When ADHD and substance use disorders intersect: Relationship and treatment implications

Pediatric Psychopharmacology Unit, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA.
Current Psychiatry Reports (Impact Factor: 3.24). 11/2007; 9(5):408-14. DOI: 10.1007/s11920-007-0053-3
Source: PubMed


There has been increasing interest in the overlap between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs). In this report, we describe the developmental relationship between ADHD and SUDs. ADHD alone and in combination with co-occurring psychopathology is a risk factor for the development of SUDs in adulthood. Conversely, approximately one fifth of adults with SUDs have ADHD. Pharmacotherapeutic treatment of ADHD in children reduces the risk for later cigarette smoking and SUDs in adulthood. In contrast, medication treatment alone of adults with ADHD and current SUD is inadequate for both ADHD and SUD. Stimulant diversion continues to be of concern, particularly in older adolescents and young adults.

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    • "risk factor for the development of substance use disorder. Furthermore ADHD increases the likelihood that drug dependence will become more severe and be of a longer duration [10]. It is likely that ADHD plays a role in the pathogenesis of SUD. "
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    ABSTRACT: Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopment disorder occurring during childhood. However, ADHD persists into adulthood in 45.7% of cases. The global prevalence of adult ADHD is estimated to 5.3%, with no difference between Europe and North America. ADHD is often comorbid with substance use disorder (SUD), with Odds Ratio ranges from 1.5 to 7.9, depending on the substance and the dependence level. Conversely, the prevalence of ADHD among patients with SUD is 10.8%, versus 3.8% for patients without SUD. Methylphenidate (MPH) alleviates ADHD symptoms and, as such, is currently considered as a first choice medication. MPH blocks the dopamine and norepinephrine transporters leading to an increase in extracellular dopamine. It should be noted that its subjective effects are highly dependent on the pharmacokinetic and especially on the rate of input, which highlights the importance of choosing a sustained-release formulation. Meanwhile, prescribing MPH to patients with comorbid SUD has always been challenging for clinicians. The aim of this review is to address the benefits and pitfalls of using MPH in adults with ADHD comorbid SUD, depending on each of the following types of SUD: amphetamine, cocaine, nicotine, alcohol, cannabis and opiates. Overall, due to the prevalence of ADHD in SUD and to the benefits of MPH observed in this population, and considering the mild or low side effects observed, the response to MPH treatment should be evaluated individually in adults with comorbid ADHD and SUD. The choice of the formulation should favor sustained-release MPH over immediate release MPH. Cardiovascular parameters also have to be monitored during long-term use.
    Full-text · Article · Jun 2015 · Current pharmaceutical design
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    • "Research highlights the lack of clear effect of medication treatment on substance use (van Emmerik-van Oortmerssen et al. 2012), with the exception of a study on cocaine-dependent ADHD patients receiving methylphenidate , whereby the reduction in ADHD symptoms was associated with reduced cocaine use, a typically impulsive form of drug-taking behaviour (Levin et al. 2006). Furthermore, ADHD symptoms such as inattention and impulsivity negatively affect treatment engagement, retention and outcomes and, because of symptom overlap, are not easily distinguishable from other psychiatric disorders or the symptoms of drug intoxication or withdrawal (Wilens & Upadhyaya, 2007; van Emmerik-van Oortmerssen et al. 2011; Matthies et al. 2012). Goossensen et al. (2006) have underscored the need to develop standardised protocols for the screening, diagnosis and treatment of ADHD in patients with SUD. "
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    ABSTRACT: Objectives Attention-deficit hyperactivity disorder (ADHD) is a neuro-behavioural disorder characterised by early onset of persistent inattention–disorganisation and hyperactivity–impulsivity. Symptoms causing significant impairment in psychosocial function commence in childhood and heighten the risk for early substance experimentation and potential development of substance-use disorders (SUD). The research aimed to estimate the occurrence of adult attention-deficit hyperactivity disorder (ADHD) in new treatment cases of adults attending addiction treatment services.Methods The Adult ADHD Symptoms Rating Scale (ASRS) self-administered questionnaire was administered on entry and 2 weeks later for first admissions to inpatient and outpatient addiction treatment settings The ASRS is a validated and reliable 18-item self-report scale derived from the DSM-IV-TR diagnostic criteria for ADHD, comprising nine items on inattention and nine items on hyperactivity/impulsivity.Results A total of 47 new treatment cases took part in the study. The occurrence of ADHD among SUDs in this sample was 13% (n = 6). Four of the participants were being treated for Problem Poly Substance use, whereas two participants were being treated for Problem Drug use. None of the participants screening positive for ADHD were being treated for Problem Alcohol use. Of the positively screened cases, all were male, predominantly single and unemployed.Conclusions The ASRS screening instrument may be a useful tool to detect ADHD co-morbidity in SUD treatment-seeking cases. More research is needed to appropriately develop the SUD treatment pathways for adolescent and adult ADHD sufferers in Ireland.
    Full-text · Article · Sep 2013
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    ABSTRACT: Attention deficit hyperactivity disorder (ADHD) is a condition typically arising in childhood, which untreated, can have consequences reaching into adolescence and beyond. Effective pharmacological treatment is available and has become widespread in the West. Outcomes for both the child with ADHD and the parent may be influenced by the nature of interaction between them. The authors of this article aim to review published research examining the interaction between parents and their children with ADHD. A PubMed search was conducted of studies written in English between 2000 and 2007 with the keywords ADHD and parenting. Child ADHD elicits high levels of parental stress and maladaptive parenting. The presence of parental psychopathology is common and influences the parent's response to the child's ADHD symptoms. Optimizing parent-child interaction and parental psychiatric status may improve outcomes for both parent and child.
    No preview · Article · Jul 2008 · Clinical Pediatrics
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