ADHD and severe substance use disorder (SUD) in compulsory care: Characterization, treatment and long-term outcome


Some individuals with attention deficit hyperactivity disorder (ADHD) have co-existing substance use disorder (SUD). In Sweden, individuals with very severe SUD can be required to complete compulsory treatment in accordance with the Care of Alcoholics and Drug Abusers Act (LVM). The legislated duration of compulsory care is six months. The aim is intoxication, stabilization and motivating for voluntary care. The National Board of Institutional Care (SiS) is the authority that is responsible for the compulsory treatment of adults with severe SUD.

This project is a co-operation between KIND and SiS Institution Hornö and comprises following studies:

1. Clinical characterization of men with ADHD and severe SUD in compulsory care

Sixty patients with ADHD and substance use disorder (SUD) in compulsory care were compared with (1) 120 SUD patients without known ADHD and (2) 107 psychiatric outpatients with ADHD, but without severe SUD. ADHD/SUD patients were characterized by early and persistent antisocial behaviours and more severe cognitive impairments, as compared to the other groups. See the study here.

2. Long-term outcome in pharmacologically treated versus non-treated men with ADHD and SUD: a naturalistic study

This study is a naturalistic follow-up of the group characterized in study 1 (see above). The follow-up was conducted after discharge from compulsory care and information was obtained from local social workers. Thirty patients with ADHD and SUD, who were pharmacologically treated for ADHD, were compared with 30 pharmacologically untreated patients. The group that received pharmacological treatment for ADHD exhibited fewer substance abuse relapses, received more frequently voluntary treatments in accordance with their rehabilitation plans, and displayed a higher employment rate than the non-treated group. Premature mortality was high in the total study group (Bihlar Muld, Jokinen, Bölte, & Hirvikoski, re-submitted after revision).

3. Structured skills training in group for men with ADHD and SUD in compulsory care

We are currently evaluating structured skills training groups for men with ADHD and SUD. Skills training is based on dialectical behavior therapy (DBT) and conducted as a voluntary intervention in a compulsory care setting (SiS Institution Hornö). Previously, DBT-based skills training has been evaluated in an outpatient psychiatric context in Germany where the method was developed as well as in Sweden by us. Read more about the Swedish evalutation here. The aim of current on-going study with open study design is to evaluate the intervention’s feasibility in a compulsory care context. A long-term follow-up will be conducted six months after discharge from the compulsory care.

Research group: Berit Bihlar Muld, Jussi Jokinen, Sven Bölte, Tatja Hirvikoski.
Involved clinicians from SiS Institution Hornö: psychologists Jaana Sawires och Mikaela Silvemark Junemar and ward staff from ADHD-ward Uppgård.




Tatja Hirvikoski

Affiliated to research
K6 Department of Women's and Children's Health