OTOS Continuity™
Evidence & Sources

Every claim is sourced.
Every estimate is labelled.

Published evidence, local service figures, OTOS modelling estimates and assumptions are kept visibly separate. OTOS does not turn modelling into fact.

Published sources OTOS modelling What we're proving
Key supporting evidence

The research already says
what we know is true.

Four studies and frameworks that directly underpin the OTOS clinical rationale. All published. All traceable.

RCPsych 2022

ADHD with substance use

More benefit than risk from treating ADHD in patients with substance use disorder — in both ADHD and substance use symptom reduction.

NICE NG87

Coexisting substance misuse

NICE guidance supports ADHD assessment and treatment in active substance misuse contexts. Not a barrier — a pathway.

START study 2025

61.3% improvement

Improvement in addictive disorders at six months after ADHD diagnosis and appropriate treatment. France, 2025.

Co-occurring framework

No wrong door

National policy direction supports clearer pathways, better continuity and shared responsibility across services.

Full evidence register

Published, local, modelled, policy.

Royal College of Psychiatrists — 2022
Published source

ADHD and substance use disorders

There is more benefit than risk from treating ADHD in patients with substance use disorder, in both ADHD symptom reduction and substance use outcomes. Prevalence of ADHD in addiction cohorts: 23–45%.

PrevalenceTreatment rationaleClinical evidence
NICE NG87 — Attention deficit hyperactivity disorder
Published source

ADHD assessment in active substance misuse

NICE guidance supports ADHD assessment and treatment in the context of active substance misuse. Co-occurring substance use is not a contraindication to ADHD diagnosis or treatment.

Clinical guidelineNICEPathway rationale
START study — France, 2025
Published source

61.3% improvement in addictive disorders

Improvement in addictive disorders at six months after ADHD diagnosis and appropriate treatment. This is the primary comparator the OTOS pre-pilot is designed to test locally.

Comparator studyOutcomes evidence
NHS ADHD Taskforce — April 2025
Published source

£17bn avoidable economic cost

"ADHD, when unsupported, is a potent route into educational failure, long-term unemployment, crime, substance misuse, suicide, mental and physical illness. Economic costs to individuals and the government of at least £17 billion are avoidable."

NHS policyEconomic case
Turning Point / LSE
Published source

£4.07 return per £1 invested in addiction continuity

Social return on investment analysis of addiction continuity interventions. Used as a ROI comparator for the OTOS pre-pilot cost model. Subject to local validation.

ROIEconomic comparator
CPFT — planning data
Local source / pending validation

Adults in addiction treatment — Cambridgeshire + Peterborough

4,175 adults in structured addiction treatment across Cambridgeshire and Peterborough. Used as the planning denominator for the local risk cohort estimate. Source: CPFT / NDTMS extracted data.

CPFT ADHD waiting list — planning estimate
Local source / pending validation

ADHD waiting list length and duration

Significant and growing ADHD waiting list within CPFT. Exact figures subject to local validation. The waiting period — not the list length — is the gap OTOS addresses.

OTOS Digital Ltd — planning estimate
OTOS modelling estimate

800–900 local risk cohort

Based on NDTMS published addiction denominators (4,175 adults in treatment) applied against RCPsych ADHD prevalence range (23–45%). Planning estimate only. The pre-pilot is designed to validate this locally.

OTOS Digital Ltd — budget estimate
Budget estimate

£91,520 pre-pilot cost

Includes: platform infrastructure, partner coordination, co-production, independent evaluation, data and governance infrastructure, evidence pack for ICB commissioning decision. Not a therapy budget.

OTOS Digital Ltd — scenario modelling
OTOS modelling estimate

≈£18m modelled avoidable annual demand

Scenario-based modelling only. Not a guaranteed saving or projected outcome. The pre-pilot exists to replace this modelling with locally validated evidence. Do not present as a committed figure.

Policy alignment

NHS 10 Year Health Plan

Hospital to community, analogue to digital, sickness to prevention. OTOS tests this transition at the earliest possible point of contact with services.

Policy alignment

NHS ADHD Taskforce — April 2025

Undiagnosed ADHD framed as a major and under-addressed public health issue. Recommends improved identification, continuity and pathway coordination.

Policy alignment

DHSC addiction healthcare goals

Government investment in addiction technology addressing structural fragmentation. OTOS aligns directly with the stated goal of reducing fragmentation in the addiction and mental health pathway.

Policy alignment

250 NHS Community Hubs

The OTOS continuity layer is designed to operate naturally in the community health infrastructure described in the 10 Year Plan — lightweight, non-clinical, human-reviewed.

What the pre-pilot proves

Twelve weeks. Three questions.
One locally validated answer.

Continuity
Does receipted handoff reduce silent disengagement?
Does the thread hold across service transitions?
What is the proportion of participants reaching the next step?
Partner experience
Is keyworker burden measurably increased?
Does OTOS create any unintended clinical risk?
What is the partner-reported usability score?
Commissioning readiness
Is local cohort size within 800–900 planning estimate?
Is the cost per person within the modelled range?
Does the evidence pack support an ICB commissioning case?
Full numbers & model Partner routes