Abstract
Background: Attention-deficit hyperactivity disorder (ADHD) is predominantly a diagnosis of childhood and adolescence but has also been recognized in adults. It is associated with high rates of comorbid psychiatric conditions, particularly substance use disorders (SUD).
Methods: A review of the literature was conducted with a focus on ADHD, SUD, their comorbidity, and treatment considerations.
Results: Literature suggests that the use of methylphenidate (MPH) in children does not increase SUD later in life, and may in fact reduce substance use and abuse in adolescence and adulthood. Concurrent treatment of ADHD-SUD, which may be supported theoretically, has yielded inconsistent data on clinical trials. While MPH use in adults with ADHDSUD may be effective in alleviating ADHD symptoms, the benefits on SUD are not clear and remain controversial. Studies suggest that adults with comorbid ADHD-SUD do not misuse or divert their medication, but MPH does not consistently improve substance use. However, data are lacking for substances other than cocaine and stimulants other than MPH. While the risk of stimulant abuse should not be ignored, it may be minimized by selecting medications that are not readily crushed and solubilized for parenteral administration, or by utilizing non-stimulant medications and/or psychotherapy.
Conclusion: While there are a lack of evidence-based guidelines for the concurrent treatment of ADHD and SUD, evidence to date suggests that stimulant medications should not necessarily be avoided for patients with comorbid ADHDSUD and that concurrent treatment may be a successful approach to improve ADHD outcomes without worsening SUD symptoms.
Keywords: Attention-deficit/hyperactivity disorder, comorbidity, stimulant, substance abuse, substance dependence, treatment, conduct disorder, diagnosis, adults, psychotherapy.
Current Drug Abuse Reviews
Title:Comorbid Attention Deficit/Hyperactivity Disorder and Substance Use Disorder: Treatment Considerations
Volume: 5 Issue: 3
Author(s): Larry J. Klassen, Timothy S. Bilkey, Martin A. Katzman and Pratap Chokka
Affiliation:
Keywords: Attention-deficit/hyperactivity disorder, comorbidity, stimulant, substance abuse, substance dependence, treatment, conduct disorder, diagnosis, adults, psychotherapy.
Abstract: Background: Attention-deficit hyperactivity disorder (ADHD) is predominantly a diagnosis of childhood and adolescence but has also been recognized in adults. It is associated with high rates of comorbid psychiatric conditions, particularly substance use disorders (SUD).
Methods: A review of the literature was conducted with a focus on ADHD, SUD, their comorbidity, and treatment considerations.
Results: Literature suggests that the use of methylphenidate (MPH) in children does not increase SUD later in life, and may in fact reduce substance use and abuse in adolescence and adulthood. Concurrent treatment of ADHD-SUD, which may be supported theoretically, has yielded inconsistent data on clinical trials. While MPH use in adults with ADHDSUD may be effective in alleviating ADHD symptoms, the benefits on SUD are not clear and remain controversial. Studies suggest that adults with comorbid ADHD-SUD do not misuse or divert their medication, but MPH does not consistently improve substance use. However, data are lacking for substances other than cocaine and stimulants other than MPH. While the risk of stimulant abuse should not be ignored, it may be minimized by selecting medications that are not readily crushed and solubilized for parenteral administration, or by utilizing non-stimulant medications and/or psychotherapy.
Conclusion: While there are a lack of evidence-based guidelines for the concurrent treatment of ADHD and SUD, evidence to date suggests that stimulant medications should not necessarily be avoided for patients with comorbid ADHDSUD and that concurrent treatment may be a successful approach to improve ADHD outcomes without worsening SUD symptoms.
Export Options
About this article
Cite this article as:
J. Klassen Larry, S. Bilkey Timothy, A. Katzman Martin and Chokka Pratap, Comorbid Attention Deficit/Hyperactivity Disorder and Substance Use Disorder: Treatment Considerations, Current Drug Abuse Reviews 2012; 5 (3) . https://dx.doi.org/10.2174/1874473711205030190
DOI https://dx.doi.org/10.2174/1874473711205030190 |
Print ISSN 1874-4737 |
Publisher Name Bentham Science Publisher |
Online ISSN 1874-4745 |
Related Articles
-
Abnormal Head Posture due to Ocular Problems- A Review
Current Pediatric Reviews 5 Hz Repetitive Transcranial Magnetic Stimulation with Maximum Voluntary Muscle Contraction Facilitates Cerebral Cortex Excitability of Normal Subjects
CNS & Neurological Disorders - Drug Targets Time-resolved and in-situ X-ray scattering methods beyond photoactivation: Utilizing high-flux X-ray sources for the study of ubiquitous non-photoactive proteins
Protein & Peptide Letters Neck Circumference and its Correlation to Other Anthropometric Parameters and Finnish Diabetes Risk Score (FINDRISC)
Current Diabetes Reviews Vascular Endothelial Growth Factor and Angiopoietins in Neurovascular Regeneration and Protection Following Stroke
Current Neurovascular Research β-Hydroxy-β-Methylbutyrate as a Countermeasure for Cancer Cachexia: A Cellular and Molecular Rationale
Anti-Cancer Agents in Medicinal Chemistry Synthesis and Biological Evaluation of Dihydroisoquinoline-2(1H)- Carbothioamide Derivatives as TRPV1 Antagonists
Letters in Drug Design & Discovery Major Mental Disorders and Violence: A Critical Update
Current Psychiatry Reviews The Expression of Cell Cycle Proteins in Neurons and its Relevance for Alzheimers Disease
Current Drug Targets - CNS & Neurological Disorders Recent Topics on Pharmacotherapy for Amphetamine-Type Stimulants Abuse and Dependence
Current Drug Abuse Reviews Memorization Test and Resting State EEG Components in Mild and Subjective Cognitive Impairment
Current Alzheimer Research The Language Development <i>Via</i> FOXP2 in Autism Spectrum Disorder: A Review
Current Pharmaceutical Design Commentary (Research Highlights: Linking Productive Autophagy to Neuroprotection: Potential Implications for Anti-Ischemic Therapy)
CNS & Neurological Disorders - Drug Targets Bio-AIMS Collection of Chemoinformatics Web Tools based on Molecular Graph Information and Artificial Intelligence Models
Combinatorial Chemistry & High Throughput Screening Lysosomal Potassium Channels: Potential Roles in Lysosomal Function and Neurodegenerative Diseases
CNS & Neurological Disorders - Drug Targets Major Developments in the Design of Inhibitors along the Kynurenine Pathway
Current Medicinal Chemistry Cardiovascular Tests: Use & Limits of Biochemical Markers - Therapeutic Measurements of ADMA Involved in Cardiovascular Disorders
Current Pharmaceutical Design Mechanical Support in Cardiogenic Shock Complicating Acute Coronary Syndrome: Ready for Prime Time?
Current Vascular Pharmacology Targeting Metallothionein for Prognosis and Treatment of Breast Cancer
Recent Patents on Anti-Cancer Drug Discovery Opioid Alkaloids in Fire Poppies, Papaver Californicum
The Natural Products Journal