Managing attention-deficit/hyperactivity disorder in the presence of substance use disorder

Abstract

Patients with attention-deficit/hyperactivity disorder (ADHD), especially adolescents and young adults, commonly have comorbid conditions, including substance use disorder (SUD), which can complicate the treatment and management of both illnesses. Patients with ADHD and SUD have an earlier age at onset of SUD, may take longer to achieve remission than those with only SUD, and are likely to have a longer course, poorer outcome, and higher rates of other psychiatric comorbidities. There is evidence of misuse and diversion with stimulant medications, which raises several safety concerns. Studies of pharmacotherapy for ADHD and comorbid SUD are limited but have shown that stimulant medications probably do not exacerbate the SUD. Nonstimulant medications for ADHD and extended-release stimulant formulations are available and may be less likely to be misused or diverted. Understanding the motives for drug use and misuse is important in treating patients with ADHD and comorbid SUD. A number of tools are available to the clinician to detect substance use problems in patients with ADHD, including drug and alcohol screening questionnaires and toxicology screens. Clinical recommendations for treating this dual diagnosis include using nonstimulant agents or extended-release stimulant formulations in conjunction with psychosocial therapies to treat both the ADHD and the SUD.