Substance-use disorders in adolescents and adults with ADHD: focus on treatment

Abstract

SUMMARY A high prevalence of comorbidity of ADHD and substance-use disorders (SUDs) has been shown in the literature. In this article, the literature for the treatment of adolescents and adults with co-occurring ADHD and SUD is examined. Findings from pharmacotherapy suggest mild improvement in ADHD without demonstrable changes in SUD unless the addiction was stabilized prior to treating the ADHD. No unique adverse effects, worsening of SUD, misuse or diversion of stimulants are reported in the included studies. Treating ADHD pharmacologically in individuals with ADHD plus SUD only has a modest impact on ADHD and SUD that is not observed in controlled trials. Limited data in adults with ADHD and brief abstinence of their SUD showed improvements in both ADHD and SUD with treatment. Further studies of cognitive behavioral therapy, sequencing of therapies and longer term treatment outcomes for groups with ADHD and active SUD are necessary.

International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder

“…This is important because ADHD symptoms can interfere with SUD treatment and/or SUD can complicate the treatment of ADHD. It is advisable to first start SUD treatment, followed by ADHD treatment as soon as possible thereafter [27]. When the SUD is too severe, brief residential treatment may be appro priate.…”

“…On the other hand, medication has more positive effects when combined with psychotherapy, while ADHD pharmaco-therapy by itself is generally not effective in reducing the use of substances and is associated with a higher frequency of adverse effects and treatment discontinuation [7, 27]. …”

“…The literature does not mention severe complications or increases in substance abuse with prescribing central stimulants in this patient population [27]. However, a dose-dependent interaction between disulfiram and methylphenidate resulting in psychotic episodes has been described [39].…”

Attention-Deficit/Hyperactivity Disorder and Substance Abuse

“…The following demographic/methodologic factors did not significantly moderate the associations between childhood ADHD and substance outcomes: gender, age, race, publication year, sample source, version of the Diagnostic and Statistical Manual of Mental Disorders used to diagnose ADHD, family history of SUD, cognitive impairment, executive dysfunction, and family environment. 16 Lee et ADHD is associated with an earlier age at onset of substance use and a higher likelihood of use of a variety of substances. [17][18][19] Brook et al 20 reported that the diagnosis of ADHD poses an increased risk of SUD into adulthood; meeting criteria for a diagnosis of ADHD in adolescence is associated with developing SUDs in a subject' s 20s and 30s.…”

Sustained release methylphenidate for the treatment of ADHD in amphetamine abusers: A pilot study

“…The published RCTs of MPH for ADHD in adult SUD populations in outpatient settings (Levin et al, 2007, Levin et al, 2006a, Schubiner et al, 2002 have all provided additional CBT treatment along with the medication. CBT in adults with ADHD has shown to be effective with moderate effect size (Safren et al 2006) therefore, it has been suggested that the improvement as a result of psychosocial treatment would mask the medication effect (Riggs et al, 2011, Thurstone et al, 2010, Wilens and Morrison, 2012. CBT trials in adults with ADHD have included participants on medication (Safren et al, 2005, Solanto et al, 2010.…”