Systematic Review and Meta-Analysis of Attention Deficit Hyperactivity Disorder: First Estimates of the Prevalence by Sex Amongst People Who Use Psychoactive Substances and Alcohol.
Level 1 - systematic review of randomized trials
Systematic review and meta-analysis of prevalence studies (design analogy)
PubMed 42429286 · doi:10.1080/15504263.2026.2686088
What was done
A systematic review and meta-analysis assessing the prevalence of attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) among adults (age 18 and older) attending drug and alcohol treatment and support services across acute hospital, community, and prison healthcare settings. Studies were included if they used suitable diagnostic tools capturing childhood history or current adult diagnosis.
What was found
Across 84 studies (99 estimates, total n = 34,036), the overall pooled ADHD prevalence was 22% (95% CI [19, 25]) with significant study heterogeneity. Meta-analysis of ASD prevalence was not feasible due to only one paper reporting on it. Subgroup findings included: - Cannabis: ADHD prevalence of 33% (95% CI [28, 39]), significantly higher than the overall rate. - Benzodiazepines: 33% (95% CI [23, 44]) in women and 31% (95% CI [23, 44]) in men. - Opioids: 27% (95% CI [20, 36]) in women and 24% (95% CI [19, 30]) in men. - Cocaine: Lowest prevalence was among women at 5% (95% CI [1, 11]). Estimates for substance-specific subgroups exhibited low to moderate heterogeneity.
Why it matters
This review demonstrates that over one-fifth of adults in substance use treatment have comorbid ADHD, establishing sex- and substance-specific prevalence estimates that support integrating routine ADHD screening and management into addiction services.
Limits
Significant heterogeneity was detected in the overall meta-analysis. Only one study assessed ASD, precluding meta-analytic estimation. Findings are limited to treatment-seeking or incarcerated populations and cannot be generalized to all individuals using substances in the community.
Cited by
- supports There is a very high prevalence of ADHD among adults who are addicted to alcohol.