Treatment of Adolescents with Concurrent Substance Use Disorder and Attention-Deficit/Hyperactivity Disorder: A Systematic Review

Abstract

Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development of substance abuse and substance use disorders (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. In this study, we provide a systematic review of controlled studies on the effectiveness of pharmacological, psychosocial, and complementary treatments of ADHD in adolescents with and without comorbid SUD. In addition, we review the longitudinal association between pharmacotherapy for childhood ADHD and the development of SUD in adolescence and early adulthood. We conducted a systematic review of the research literature published since 2000 using Medline, PsycINFO, and the Cochrane Database of Systematic Reviews databases to select randomized clinical trials, observational studies, and meta-analyses. The quality of the evidence from each study was rated using the SIGN grading system. Based on the limited evidence available, strong clinical recommendations are not justified, but provisionally, we conclude that stimulant treatment in children with ADHD may prevent the development of SUD in adolescence or young adulthood, that high-dose stimulant treatment could be an effective treatment for adolescents with ADHD and SUD comorbidity, that cognitive behavior therapy might have a small beneficial effect in these patients, and that alternative treatments are probably not effective. More studies are needed to draw definitive conclusions that will allow for strong clinical recommendations.

Co-occurring Mental Disorders in Transitional Aged Youth With Substance Use Disorders – A Narrative Review

“…Wilens et al found an overall reduced risk of developing any SUD in later life (mean OR = 1.9) in patients who had received stimulant treatment than those who had not (50). In line with these findings, reviews suggest that stimulant treatment of childhood ADHD may have a preventive effect on the development of SUD in adolescence and early adulthood (23). More specifically, Groenman et al described that stimulant treatment at an early stage, high dose, and longer duration were associated with a reduced risk of SUD in adolescence (51,52).…”

“…The link between childhood attention-deficit/hyperactivity disorder (ADHD) and early SUD in youth and young adults has been well-established ( 23 , 24 ). Skoglund et al ( 25 ) found that not only the affected but also relatives of individuals with ADHD are more likely to develop SUDs ( 25 ).…”

“…This can partially be explained by either general vulnerability, genetic predispositions, or dysfunctions in the inhibitory and reward related neural circuits of the brain ( 30 , 31 ). Consequently, symptoms of ADHD such as inattention, hyperactivity, and impulsivity may increase behavioral and social problems, as well as risk and drug seeking behavior ( 23 , 32 ). Conversely, it seems less likely that substance use leads to ADHD since the age of onset of the latter generally predates first drug or alcohol use ( 33 , 34 ).…”

“…However, other studies reported on higher nicotine, alcohol, and illicit drug use in ADHD patients independent of CD ( 32 ). A meta-analysis by Özgen et al found that the risk of SUD was highest in children with concurrent ADHD and CD ( 23 , 38 ). Katusic et al reported that individuals with comorbid ADHD and CD were 8.8 times more likely to have any SUD before the age of 18 years compared to those with ADHD alone ( 39 ).…”

“…Across the literature, ADHD is more common in males with rates ranging between 3:1 and 1.5:1 in population-based studies ( 23 ). Also, ADHD seems to be detected and diagnosed less often in females ( 42 , 43 ) which in turn can lead to delayed and insufficient treatment and more severe outcomes over time in female patients ( 23 ). Gender differences have also been observed regarding the age of onset, type of symptoms, use of medication, and quality of life ( 44 ).…”