Levels of Impulsivity, Hyperactivity, and Inattention and the Association with Mental Health and Substance Use Severity in Opioid-Dependent Patients Seeking Treatment with Extended-Release Naltrexone.

Ann Tarja Karlsson,John-Kåre Vederhus,Thomas Clausen,Bente Weimand,Lars Tanum,Kristin Klemmetsby Solli

doi:10.3390/jcm10194558

Abstract

The level of impulsivity, hyperactivity, and inattention (IHI) is higher among patients with substance use disorder (SUD) than in the general population. However, the prevalence of such symptoms in patients seeking treatment with an opioid antagonist, such as extended-release naltrexone (XR-NTX), is unknown. We screened 162 patients with opioid use disorder (OUD) seeking treatment with XR-NTX in Norway using the Adult ADHD Self-Report Scale (ASRS) to estimate the prevalence of IHI alongside an assessment of mental and physical health and substance use. Sixty-six patients scored above the clinical cut-off on the ASRS. Higher levels of IHI were significantly associated with a longer history of frequent amphetamine use, current alcohol use, and greater mental distress. Mental distress was the strongest factor associated with higher levels of IHI. The introduction of screening for IHI and mental distress in opioid maintenance treatment and XR-NTX would likely improve the quality of care and enable clinicians to tailor interventions to the needs of patients with high levels of IHI to prevent treatment discontinuation.

Highlights

A high prevalence of psychiatric comorbidity, mental distress, and attention deficit hyperactivity disorder (ADHD) has been observed in a number of patient populations with substance use disorder (SUD) [1,2]
To broaden our understanding of the challenges encountered by these patients, in treatment settings in which non-adherence to treatment incurs increased risks, we examined the reported level of IHI and its association with SUD complexity and mental health burden
The study was conducted in accordance with the ethical principles of the Declaration of Helsinki [15], which are consistent with the International Conference on Harmonisation (ICH) guidelines for Good Clinical Practice (GCP) [16] and national regulatory requirements

Summary

Introduction

A high prevalence of psychiatric comorbidity, mental distress, and attention deficit hyperactivity disorder (ADHD) has been observed in a number of patient populations with substance use disorder (SUD) [1,2]. Knowledge of the impact of ADHD symptomatology as a co-occurring condition among opioid-dependent patients enrolled in opioid maintenance treatment (OMT) is sparse [3,4]. The core symptoms of ADHD are impulsivity, hyperactivity, and inattention (IHI) and difficulties performing executive functions. Previous findings have shown that the presence of IHI is associated with earlier onset and a more severe course of illicit substance use [7]. Diagnosing ADHD is a comprehensive and challenging task, even more so when co-occurring with SUD [8]. IHI can be symptoms of many conditions and not

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