Abstract
Evidence suggests that substance use disorders (SUD) tend to be underdiagnosed in psychiatry. The objective of this study was to investigate whether drug and alcohol screening is a clinical routine in the assessment of two prominent neurodevelopmental disorders, namely ADHD and autism spectrum disorder (ASD). We surveyed drug and alcohol screening routines in 34 general child and adolescent (only practice for adolescents, not children, was assessed) and 29 adult psychiatric outpatient departments in Stockholm County, Sweden. Structured telephone interviews mapping SUD screening procedures were conducted with department representatives in charge. Only a minority of child and adolescent departments regularly used SUD screening questionnaires (6 %) in ADHD and ASD assessment, while this was more common in adult psychiatry (55 %). Urine/blood-based toxicology tests were always used in 28 % and sometimes or in case of clinical suspicion in 38 % of the adult units. Such tests were used sometimes or in case of clinical suspicion in 15 % of the child psychiatric departments, but never routinely. Findings reveal that screening for SUD in ADHD and ASD is not an integral part of routine clinical assessments in psychiatry, although increasingly an integral part of many clinical guidelines. Thus, SUD might be underdiagnosed in neurodevelopmental disorders, which could be particularly true for child and adolescent psychiatry settings.
References
Squeglia LM, Jacobus J, Tapert SF (2009) The influence of substance use on adolescent brain development. Clin EEG Neurosci 40:31–38
World Health Organization (2004) Global Health Observatory. www.who.int/gho/substance_abuse/burden/en/
National Institute on Drug Abuse (2008) Comorbidity: addiction and other mental illnesses. Research Report Series, National Institute on Drug Abuse (NIDA)
Mallin R, Slott K, Tumblin M, Hunter M (2002) Detection of substance use disorders in patients presenting with depression. Subst Abus 23:115–120
Drake RE, Alterman AI, Rosenberg SR (1993) Detection of substance use disorders in severely mentally ill patients. Community Ment Health J 29:175–192 discussion 193–174
Hansen SS, Munk-Jorgensen P, Guldbaek B, Solgard T, Lauszus KS, Albrechtsen N, Borg L, Egander A, Faurholdt K, Gilberg A, Gosden NP, Lorenzen J, Richelsen B, Weischer K, Bertelsen A (2000) Psychoactive substance use diagnoses among psychiatric in-patients. Acta Psychiatr Scand 102:432–438
Szuster RR, Schanbacher BL, McCann SC, McConnell A (1990) Underdiagnosis of psychoactive-substance-induced organic mental disorders in emergency psychiatry. Am J Drug Alcohol Abuse 16:319–327
Wilson CR, Sherritt L, Gates E, Knight JR (2004) Are clinical impressions of adolescent substance use accurate? Pediatrics 114:e536–e540
Riggs P, Levin F, Green AI, Vocci F (2008) Comorbid psychiatric and substance abuse disorders: recent treatment research. Subst Abus 29(3):51–63
van Holst RJ, Schilt T (2011) Drug-related decrease in neuropsychological functions of abstinent drug users. Curr Drug Abuse Rev 4:42–56
Regier DA, Narrow WE, Kuhl EA, Kupfer DJ (2009) The conceptual development of DSM-5. Am J Psychiatry 166:645–650
Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164:942–948
Baird G, Simonoff E, Pickles A, Chandler S, Loucas T, Meldrum D, Charman T (2006) Prevalence of disorders of the autism spectrum in a population cohort of children in South Thames: the Special Needs and Autism Project (SNAP). Lancet 368:210–215
Wilens TE, Martelon M, Joshi G, Bateman C, Fried R, Petty C, Biederman J (2011) Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. J Am Acad Child Adolesc Psychiatry 50:543–553
Abdallah MW, Greaves-Lord K, Grove J, Norgaard-Pedersen B, Hougaard DM, Mortensen EL (2011) Psychiatric comorbidities in autism spectrum disorders: findings from a Danish Historic Birth Cohort. Eur Child Adolesc Psychiatry 20:599–601
Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G (2008) Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry 47:921–929
Levin FR, Upadhyaya HP (2007) Diagnosing ADHD in adults with substance use disorder: DSM-IV criteria and differential diagnosis. J Clin Psychiatry 68:e18
SLL (2010) Regionalt vårdprogram. ADHD, lindrig utvecklingsstörning och autismspektrumtillstånd hos barn, ungdomar och vuxna. Stockholms läns landsting, Stockholm
Acknowledgments
We sincerely thank all clinical units in Stockholm County which participated in this study. Sven Bölte was supported by the Swedish Research Council (Grant nr. 523–2009–7054).
Conflict of interest
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Palmqvist, M., Edman, G. & Bölte, S. Screening for substance use disorders in neurodevelopmental disorders: a clinical routine?. Eur Child Adolesc Psychiatry 23, 365–368 (2014). https://doi.org/10.1007/s00787-013-0459-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00787-013-0459-x