International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Heval Özgen^{1

2}, Renske Spijkerman³, Moritz Noack⁴, Martin Holtmann⁴, Arnt S A Schellekens^{5

6}, Geurt van de Glind^{6

7}, Tobias Banaschewski⁸, Csaba Barta^{9

10}, Alex Begeman¹¹, Miguel Casas¹², Cleo L Crunelle¹³, Constanza Daigre Blanco^{14

15

16}, Søren Dalsgaard¹⁷, Zsolt Demetrovics¹⁸, Jacomine den Boer¹¹, Geert Dom¹⁹, Valsamma Eapen²⁰, Stephen V Faraone²¹, Johan Franck²², Rafael A González^{23

24}, Lara Grau-López^{14

15

16

25}, Annabeth P Groenman^{26

27}, Malin Hemphälä²², Romain Icick^{28

29

30}, Brian Johnson²¹, Michael Kaess^{31

32}, Máté Kapitány-Fövény^{33

34}, John G Kasinathan³⁵, Sharlene S Kaye³⁶, Falk Kiefer³⁷, Maija Konstenius²², Frances R Levin³⁸, Mathias Luderer³⁹, Giovanni Martinotti⁴⁰, Frieda I A Matthys⁴¹, Gergely Meszaros⁴², Franz Moggi⁴³, Ashmita P Munasur-Naidoo^{44

45}, Marianne Post⁴⁶, Sharon Rabinovitz⁴⁷, J Antoni Ramos-Quiroga^{15

16

48

25}, Regina Sala⁴⁹, Abu Shafi⁵⁰, Ortal Slobodin⁵¹, Wouter G Staal^{52

53}, Rainer Thomasius⁵⁴, Ilse Truter⁵⁵, Michiel W van Kernebeek⁵⁶, Maria C Velez-Pastrana⁵⁷, Sabine Vollstädt-Klein³⁷, Florence Vorspan^{29

58

59

60}, Jesse T Young^{61

62

63

64}, Amy Yule⁶⁵, Wim van den Brink^{7

66}, Vincent Hendriks^{3

67}

Affiliations

¹ Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, The Hague, The Netherlands, m.h.ozgen@parnassiagroep.nl.
² Curium, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands, m.h.ozgen@parnassiagroep.nl.
³ Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, The Hague, The Netherlands.
⁴ Department of Child and Adolescent Psychiatry, LWL-University Hospital, Ruhr-University Bochum, Hamm, Germany.
⁵ Department of Psychiatry, Donders institute, RadboudUMC, Nijmegen, The Netherlands.
⁶ Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), RadboudUMC, Nijmegen, The Netherlands.
⁷ International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, Nijmegen, The Netherlands.
⁸ Department of Child and Adolescent Psychiatry, Central Institute of Mental Health Mannheim (CIMH), Heidelberg University, Mannheim, Germany.
⁹ Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary.
¹⁰ Institute of Psychology, Faculty of Humanities and Social Sciences, Pázmány Péter Catholic University, Budapest, Hungary.
¹¹ De Hoop GGZ, Dordrecht, The Netherlands.
¹² Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain.
¹³ Department of Psychiatry, University Hospital Brussels, Brussels, Belgium.
¹⁴ Department of Psychiatry, Mental Health and Addictions, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
¹⁵ Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
¹⁶ Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain.
¹⁷ Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.
¹⁸ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
¹⁹ Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium.
²⁰ Academic Unit of Infant, Child, Adolescent Psychiatry South West Sydney, University of New South Wales, Sydney, New South Wales, Australia.
²¹ Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA.
²² Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Sweden.
²³ Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom.
²⁴ East London NHS Foundation Trust, Child and Adolescent Mental Health Service (CAMHS) - ADHD clinic, London, United Kingdom.
²⁵ Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
²⁶ Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
²⁷ Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
²⁸ Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, France.
²⁹ INSERM U1144, Paris, France.
³⁰ Inserm UMR-S1144, Université de Paris, Paris, France.
³¹ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
³² Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
³³ Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
³⁴ Drug Outpatient Centre, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary.
³⁵ Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australia.
³⁶ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
³⁷ Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany.
³⁸ Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York, USA.
³⁹ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany.
⁴⁰ Department of Neuroscience, Imaging, Clinical Sciences, University "G.d'Annunzio", Chieti-Pescara, Chieti, Italy.
⁴¹ Department of Psychiatry, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
⁴² Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
⁴³ University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
⁴⁴ Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa.
⁴⁵ Cipla Medpro Pharmaceuticals, Durban, South Africa.
⁴⁶ Brijder Youth Addiction Treatment, Parnassia Psychiatric Institute, The Hague, The Netherlands.
⁴⁷ School of Criminology and The Unit for Excellence in Research & Study of Addiction (ERSA), The Center for Rehabilitation Research, University of Haifa, Haifa, Israel.
⁴⁸ Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
⁴⁹ Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
⁵⁰ East London NHS Foundation Trust, London, United Kingdom.
⁵¹ Department of Education, Ben-Gurion University, Beer-Sheva, Beer-Sheva, Israel.
⁵² Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
⁵³ Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.
⁵⁴ German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
⁵⁵ Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa.
⁵⁶ Department of Psychiatry, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
⁵⁷ PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico.
⁵⁸ Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Paris, France.
⁵⁹ Faculté de Médecine, Université de Paris, Paris, France.
⁶⁰ FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France.
⁶¹ Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
⁶² Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁶³ School of Population and Global Health, The University of Western Australia, Perth, Washington, Australia.
⁶⁴ National Drug Research Institute, Curtin University, Perth, Washington, Australia.
⁶⁵ Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
⁶⁶ Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.
⁶⁷ Curium, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.

PMID: 32634814
DOI: 10.1159/000508385

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Heval Özgen et al. Eur Addict Res. 2020.

. 2020;26(4-5):223-232.

doi: 10.1159/000508385. Epub 2020 Jul 7.

Authors

Affiliations

¹ Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, The Hague, The Netherlands, m.h.ozgen@parnassiagroep.nl.
² Curium, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands, m.h.ozgen@parnassiagroep.nl.
³ Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, The Hague, The Netherlands.
⁴ Department of Child and Adolescent Psychiatry, LWL-University Hospital, Ruhr-University Bochum, Hamm, Germany.
⁵ Department of Psychiatry, Donders institute, RadboudUMC, Nijmegen, The Netherlands.
⁶ Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), RadboudUMC, Nijmegen, The Netherlands.
⁷ International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, Nijmegen, The Netherlands.
⁸ Department of Child and Adolescent Psychiatry, Central Institute of Mental Health Mannheim (CIMH), Heidelberg University, Mannheim, Germany.
⁹ Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary.
¹⁰ Institute of Psychology, Faculty of Humanities and Social Sciences, Pázmány Péter Catholic University, Budapest, Hungary.
¹¹ De Hoop GGZ, Dordrecht, The Netherlands.
¹² Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain.
¹³ Department of Psychiatry, University Hospital Brussels, Brussels, Belgium.
¹⁴ Department of Psychiatry, Mental Health and Addictions, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
¹⁵ Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
¹⁶ Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spain.
¹⁷ Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.
¹⁸ Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
¹⁹ Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium.
²⁰ Academic Unit of Infant, Child, Adolescent Psychiatry South West Sydney, University of New South Wales, Sydney, New South Wales, Australia.
²¹ Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA.
²² Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Sweden.
²³ Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom.
²⁴ East London NHS Foundation Trust, Child and Adolescent Mental Health Service (CAMHS) - ADHD clinic, London, United Kingdom.
²⁵ Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
²⁶ Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
²⁷ Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
²⁸ Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, France.
²⁹ INSERM U1144, Paris, France.
³⁰ Inserm UMR-S1144, Université de Paris, Paris, France.
³¹ University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
³² Department of Child and Adolescent Psychiatry, Center for Psychosocial Medicine, University Hospital Heidelberg, Heidelberg, Germany.
³³ Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
³⁴ Drug Outpatient Centre, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Hungary.
³⁵ Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australia.
³⁶ National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
³⁷ Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany.
³⁸ Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York, USA.
³⁹ Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany.
⁴⁰ Department of Neuroscience, Imaging, Clinical Sciences, University "G.d'Annunzio", Chieti-Pescara, Chieti, Italy.
⁴¹ Department of Psychiatry, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
⁴² Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
⁴³ University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
⁴⁴ Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa.
⁴⁵ Cipla Medpro Pharmaceuticals, Durban, South Africa.
⁴⁶ Brijder Youth Addiction Treatment, Parnassia Psychiatric Institute, The Hague, The Netherlands.
⁴⁷ School of Criminology and The Unit for Excellence in Research & Study of Addiction (ERSA), The Center for Rehabilitation Research, University of Haifa, Haifa, Israel.
⁴⁸ Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
⁴⁹ Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
⁵⁰ East London NHS Foundation Trust, London, United Kingdom.
⁵¹ Department of Education, Ben-Gurion University, Beer-Sheva, Beer-Sheva, Israel.
⁵² Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
⁵³ Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, The Netherlands.
⁵⁴ German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
⁵⁵ Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa.
⁵⁶ Department of Psychiatry, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
⁵⁷ PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico.
⁵⁸ Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Paris, France.
⁵⁹ Faculté de Médecine, Université de Paris, Paris, France.
⁶⁰ FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, France.
⁶¹ Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
⁶² Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
⁶³ School of Population and Global Health, The University of Western Australia, Perth, Washington, Australia.
⁶⁴ National Drug Research Institute, Curtin University, Perth, Washington, Australia.
⁶⁵ Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
⁶⁶ Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, The Netherlands.
⁶⁷ Curium, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, The Netherlands.

PMID: 32634814
DOI: 10.1159/000508385

Abstract

Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations.

Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience.

Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD.

Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion.

Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Keywords: Adolescents; Attention-deficit/hyperactivity disorder; Consensus statement; Substance use disorder.

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International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Affiliations

International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Authors

Affiliations

Abstract

Publication types

MeSH terms

Substances

LinkOut - more resources

Full Text Sources

Medical