The Screening-First Protocol

1. 1. Screen Everyone At Intake

   Within the first days of admission, give every client a brief validated ADHD screener such as the WHO Adult ADHD Self-Report Scale (ASRS v1.1). It takes about five minutes.

2. 2. Flag, Don't Diagnose

   A positive screen is a flag for follow-up, not a diagnosis. Withdrawal and intoxication can mimic ADHD, so record the result and plan a full assessment.

3. 3. Assess Once Stable

   After detox and initial stabilization (often a few weeks), a qualified clinician completes a full ADHD evaluation, including childhood history and, when possible, input from family.

4. 4. Build An Integrated Plan

   If ADHD is confirmed, treat it alongside the substance-use disorder in one coordinated plan. Consider non-stimulant or long-acting, lower-misuse options and monitor closely.

5. 5. Follow Up After Discharge

   Hand off ADHD care to an outpatient prescriber or therapist before discharge, so treatment continues when relapse risk is highest.

The steps above line up with recommendations from national and international bodies. Each summary below is paraphrased; clinicians should read the original documents.

• NICE Guideline NG87 — ADHD: Diagnosis And Management (UK, 2018, updated 2019)

  • Lists people with drug or alcohol misuse among groups with higher ADHD prevalence who should be considered for assessment.
  • Diagnosis should be made by a specialist using a full clinical and psychosocial assessment.
  • Co-occurring substance misuse calls for coordinated care and careful medication choices, not exclusion from treatment.
  Read the source

• SAMHSA TIP 42 — Substance Use Treatment For Persons With Co-Occurring Disorders (US, rev. 2020)

  • Screen every client for co-occurring mental health conditions at entry to substance-use treatment.
  • Follow positive screens with assessment and provide integrated, coordinated treatment.
  Read the source

• International Consensus Statement On Screening, Diagnosis And Treatment Of SUD Patients With Comorbid ADHD (Crunelle et al., European Addiction Research, 2018)

  • Recommends screening all patients entering substance-use treatment for ADHD.
  • Diagnosis is possible during treatment once acute effects have settled, using structured interviews and collateral history.
  • Recommends treating both conditions in an integrated way, with pharmacotherapy combined with psychological support.
  Read the source

• ASRS v1.1 Validation In Substance-Use Treatment (van de Glind et al., Drug and Alcohol Dependence, 2013)

  • Found the ASRS screener performs well across countries in treatment-seeking SUD patients, supporting its use as a first-step screen.
  Read the source

• American Academy Of Pediatrics ADHD Guideline (2019) and CADDRA Canadian ADHD Practice Guidelines

  • Advise screening young people with ADHD for substance use and addressing it in the treatment plan.
  Read the source

• Screener: the 6-item ASRS v1.1 Part A is free and validated in addiction treatment populations; positive screens are common, so confirm with a structured interview (for example DIVA-5 or CAARS).
• Timing: screen at intake; complete the diagnostic assessment once intoxication and acute withdrawal have resolved, using a reliable childhood history and collateral reports.
• Rule outs: consider substance-induced symptoms, mood and anxiety disorders, PTSD, sleep problems, and traumatic brain injury.
• Medication: a substance-use disorder is not by itself a reason to withhold ADHD treatment. Guidelines favour non-stimulants or long-acting stimulant formulations, with monitoring and diversion safeguards, decided by the prescriber.
• Youth: screen adolescents with ADHD for substance use at routine visits (for example with the CRAFFT).

• Add the ADHD screener to your standard intake packet.
• Name a clinician responsible for follow-up assessments.
• Train staff to tell ADHD apart from withdrawal symptoms.
• Track screening rates, confirmed diagnoses, and completion rates over time.

• Screen new patients with substance-use concerns, and patients with ADHD for substance use.
• Time the full evaluation for when the patient is stable, not intoxicated or in withdrawal.
• Coordinate with addiction specialists so both conditions share one plan.

• Ask any treatment program: “Do you screen for ADHD at intake?”
• Share school records or childhood memories that may help an assessment.
• Start with our free self-check and bring your results to your first appointment.

Help strengthen the guidelines, studies, and clinical wording in this proposal.