65 years receiving SUD treatment in six rehabilitation centres in Nairobi, Kenya. Of 390 eligible patients, 322 participated (82.6%). Adult ADHD was screened using the Adult ADHD Self-Report Scale Version 1.1 (ASRS v1.1), while alcohol- and drug-related severity were assessed using the Alcohol Use Disorders Identification Test (AUDIT) and Drug Abuse Screening Test-10 (DAST-10), respectively. Mean severity scores were compared between participants with and without ASRS-based probable adult ADHD, with mean differences, 95% confidence intervals (CIs), and Hedges’ g reported. Ninety participants (28.0%) met the study criteria for ASRS-based probable adult ADHD. Mean AUDIT scores were higher among participants with probable ADHD than among those without probable ADHD (28.81 vs. 21.88; mean difference = 6.93, 95% CI [4.52, 9.34]; Hedges’ g = 0.70; p < .001). Mean DAST-10 scores were also higher (6.59 vs. 4.09; mean difference = 2.50, 95% CI [1.77, 3.23]; Hedges’ g = 0.77; p < .001). ASRS-based probable adult ADHD was associated with greater alcohol- and drug-related SUD severity among adults receiving treatment in Nairobi. The findings support further evaluation of the clinical utility of ADHD screening and comprehensive assessment within Kenyan SUD treatment settings.
References
Abdel-Fadeel, N. A., Kamal, A. M., Abdel Naem, M. M., & Abdel Hafeez, M. H. (2023).
Prevalence and effect of attention-deficit hyperactivity disorder on the pattern and severity of substance use disorders. Egyptian Journal of Psychiatry, 44(2), 90–97. doi: 10.21608/EJPSY.2024.340973
Ameringer, K. J., & Leventhal, A. M. (2013). Associations between attention deficit hyperactivity disorder symptom domains and DSM-IV lifetime substance dependence. The American Journal on Addictions, 22(1), 23–32. https://doi.org/10.1111/j.1521 0391.2013.00325.x
Barbuti, M., Maiello, M., Spera, V., Pallucchini, A., Brancati, G. E., Maremmani, A. G.
I., Perugi, G., & Maremmani, I. (2023). Challenges of treating ADHD with comorbid substance use disorder: Considerations for the clinician. Journal of Clinical Medicine, 12(9), 3096. https://doi.org/10.3390/jcm12093096
Breyer, J. L., Lee, S., Winters, K. C., August, G. J., & Realmuto, G. M. (2014). A longitudinal study of childhood ADHD and substance dependence disorders in early adulthood. Psychology of addictive behaviors: journal of the Society of Psychologists in Addictive Behaviors, 28(1), 238–246. https://doi.org/10.1037/a0035664
Daurio, A. M., Aston, S. A., Schwandt, M. L., Bukhari, M. O., Bouhlal, S., Farokhnia, M., Lee, M. R., & Leggio, L. (2018). Impulsive personality traits mediate the relationship between adult attention-deficit/hyperactivity symptoms and alcohol dependence severity. Alcoholism: Clinical and Experimental Research, 42(1),
173–183. https://doi.org/10.1111/acer.13538
Faraone, S. V., Kunwar, A., Adamson, J., & Biederman, J. (2009). Personality traits among ADHD adults: Implications of late-onset and subthreshold diagnoses. Psychological Medicine, 39(4), 685–693. https://doi.org/10.1017/S0033291708003917
Ilbegi, S., Groenman, A. P., Schellekens, A., Hartman, C. A., Hoekstra, P. J., Franke, B.,
& Buitelaar, J. K. (2018). Substance use and nicotine dependence in persistent, remittent, and late-onset ADHD: A 10-year longitudinal study from childhood to young adulthood. Journal of Neurodevelopmental Disorders, 10(1), 42. https://doi.org/10.1186/s11689-018-9260-y
Jenkins, R., Othieno, C., Ongeri, L., Ogutu, B., Sifuna, P., Mboroki, J., & Omollo, R. (2015). Attention deficit hyperactivity disorder symptom self-report in adults in Kenya and its associated risk factors: An analysis from a household survey in a demographic surveillance site. Global Mental Health (Cambridge, England), 2, e14. https://doi.org/10.1017/gmh.2015.14
Khantzian, E. J. (1997). The self-medication hypothesis of substance use disorders: A
reconsideration and recent applications. Harvard Review of Psychiatry, 4(5),231-
244. https://doi.org/10.3109/10673229709030550
Levy, S., Katusic, S. K., Colligan, R. C., Weaver, A. L., Killian, J. M., Voigt, R. G., & Barbaresi, W. J. (2014). Childhood ADHD and risk for substance dependence inadulthood: a longitudinal, population-based study. PloS one, 9(8), e105640. https://doi.org/10.1371/journal.pone.0105640
Miranda, A., Colomer, C., Berenguer, C., Roselló, R., & Rosello, B. (2016). Substance use in young adults with ADHD: Comorbidity and symptoms of inattention and hyperactivity/impulsivity. International Journal of Clinical and Health Psychology, 16(2), 157–165. https://doi.org/10.1016/j.ijchp.2015.07.002
Ohlmeier, M. D., Goseberg, E., Roy, M., Dillo, W., Kordon, A., & Prox-Vagedes, V. (2011). Alcohol and drug dependence in adults with attentiondeficit/hyperactivity disorder: Data from Germany. The European Journal of Psychiatry, 25(3), 139
150. https://doi.org/10.4321/S0213-61632011000300005
Oigara, L. O. (2022). Prevalence of attention-deficit hyperactivity disorder symptoms among adults seeking treatment for substance use disorders in Nairobi County (Master's thesis, United States International University-Africa). eRepo. http://erepo.usiu.ac.ke/11732/7655
Regnart, J., Truter, I., Zingela, Z., & Meyer, A. (2019). A pilot study: Use of the Adult Attention-Deficit/Hyperactivity Disorder Self-Report Scale in a South African patient population. The South African journal of psychiatry: SAJP: the journal of the Society of Psychiatrists of South Africa, 25, 1326. https://doi.org/10.4102/sajpsychiatry.v25i0.1326
Rohner, H., Gaspar, N., Philipsen, A., & Schulze, M. (2023). Prevalence of attention populations: Meta- analysis. International Journal of Environmental Research and Public Health, 20(2),1275. https://doi.org/10.3390/ijerph20021275
Seitz, A., Wapp, M., Burren, Y., Stutz, S., Schläfli, K., & Moggi, F. (2013). Association between craving and attention deficit/hyperactivity disorder symptoms among patients with alcohol use disorders. The American Journal on Addictions, 22(3),
292–296. https://doi.org/10.1111/j.1521-0391.2012.12000.x
Song, P., Zha, M., Yang, Q., Zhang, Y., Li, X., & Rudan, I. (2021). The prevalence of adult attention-deficit hyperactivity disorder: A global systematic review and meta-analysis. Journal of Global Health, 11, 04009. https://doi.org/10.7189/jogh.11.04009
Vold, J. H., Halmøy, A., Chalabianloo, F., Pierron, M. C., Løberg, E.-M., Johansson, K.
A., & Fadnes, L. T. (2023). 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. BMC Psychiatry, 23(1), 479. https://doi.org/10.1186/s12888-023-04980-w
Volkow, N. D., Wang, G.-J., Kollins, S. H., Wigal, T. L., Newcorn, J. H., Telang, F., Fowler, J.S., Zhu, W., Logan, J., Ma, Y., Pradhan, K., Wong, C., & Swanson, J. M. (2009). Evaluating dopamine reward pathway in ADHD: Clinical implications. JAMA, 302(10), 1084–1091. https://doi.org/10.1001/jama.2009.1308
World Health Organization (WHO). (2024). Global Report on the Health of Adolescents and Young People: Addressing Substance Use and Mental Health Disorders. Geneva: WHO.
Young, J. T., Carruthers, S., Kaye, S., Allsop, S., Gilsenan, J., & Degenhardt, L. (2015).
Comorbid attention deficit hyperactivity disorder and substance use
disorder complexity and chronicity in treatment-seeking adults. Drug and Alcohol
Review, 34(6), 683–693. https://doi.org/10.1111/dar.12249
Young, S., & Sedgwick, O. (2015). Attention deficit hyperactivity disorder and substance misuse: An evaluation of causal hypotheses and treatment considerations. Expert Review of Neurotherapeutics, 15(9), 1005–1014. https://doi.org/10.1586/14737175.2015.1059756
Young, S., & Woodhouse, E. (2021). Assessment and treatment of substance use in adults with ADHD: A psychological approach. Journal of Neural Transmission, 128(8),
1099–1108. https://doi.org/10.1007/s00702-020-02277-w
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