CWP Adult ADHD Service

Dr. Peter Mason

Consultant Psychiatrist

Cheshire and Wirral Partnership NHS Foundation Trust

GP Referral

• 35 year old man

• 11 year old son ADHD

• Similar symptoms (inattentive, restless and impulsive)

• Had tried his son’s Methylphenidate to good effect

CWP Adult ADHD Service

• Wirral Pilot – January 2008• Chester & Central, East & South Cheshire• Liverpool – March 2009

• Full time Adult ADHD Consultant & secretary –September 2009

• Full time Band 7 Practitioner – March 2010

CWP Adult ADHD Service

• Wirral Drug Service – June 2010 – Jan 2012• HMP Liverpool – November 2010 – Dec 2011

• Bolton – November 2011

• Central Lancashire, Stockport, Tameside & Glossop, Cumbria, Staffordshire

• Chester & CECPCT consultant October 2015

Big developments

• QbTest

• Support workers

• Additional non-medical prescriber

• Electronic pathway

Big obstacles

• Demand exceeds capacity

Big obstacles

• Demand exceeds capacity

Big obstacles

• Commissioned services

• No way out

• Co morbidity

• Medicines management groups

Consequences of ADHD

• Relationship problems

• Academic failure

• Employment problems

• Money problems

• Crime

• Drug & alcohol misuse

ADHD & driving

• 4 x more likely to crash

• 7 x more likely to have 2 or more incidents

• 4 x more likely to be at fault

ADHD & SUD

Prevalence: 52%

• More likely to be severe

• Earlier onset

• Greater impairment

• Shorter transition from use to dependence

• Lower treatment success rates

Arias et al, 2008, Biederman et al, 1995, 1997, 2008, Flory et al, 2003, Kolpe & Carlson, 2007

Treatment of ADHD & SUD

Evidence is poor in adults for treating ADHD in adults with active SUD

Magon & Muller (2012)

Stimulant treatment of ADHD in childhood is associated with a reduction in risk for SUD of up to 85%

Biederman et al (1999)

Wilens et al (2003)

Wirral Drug Service ADHD Pilot

Pre – treatment 6 month follow-up 2 year follow-up

Dependent & chaotic 29 9 (15) 8 (12)

Dependent & stable 11 17 (17) 14 (16)

Dependent & reducing 1 3 (3) 6 (7)

Occasional use 0 1 (1) 0

Abstinent 0 5 (5) 6 (6)

Total 41 35 (41) 34 (41)

ADHD & Crime

• Up to 45% male prisoners

• People with ADHD 2 x more likely to commit crime

• People with ADHD commit 3 x as many offences

HMP Liverpool – Pilot ADHD Service

• 60 prisoners assessed

• No useful quantitative outcomes

• Follow-up almost impossible

• Some dramatic outcomes

Thank you