Diagnosing attention-deficit/hyperactivity disorder in patients with substance use disorders

Diagnosing attention-deficit/hyperactivity disorder (ADHD) in adults can be complicated by several factors including the inability to meet appropriate developmental criteria as listed in the DSM-IV. The stringent DSM-IV criteria for ADHD may make diagnosing ADHD in adults difficult, which may lead to an underdiagnosis of ADHD in the adult population. Clinicians must rely on the diagnosis of ADHD not otherwise specified for adults with ADHD symptomatology, but this category does not provide clear delineations for patients whose symptoms vary within this category. Further complications arise due to high rates of comorbid psychiatric disorders, especially substance use disorders, in individuals with ADHD. Comorbid substance use disorders in individuals with ADHD can have a negative impact on the course of illness and quality of life. Further, cognitive deficits associated with substance abuse can hinder the ability to recall ADHD symptoms for appropriate diagnostic purposes. On the other hand, symptoms associated with intoxication or withdrawal may mimic ADHD symptoms, which can lead to an overdiagnosis of ADHD in the substance use disorder population. Another factor that can lead to the overdiagnosis of ADHD in the substance use disorder population is that patients may feign ADHD symptoms in order to obtain stimulant medication. If proper attention is paid to age-appropriate symptoms of ADHD, and careful longitudinal data are obtained from patients presenting with ADHD or substance use disorders, proper treatment can be given to patients with these comorbid disorders.