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
Open accessAbstract
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.
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Differences in diagnostic criteria (DSM-IV, DSM-5, ICD-10) and assessment tools substantially affect reported prevalence rates of adult ADHD.
“Differences in diagnostic criteria, such as DSM-IV, DSM-5, or ICD-10, as well as the assessment tools employed, ranging from self-report questionnaires to structured clinical interviews, substantially affect reported prevalence rates”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [16]
The Conclusions report that using the same definitions and diagnostic instruments across centers substantially reduced variability in adult ADHD prevalence estimates among treatment-seeking substance use disorder patients. But the Discussion describes only a modest increase under DSM-5 versus DSM-IV; the paper does not evaluate ICD-10 or directly compare prevalence from self-report questionnaires with structured interviews. (LLM, conf=0.89)
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- Authors
- van de Glind, G., Konstenius, M., Koeter, M. W. J., van Emmerik-van Oortmerssen, K., Carpentier, P.-J., Kaye, S., Degenhardt, L., Skutle, A., Franck, J., Bu, E.-T., Moggi, F., Dom, G., Verspreet, S., Demetrovics, Z., Kapitány-Fövény, M., Fatséas, M., Auriacombe, M., Schillinger, A., Møller, M., Johnson, B., Faraone, S. V., Ramos-Quiroga, J. A., Casas, M., Allsop, S., Carruthers, S., Schoevers, R. A., Wallhed, S., Barta, C., Alleman, P., Levin, F. R., & van den Brink, W.
- Affiliations
- Karolinska Institutet (SE)
- Amsterdam UMC Location University of Amsterdam (NL)
- Reinier van Arkel (NL)
- UNSW Sydney (AU)
- The University of Melbourne (AU)
- University of Fribourg (CH)
- University of Antwerp (BE)
- Eötvös Loránd University (HU)
- Centre National de la Recherche Scientifique (FR)
- Østfold Hospital Trust (NO)
- SUNY Upstate Medical University (US)
- Universitat Autònoma de Barcelona (ES)
- Curtin University (AU)
- University Medical Center Groningen (NL)
- Semmelweis University (HU)
- New York State Psychiatric Institute (US)
- ORCID
- Venue
- Drug and Alcohol Dependence
- Publisher
- Elsevier BV
- Published
- 2014-01
- Volume
- 134
- Pages
- 158-166
- ISSN
- 0376-8716 (ISSN-L)
- PMC
- PMC4133781
- OpenAlex
- W2134299138
- Cited by
- 193
- References
- 43
- Citations by year
- 2026: 6 · 2025: 6 · 2024: 16 · 2023: 12 · 2022: 19 · 2021: 13 · 2020: 30 · 2019: 14 · 2018: 18 · 2017: 16 · 2016: 16 · 2015: 12 · 2014: 11 · 2013: 3
- FWCI
- 9.92
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Drug and Alcohol Dependence (publishedVersion, cc-by-nc-sa)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
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- PubMed Central (acceptedVersion, cc-by-nc)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by-nc)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
- Radboud Repository (Radboud University) (submittedVersion, cc-by-nc-sa)
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- ELTE Digital Institutional Repository (EDIT) (Eötvös Loránd University) (submittedVersion, other-oa)
- eSpace (Curtin University) (submittedVersion, cc-by-nc-sa)
- Semmelweis University Repository (Semmelweis University) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc-sa)
- Open Access CRIS of the University of Bern
- Funders
- Eli Lilly and Company
- Pfizer
- Syracuse University
- Waterloo Foundation
- GW Pharmaceuticals
- Australian Government
- Noaber Foundation
- University of Oxford
- European Commission (TÁMOP-4.2.1/B-09/1/KMR-2010-0003, KMR-2010-0003)
- Agence Nationale de la Recherche
- Curtin University of Technology
- Generalitat de Catalunya
- Fonds NutsOhra
- Karolinska Institutet
- Helse Vest
- Centre National de la Recherche Scientifique
- Sykehuset Østfold
- H. Lundbeck A/S
- National Institutes of Health
- Plan Nacional sobre Drogas
- Medical Research Council
- National Health and Medical Research Council
- National Institute on Drug Abuse (K24DA029647)
- European Social Fund (TÁMOP 4.2.1/B‐09/1/KMR‐2010‐0003, 4.2.1/B-09/1/KMR-2010-0003, KMR-2010-0003)
- Regionalt Kompetansesenter for Rusmiddelforskning i Helse Vest
- Cilag
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- adult ADHD, substance use disorders, prevalence, DSM-IV, DSM-5, diagnostic criteria revision, addiction treatment patients, alcoholism, drug use disorders, ADHD screening, comorbidities
- MeSH terms
- Adult, Attention Deficit Disorder with Hyperactivity, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Prevalence, Treatment Outcome, Substance-Related Disorders, Internationality, Diagnostic and Statistical Manual of Mental Disorders
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