ADHD and Addictions
Discussion What phrase best describes your beliefs about a diagnosis of AD(H)D in adults? Unconvinced Sceptical Open-minded Accepting Unsure
Aims of Training To have an understanding of the presentation of AD(H)D in adults with comorbid addiction. To understand barriers to diagnosis and treatment access To think about what to do next
Prevalence of AD(H)D as a developmental disorder across the lifespan AD(H)D in children is 5% in UK. Up to 60% of children with AD(H)D will continue to experience impairment in adulthood. AD(H)D in adults: 4 5% - USA/Canada 2 % - worldwide (NICE,2008) AD(H)D in Addictions 10-12%
AD(H)D What it is: A common behavioural disorder with 3 core symptoms Inattention Hyperactivity Impulsivity These symptoms can cause degrees of psychological, social and functional impairment across a variety of settings
AD(H)D Inattention Some quotes I find myself more and more socially disorganized to meet friends who are in town and to do things I enjoy I couldn t settle down to study and only got by because I was clever I ve had 7 different jobs in the last year, losing each one after making careless mistakes, forgetting things and daydreaming Daily life is tricky, I'm usually late for work, not massively but regularly
AD(H)D Impulsivity Some quotes I'm now 28 and finally a bit better at controlling impulse buying I like the buzz of trying dangerous stunts that my friends say are too crazy My AD(H)D behaviours have been the cause of many workplace explosions
AD(H)D Hyperactivity Some quotes I liked my job as a fireman as the hustle of the job helped keep my attention. Now I have a desk job, which doesn t suit me as I m behind on paperwork, have difficulty organizing tasks and meeting deadlines I constantly battle with procrastination, worry, insomnia, impulsivity, excessive talking, being argumentative, interrupting others when talking
Risks associated with high AD(H)D traits Behavioural disturbance Academic impairment Poor social interaction Lower self-esteem Smoking Criminality Co-morbidity Unemployment Low self esteem Relationship problems Motor accidents Marital discord Alcohol/substance misuse Mood instability Co-morbidity Pre-School School age Adolescent College age Adult Behavioural disturbance Academic impairment Poor social interaction Peer non-acceptance Co-morbidity Academic failure Occupational difficulties Low self esteem Alcohol/substance abuse Injury accidents Co-morbidity
Differential diagnosis / co-morbidity Up to 80% of adults with AD(H)D also have at least one co-existing psychiatric diagnosis There is high co-morbidity of AD(H)D and: Bipolar disorder; depression and anxiety especially in females Substance use and addictions Personality disorders Other developmental disorders e.g. Autism, dyspraxia and impaired motor co-ordination, tics and Tourette Syndrome High incidence of AD(H)D within prison and forensic populations.
AD(H)D in Adults NHS Lothian SMD Referral Pathway Keyworker suspects possible AD(H)D Screening tool - outcome Impact on function/co-morbidity Self Management/signposting resources Refer to / Joint work with Local Mental Health Service/Sector Team Discuss who best to prescribe if needed
Questions... Have you thought of anyone in particular so far? With a 10% prevalence, how many people with ADHD might there be in your service? What one change to your processes might improve identification? What are you going to do next?