{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T00:40:45Z","timestamp":1792111245346,"version":"4.4.0"},"reference-count":38,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2023,1,31]],"date-time":"2023-01-31T00:00:00Z","timestamp":1675123200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>(1) Background: Attention deficit hyperactivity disorder (ADHD) is a common comorbid condition in opioid use disorder (OUD) and is associated with a more severe course of substance use. Patients with severe OUD who have not responded to oral opioid maintenance treatment can be treated with intravenous diamorphine up to three times per day. Here, we investigated the prevalence of ADHD among patients undergoing either daily diamorphine maintenance treatment or daily oral opioid maintenance treatment. (2) Methods: We assessed all participants with the WURS-k and the ADHD-SR. The Diagnostic Interview for ADHD in Adults (DIVA) was performed with all participants who met the cut-off in the WURS-k and\/or ADHD-SR. (3) Results: The overall prevalence of ADHD was 17.9%. Prevalence of ADHD among patients undergoing daily diamorphine maintenance treatment was 14.3%. Prevalence of ADHD among patients undergoing daily oral opioid maintenance treatment was 20.3%. The combined presentation of ADHD was the most prevalent condition. In urine samples of participants with comorbid ADHD, heroin was detected the most and cocaine the least frequently. (4) Conclusions: Almost one out of five patients with OUD suffered from comorbid ADHD. In 83.3%, ADHD had not been diagnosed prior to participation in this study. Thus, patients with SUD could benefit from being routinely screened for ADHD.<\/jats:p>","DOI":"10.3390\/ijerph20032534","type":"journal-article","created":{"date-parts":[[2023,2,1]],"date-time":"2023-02-01T02:29:03Z","timestamp":1675218543000},"page":"2534","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["ADHD Prevalence among Outpatients with Severe Opioid Use Disorder on Daily Intravenous Diamorphine and\/or Oral Opioid Maintenance Treatment"],"prefix":"10.3390","volume":"20","author":[{"given":"Henrik","family":"Rohner","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2651-9137","authenticated-orcid":false,"given":"Nikolas","family":"Gaspar","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Helena","family":"Rosen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tim","family":"Ebert","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura Luisa","family":"Kilarski","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix","family":"Schrader","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moaz","family":"Al Istwani","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna Julia","family":"Lenz","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Dilg","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Welskop","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tatjana","family":"Goldmann","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ulrike","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"},{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University Medical Center of Goettingen, 37075 Goettingen, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Philipsen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychotherapy, Faculty of Medicine, University of Bonn, 53111 Bonn, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1093\/ije\/dyt261","article-title":"ADHD prevalence estimates across three decades: An updated systematic review and meta-regression analysis","volume":"43","author":"Polanczyk","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1192\/bjp.bp.107.048827","article-title":"Prevalence and correlates of adult attention-deficit hyperactivity disorder: Meta-analysis","volume":"194","author":"Simon","year":"2009","journal-title":"Br. J. Psychiatry"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.3949\/ccjm.82.s1.01","article-title":"ADHD and behavioral disorders: Assessment, management, and an update from DSM-5","volume":"82","author":"Austerman","year":"2015","journal-title":"Cleve. Clin. J. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1097\/01.chi.0000189134.97436.e2","article-title":"Young adult outcome of hyperactive children: Adaptive functioning in major life activities","volume":"45","author":"Barkley","year":"2006","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_5","unstructured":"(1994). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [4th ed.]."},{"key":"ref_6","first-page":"84","article-title":"ADHD in adults: Clinical subtypes and associated characteristics","volume":"54","author":"Salvi","year":"2019","journal-title":"Riv. Psichiatr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1080\/10550887.2013.824359","article-title":"The Effects of Adhd in Adult Substance Abusers","volume":"32","author":"Moura","year":"2013","journal-title":"J. Addict. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1016\/j.cpr.2011.01.006","article-title":"Prospective association of childhood attention-deficit\/hyperactivity disorder (ADHD) and substance use and abuse\/dependence: A meta-analytic review","volume":"31","author":"Lee","year":"2011","journal-title":"Clin. Psychol. Rev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1111\/ajad.13231","article-title":"Prevalence, correlates, and consequences of attention-deficit\/hyperactivity disorder in a clinical sample of adults with tramadol use in Egypt","volume":"31","author":"Bassiony","year":"2022","journal-title":"Am. J. Addict."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"43","DOI":"10.1159\/000487767","article-title":"International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit\/Hyperactivity Disorder","volume":"24","author":"Crunelle","year":"2018","journal-title":"Eur. Addict. Res."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1199","DOI":"10.1016\/j.addbeh.2008.05.003","article-title":"Correlates of co-occurring ADHD in drug-dependent subjects: Prevalence and features of substance dependence and psychiatric disorders","volume":"33","author":"Arias","year":"2008","journal-title":"Addict. Behav."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"26","DOI":"10.12740\/APP\/80833","article-title":"Prevalence of undiagnosed and untreated attention deficit hyperactivity disorder in men with alcohol dependence: A case-control study","volume":"20","author":"Kumar","year":"2018","journal-title":"Arch. Psychiatry Psychother."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.drugalcdep.2011.12.007","article-title":"Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis","volume":"122","author":"Smit","year":"2012","journal-title":"Drug Alcohol. Depen."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"501","DOI":"10.4103\/psychiatry.IndianJPsychiatry_705_19","article-title":"Adult attention-deficit hyperactivity disorders and its correlates in patients with opioid dependence: An exploratory study","volume":"62","author":"Gupta","year":"2020","journal-title":"Indian J. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"109551","DOI":"10.1016\/j.drugalcdep.2022.109551","article-title":"Prevalence of mental disorders among people with opioid use disorder: A systematic review and meta-analysis","volume":"238","author":"Santo","year":"2022","journal-title":"Drug Alcohol Depen."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1159\/000321259","article-title":"Influence of attention deficit hyperactivity disorder and conduct disorder on opioid dependence severity and psychiatric comorbidity in chronic methadone-maintained patients","volume":"17","author":"Carpentier","year":"2011","journal-title":"Eur. Addict. Res."},{"key":"ref_17","first-page":"164","article-title":"Substitution therapy with diamorphine","volume":"84","author":"Roy","year":"2016","journal-title":"Neurol. Psychiatr."},{"key":"ref_18","unstructured":"(1993). The ICD-10 Classification of Mental and Behavioural Disorders, World Health Organization."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"a1239","DOI":"10.1136\/bmj.a1239","article-title":"Diagnosis and management of attention-deficit\/hyperactivity disorder in children, young people, and adults: Summary of NICE guidance","volume":"337","author":"Kendall","year":"2008","journal-title":"BMJ"},{"key":"ref_20","first-page":"830","article-title":"Wender Utah rating scale. The short-version for the assessment of the attention-deficit hyperactivity disorder in adults","volume":"73","author":"Retz","year":"2002","journal-title":"Nervenarzt"},{"key":"ref_21","first-page":"888","article-title":"Tools for the diagnosis of attention-deficit\/hyperactivity disorder in adults. Self-rating behaviour questionnaire and diagnostic checklist","volume":"75","author":"Rosler","year":"2004","journal-title":"Nervenarzt"},{"key":"ref_22","unstructured":"Kooij, J.J.S. (2010). Diagnostisch Interview Voor ADHD bij Volwassenen, DIVA Foundation."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.1111\/j.1360-0443.2005.01225.x","article-title":"Validation of techniques to detect illicit heroin use in patients prescribed pharmaceutical heroin for the management of opioid dependence","volume":"100","author":"Paterson","year":"2005","journal-title":"Addiction"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1287","DOI":"10.1007\/s00115-018-0553-x","article-title":"Attention deficit-hyperactivity disorder (ADHD) and comorbid mental disorders: ADHD-specific self-rating scales in differential diagnostics","volume":"89","author":"Paucke","year":"2018","journal-title":"Nervenarzt"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2072","DOI":"10.1177\/1087054717750272","article-title":"Prevalence Estimates of ADHD in a Sample of Inpatients With Alcohol Dependence","volume":"24","author":"Luderer","year":"2020","journal-title":"J. Atten. Disord."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1126","DOI":"10.1177\/1087054716646451","article-title":"Criteria and Concurrent Validity of DIVA 2.0: A Semi-Structured Diagnostic Interview for Adult ADHD","volume":"23","author":"Nasillo","year":"2019","journal-title":"J. Atten. Disord."},{"key":"ref_27","unstructured":"(2017). S3-Leitlinie ADHS bei Kindern, Jugendlichen und Erwachsenen Registernummer 028\u2013045, Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF)."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1159\/000496351","article-title":"Attention-Deficit Hyperactivity Disorder Symptom Status in a Mixed Gender Population of Opioid-Maintained Prison Inmates","volume":"25","author":"Silbernagl","year":"2019","journal-title":"Eur. Addict. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1159\/000508546","article-title":"Attention Deficit\/Hyperactivity Disorder and Global Severity Profiles in Treatment-Seeking Patients with Substance Use Disorders","volume":"26","author":"Icick","year":"2020","journal-title":"Eur. Addict. Res."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"523","DOI":"10.4103\/IJPSYM.IJPSYM_464_18","article-title":"Prevalence of Adult ADHD Co-morbidity in Alcohol Use Disorders in a General Hospital Setup","volume":"41","author":"Lohit","year":"2019","journal-title":"Indian J. Psychol. Med."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"328","DOI":"10.1177\/1087054714529819","article-title":"Adult ADHD Screening in Alcohol-Dependent Patients Using the Wender-Utah Rating Scale and the Adult ADHD Self-Report Scale","volume":"19","author":"Daigre","year":"2015","journal-title":"J. Atten. Disord."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s12402-017-0218-9","article-title":"Prevalence and correlates of ADHD in individuals with substance use disorder in Nigeria","volume":"9","author":"Umar","year":"2017","journal-title":"Adhd-Attend. Deficit"},{"key":"ref_33","first-page":"527","article-title":"Attention-deficit hyperactivity disorder in adult alcohol dependence","volume":"23","author":"Wodarz","year":"2004","journal-title":"Nervenheilkunde"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1111\/ajad.12573","article-title":"Screening for adult attention deficit\/hyperactivity disorder in high-dose benzodiazepine dependent patients","volume":"26","author":"Tamburin","year":"2017","journal-title":"Am. J. Addict."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1007\/s00702-020-02285-w","article-title":"Adult attention-deficit\/hyperactivity disorder symptoms, cognitive dysfunction and quality of life in high-dose use of benzodiazepine and Z-drug","volume":"128","author":"Federico","year":"2021","journal-title":"J. Neural. Transm."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"274","DOI":"10.1159\/000507852","article-title":"Adult Attention-Deficit\/Hyperactivity Disorder and Quality of Life in High-Dose Benzodiazepine and Related Z-Drug Users","volume":"26","author":"Lugoboni","year":"2020","journal-title":"Eur. Addict. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"279","DOI":"10.1159\/000329725","article-title":"Diagnosing Adult Attention Deficit\/Hyperactivity Disorder in Patients with Cocaine Dependence: Discriminant Validity of Barkley Executive Dysfunction Symptoms","volume":"17","author":"Rojas","year":"2011","journal-title":"Eur. Addict. Res."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1016\/j.psychres.2009.03.019","article-title":"Features and prevalence of patients with probable adult attention deficit hyperactivity disorder who request treatment for cocaine use disorders","volume":"185","author":"Sinol","year":"2011","journal-title":"Psychiat. Res."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2534\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T18:19:42Z","timestamp":1760120382000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/20\/3\/2534"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,31]]},"references-count":38,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2023,2]]}},"alternative-id":["ijerph20032534"],"URL":"https:\/\/doi.org\/10.3390\/ijerph20032534","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,1,31]]}}}