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:Eden Mental Health Centre, 1500 Pembina Ave., Winkler, Manitoba R6W 1T4, Canada.
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.
