Abstract
ADHD (Attention Deficit Hyperactivity Disorder) refers to a group of genetically transmitted neurobiological dysfunctions which make it difficult for a person suffering from such a condition to focus and keep their attention, adapt their behaviour, and control impulses. Estimates of the global prevalence of adult ADHD range from 2.5 to 4.3%.
The disorder persists until adulthood in 15% of children with ADHD, while about 50% experience only some symptoms in adulthood. The ADHD syndrome seems to be more common in the population of substance users than among non-users.
Adult substance users with comorbid ADHD are also more likely to suffer from other psychiatric disorders in comparison with those who have been diagnosed with only one of the two conditions. The diagnosis of ADHD in adulthood is generally based on the clinical picture of the disorder and its detailed developmental characteristics.
In some respects, the diagnostic criteria for adult ADHD overlap with the diagnostic guidelines for personality disorders. In clinical practice, it may therefore be difficult to make a reliable distinction between them and determine which comorbidity is present or what the aetiological relationship between them is.
There are two factors, in particular, which may confound both the process and outcome of the diagnosis of ADHD in addiction patients: (a) acute intoxication or residues of acute intoxication (this especially applies to stimulants) and (b) residual effects of the long-term use of specific groups of substances (again, mainly stimulants and alcohol). Overall, personality disorders and ADHD are the most common comorbidities among substance users.
This is a highly risky and complicating factor in terms of accurate diagnosis, the determination of treatment methods and procedures, and the final treatment outcome. Individuals showing symptoms of ADHD, or their residues, in adulthood may often face major difficulties in their personal, social, and professional life.
Such patients may experience higher levels of frustration, aggression, and interpersonal conflicts. All this makes them more vulnerable to the use of drugs, especially stimulants.
Based on a review of psychodiagnostic methods relevant to the Czech setting and experience from psychiatric and psychological practice, this book provides recommendations and options for clinical work with this group of patients as regards both pharmacological and psychological therapies. In addition, it points out other challenges which this specific group of comorbid clients and patients involves, as well as offering an in-depth discussion of some of the pitfalls associated with their treatment in facilities such as therapeutic communities.
It was in this setting that an original Czech research project was carried out; some of its results inform selected chapters of this book. Significantly, ADHD symptoms may be a contributory factor for issues such as a higher drop-out rate and greater concentration of conflicts.
Early diagnosis and appropriately chosen and applied treatment could thus be highly effective in improving treatment outcomes and lead in the future to a higher quality of patients' lives and a considerable reduction in the financial resources invested in this segment of treatment. Further research and clinical interest in these phenomena should therefore be particularly aimed at exploring the relationship between ADHD among adult patients undergoing drug treatment in (not only) therapeutic communities and specific cognitive and executive functioning deficits and its effect on the course and outcome of treatment and impaired adaptability.