🔍💡 ADHD and addictions: 25% of patients in addiction treatment are affected by ADHD. This guide offers practical tools to better identify, guide and manage these patients.

Source: 📒 ADHD and Addictions: Better identifying, guiding and managing📜🔗LINK

At the heart of the subject 

Analytical summary 

Context and issues: a common and overlooked comorbidity

ADHD affects 5% of children and 3% of adults, but its prevalence reaches 25% among individuals with substance use disorders. The links between ADHD and addictions are now clearly established: impulsivity, sensation-seeking, and emotional dysregulation promote early initiation and progression towards addiction. However, ADHD remains underdiagnosed, particularly in adults and girls, due to diagnostic wandering and a lack of training for professionals. The consequences are severe: worsening life trajectories, frequent relapses, and complex care pathways. This guide highlights the urgency of a comprehensive and coordinated approach between addiction treatment, psychiatry, and general medicine.

Operational contributions: tools for action

The document provides clear guidelines for detection (ASRS scales, WURS-25), diagnosis (clinical interviews, life line, DIVA-5 and CAADID tools), and management (multimodal therapeutic strategies: psychoeducation, CBT, medication treatments). It emphasizes the need for interdisciplinary collaboration and proposes protocols tailored to the specificities of ADHD patients in addiction treatment, particularly for the prescription of psychostimulants. The goal is to reduce inequalities in access to care and improve the quality of life for patients and their families.

Key points to remember

• High prevalence: 25% of patients in addiction treatment have ADHD, compared to 3% in the general population (p. 9).
• Detection tools: Use ASRS-18 and WURS-25 in addition to avoid 20% of missed diagnoses (p. 11-13).
• Diagnosis: Confirm through in-depth clinical interviews, integrating life history and testimonies from those around (p. 13-17).
• Therapeutic strategies: Combine psychoeducation, CBT, and medication treatments (methylphenidate, lisdexamfetamine), with enhanced cardiovascular and psychiatric monitoring (p. 17-25).
• Care networks: Involve ADHD resource centres and addiction structures for integrated care (p. 20-25).

Action points

• Systematic identification: Integrate the ASRS-18 and the WURS-25 into assessments in addiction (p. 11-13).
• Training for professionals: Raise awareness of the specificities of ADHD in adults and the risks of misuse of psychostimulants (p. 17-20).
• Interdisciplinary collaboration: Create networks between addiction specialists, psychiatrists, and general practitioners to facilitate access to diagnosis and treatment (p. 20-25).
• Adaptation of treatments: Prioritise multimodal and personalised approaches, taking into account comorbidities (p. 17-25).

Other references

ADDITIONAL RESOURCES

Cross-sectional analysis

The reference points - 📜🔗LINK

Cross-sectional analysis according to the values of Pratiques en Santé

• Literacy: The guide offers accessible tools (ASRS, WURS-25) and clear explanations for patients.
• Empowerment: Psychoeducation and CBT aim to make the patient an active participant in their journey.
• Participation: Involvement of patients and their families in diagnosis and follow-up.
• Community health: Promotion of coordinated care networks.
• Ethics: Attention to diagnostic biases and risks of misuse.
• Human rights: Inclusive approach, respecting equity and diversity.
• Intersectorality: Collaboration between health, social services, and education.
• Combating discrimination: Raising awareness of the specific needs of girls and adults.

Summary: This document meets the criteria for Health Practices but could strengthen tools tailored to vulnerable populations (e.g., Easy to Read).

Evaluation of the reliability of the resource

This guide is based on recommendations from the HAS, recent epidemiological data, and a validated methodology. Sources are cited, the proposed tools are standardised, and the limitations (e.g., access to psychostimulants) are clearly stated.

Multiple choice questions

Part 1: Questions

Question 1: What is the percentage of patients in addiction treatment presenting with ADHD? a) 5% b) 10% c) 25% d) 40%

Question 2: What tools are recommended for the identification of ADHD in adults? a) ASRS-18 and WURS-25 b) MMSE and MoCA c) HAD and GDS d) PHQ-9 and GAD-7

Question 3: What is the maximum allowed dose of methylphenidate in adults? a) 40 mg/day b) 60 mg/day c) 80 mg/day d) 100 mg/day

Question 4: Who can make the final diagnosis of ADHD? a) Any general practitioner b) A specialist doctor (psychiatrist, paediatrician, neurologist) c) A clinical psychologist d) An addiction nurse

Question 5: What therapeutic approach is systematically recommended as the first line? a) Medication treatment alone b) Psychoeducation c) Hospitalisation d) Family therapy

Part 2: Commented correction

Question 1: ✅ Correct answer: c) 25% 📝 Explanation: The prevalence of ADHD in addiction patients is 25%, compared to 3% in the general population (p. 9).

Question 2: ✅ Correct answer: a) ASRS-18 and WURS-25 📝 Explanation: These scales are complementary to cover current and retrospective symptoms (p. 11-13).

Question 3: ✅ Correct answer: c) 80 mg/day 📝 Explanation: The maximum allowed dose is 80 mg/day; beyond that, the treatment is off-label (p. 19).

Question 4: ✅ Correct answer: b) A specialist doctor (psychiatrist, paediatrician, neurologist) 📝 Explanation: The diagnosis must be made by a doctor trained in ADHD (p. 15).

Question 5: ✅ Correct answer: b) Psychoeducation 📝 Explanation: Psychoeducation is recommended as the first line to involve the patient (p. 22).

Frequently Asked Questions

1. Why is ADHD underdiagnosed in adults?Symptoms are often masked or compensated for, and screening tools are less well known for adults (p. 8-9).

2. What are the risks of misuse of psychostimulants?Cardiovascular, psychiatric, and diversion risks, especially in patients with active addictions (p. 19-20).

3. How can care be adapted for patients with ADHD and addictions?Combine psychoeducation, CBT, and medication treatments, with enhanced monitoring (p. 17-25).

4. What are the warning signs for ADHD in a patient in addiction treatment?Impulsivity, attention difficulties, history of relapses, and diagnostic wandering (p. 11-13).

5. How to involve the patient's surroundings in the diagnosis?Gather testimonies about the patient's current and past functioning (p. 13-15).

6. What precautions should be taken before prescribing methylphenidate?Cardiological assessment, search for contraindications, and regular monitoring (p. 19-20).

7. Where can professionals find training on ADHD?Through ADHD resource centres and learned societies (SF-TDAH, Fédération Addiction) (p. 20-25).

Easy to read and understand

Better identify and assist individuals with ADHD in addiction treatment centres

1. What is this document?

Title:Better identify, direct, and manage Attention Deficit Hyperactivity Disorder (ADHD) in patients within the addiction pathway - 2026

Who wrote it?This guide was created by theInterministerial Delegation for the National Strategy on Neurodevelopmental Disorders.. It was released inFebruary 2026..

2. What is the purpose of this guide?

This guide explains:

• Whyit is important to identify ADHD in individuals with addiction issues.
• Howto better help them.
• What toolsto use to treat them.

3. ADHD and addictions: what you need to know

What is ADHD?

ADHD is a brain disorder. Individuals with ADHD may have:

• Difficulty concentrating.
• Difficulty staying calm.
• Difficulty thinking before acting.

Why talk about ADHD in addiction centres?

• 1 in 4people who go to an addiction centre have ADHD.
• In the general population, only3 in 100have ADHD.
• ADHD can make it harder to stop using drugs, alcohol, or gambling.

Why is it important to identify ADHD?

If ADHD is not identified, the person may:

• Have more difficulty stopping their addictions.
• Relapse more often.
• Have a more difficult life.

4. How to identify ADHD?

Simple tools exist.

To determine if a person has ADHD, we can use:

• The ASRS-18 scale: a short questionnaire for adults.
• The WURS-25 scale: a questionnaire about childhood symptoms.

Why use both?Because each questionnaire provides different information. Together, they help ensure a diagnosis is not missed.

Who can make the diagnosis?

Only aspecialised doctorcan determine if a person has ADHD. This doctor can be:

• A psychiatrist.
• A paediatrician.
• A neurologist.

How is the diagnosis made?

The doctor:

• Asks questions about the person's life.
• Requests information from those around them (family, friends).
• Looks at past school reports or health records.

5. How to help people with ADHD and an addiction?

Several solutions exist

1. Psychoeducation

   • Explain to the person what ADHD is.
   • Give them advice on how to better manage their daily life.

2. Therapies

   • Cognitive-behavioural therapies (CBT)thérapies cognitivo-comportementales (TCC)help to change difficult behaviours.

3. Medications

   • Some medications help improve concentration.
   • Examples:methylphenidate, lisdexamfetamine.
   • Attention: these medications must be monitored by a doctor.

What should be considered with medications?

• The doctor checks the heart before prescribing.
• The maximum dose of methylphenidate is80 mg per day..
• Beyond that, it is dangerous.

6. What can professionals do?

Identify ADHD.

• Use the questionnairesASRS-18andWURS-25..
• Ask questions about childhood and current life.

Work together.

• Doctorspsychologists, and et addiction specialistsmust communicate.
• They can form anetworkto better help patients.

Adapt care.

• Offer appropriatetherapiesandmedications.Involve the
• Impliquer la familyand closeones..