Guidelines for Managing ADHD and Substance Use Disorders

Guideline for managing ADHD and substance use disorders (SUD)Frieda Matthys, MD, PhD.BackgroundDespite the high prevalence of ADHD in adults with SUD and the availability of an approved guideline, under diagnosis and inadequate treatment still persist. This comorbidity associates with reduced treatment effectiveness, making successful treatment in adults with ADHD and SUD a challenge.MethodsThe guideline of 2010 for recognizing and treating adult ADHD in patients with SUD is updated in 2016, in cooperation with caregivers, of the addiction centers in Belgium and based on research literature and clinical experience. The english translation is discussed by an international group of clinicians and experts to result in a consensus statement via ICASA (International Collaboration on ADHD and Substance Abuse).ResultsThis consensus presents a useful guide for the diagnosis and treatment of ADHD and SUD. Due to the lack of scientific evidence on some of the topics, the guide is a combination of evidence based and practice based recommendations.ConclusionThe management of ADHD in patients with SUD remains a challenge. Diagnosis is complicated by SUD symptoms and by the skepticism associated with the recognition of ADHD in adults. The treatment is hampered by high relapse rates and reduced effectiveness of the currently available pharmacotherapies. Combining psycho-and pharmacotherapy in an integrated treatment that covers both ADHD and SUD, may help to keep these patients in treatment.A Dutch manual for the integrated treatment of ADHD and SUD is being developed.Disclosure of interestHonorarium Lilly.Advisory board Johnson&Johnson.

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The role of posttraumatic guilt and anger in integrated treatment for PTSD and co-occurring substance use disorders among primarily male veterans.

Psychological Trauma Theory Research Practice and Policy ◽

10.1037/tra0001204 ◽

2022 ◽

Author(s):

Tanya C. Saraiya ◽

Christal L. Badour ◽

Alyssa C. Jones ◽

Amber M. Jarnecke ◽

Delisa G. Brown ◽

...

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Integrated Treatment ◽

Male Veterans

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ADHD and addictive disorders: What links?

European Psychiatry ◽

10.1016/j.eurpsy.2015.09.085 ◽

2015 ◽

Vol 30 (S2) ◽

pp. S28-S28

Author(s):

M. Fatseas

Keyword(s):

Substance Use ◽

Psychiatric Disorders ◽

Adult Adhd ◽

Age At Onset ◽

Addictive Disorders ◽

Increased Risk ◽

High Prevalence ◽

Complicated Course ◽

Comprehensive Search ◽

Relationship Of

The links between ADHD and addictive disorders have been the subject of a large number of studies showing a high prevalence rate of ADHD in substance abusing populations as well as an increased risk of substance use disorder (SUD) in ADHD patients that may be independent of other psychiatric conditions. High prevalence of ADHD has also been highlighted among individuals suffering from other addictive disorders such as pathological gambling. Adequate diagnosis of ADHD in SUD patients is challenged by phenomenological aspects of addiction and by frequently associated other psychiatric disorders that overlap with key symptoms of ADHD. A detailed comprehensive search for child and adult symptoms including the temporal relationship of ADHD, substance use and other psychiatric disorders should maximize the validity and the reliability of adult ADHD diagnosis in this population. Further, a follow-up evaluation of ADHD symptoms during treatment of SUD may reduce the likelihood of misdiagnosis. Finally, it should be noticed that when SUD occurs with ADHD, it is associated with a greater severity of SUD compared to other SUD patients. This has been shown with an earlier age at onset, antisocial behavior, risk for depression, chronicity of substance use, need for hospitalization and likelihood of a complicated course. Recent data suggest that the effects of ADHD on SUD outcomes are independent of other psychiatric comorbidities. This highlights the need of an earlier implementation of preventive interventions for substance use or behavioral addiction in children/adolescents with ADHD and the necessity to consider this disorder in the treatment of addictive disorders. Benefices and risk of MPH in adult patients with addiction and ADHD are discussed.

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The Complex Relationship Between Eating Disorders and Substance Use Disorders

Clinical Handbook of Complex and Atypical Eating Disorders ◽

10.1093/med-psych/9780190630409.003.0004 ◽

2017 ◽

pp. 60-78

Author(s):

Amy Baker Dennis ◽

Tamara Pryor

Keyword(s):

Eating Disorders ◽

Substance Use ◽

Substance Use Disorders ◽

Treatment Plan ◽

Integrated Treatment ◽

Evidence Based ◽

Complex Relationship ◽

Adaptive Function ◽

Case Examples ◽

Evidence Based Treatments

Eating disorders (ED) and substance use disorders (SUD) frequently co-occur but are rarely treated in a comprehensive integrated manner. This chapter elucidates the complex relationship between ED and SUD to help the treating professional create an integrated treatment plan that addresses both disorders and any other co-occurring conditions. Evidence-based treatments for each disorder are discussed, and recommendations on how to take “best practices” from both fields to formulate a treatment plan that addresses the specific needs of the patient are presented. The chapter includes case examples that demonstrate the importance of understanding the adaptive function of both disorders when developing an effective intervention.

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Attention-deficit/hyperactivity disorder (ADHD) in adults: Specific clinical and therapeutic issues

European Psychiatry ◽

10.1016/j.eurpsy.2015.09.083 ◽

2015 ◽

Vol 30 (S2) ◽

pp. S27-S28

Author(s):

B. Rolland ◽

D. Da Fonseca ◽

M. Fatseas ◽

N. Simon

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Clinical Features ◽

Attention Deficit ◽

Adult Adhd ◽

Adhd Symptoms ◽

Addiction Medicine ◽

Global Functioning ◽

Hyperactivity Disorder

Attention-deficit/hyperactivity disorder (ADHD) was initially considered as a childhood psychiatric disorder. However, longitudinal observations have revealed that ADHD symptoms may persist in adulthood among approximately 50% of the patients . Adult ADHD is associated with impaired social outcome and frequent comorbidities such as mood disorders, personality disorders, and substance use disorders [2,3]. Correctly identifying and treating ADHD can significantly improve the global functioning and cognition of adult subjects, and reduce the intensity and frequency of the comorbid states [2,3]. Nonetheless, the clinical features of adult ADHD are clearly different from the youth form [1,2], and ADHD symptoms are easily mixed up in adults with symptoms of the comorbid conditions [2,3]. These clinical intricacies can make the diagnosis of ADHD difficult in adults. Moreover, the management of methylphenidate in adult subjects is also associated with specific risks and pitfalls, such as abuse and tampering behaviors, and additional safety risks . Put together, it appears crucial to identify and treat ADHD in adults, but the clinical and therapeutic complexities of adult ADHD require improved expertise and caution from adult psychiatrists and addiction specialists. In this thematic session of the 2015 French Psychiatry Congress, three French leading experts of adult ADHD will address the aforementioned clinical and therapeutic issues of the adulthood form of this disorder. David Da Fonseca, professor of child psychiatry in Marseille, will disentangle the clinical features of adult ADHD from the typical symptoms observed in the youth form. Mélina FATSEAS, associate professor of psychiatry and addiction medicine in Bordeaux, will specifically focus on the many and complex relationships observed between adult ADHD and substance use disorders. Last, Nicolas Simon, professor of addiction medicine and psychopharmacology in Marseille, will synthesize what are the very risks and issues with prescribing methylphenidate in adults.

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Treating adult ADHD and comorbid substance-related disorders

European Psychiatry ◽

10.1016/j.eurpsy.2016.01.930 ◽

2016 ◽

Vol 33 (S1) ◽

pp. S54-S54

Author(s):

J.A. Ramos-Quiroga

Keyword(s):

Attention Deficit Hyperactivity Disorder ◽

Substance Use ◽

Substance Use Disorders ◽

Attention Deficit ◽

Adult Adhd ◽

Stimulant Medication ◽

Behavioral Therapy ◽

Neurodevelopmental Disorder ◽

Hyperactivity Disorder ◽

Competing Interest

Attention-deficit/hyperactivity disorder (ADHD) is a complex, and multifactorial and chronic neurodevelopmental disorder. Comorbid psychiatric disorders are highly prevalent in individuals with a diagnosis of ADHD. There is a solid overlap between ADHD and substance use disorders (SUD). Prevalence of SUD is high among patients with ADHD, so that SUD are approximately double as common among individuals with ADHD than in general population, and individuals with SUD have much higher rates than expected of a comorbid ADHD. Studies shown that treatment during childhood of attention-deficit/hyperactivity disorder with stimulant medication neither protects nor increases the risk of later substance use disorders. Nevertheless, recent studies found that patients with ADHD and SUD can reduce ADHD symptoms and SUD with stimulants and cognitive-behavioral therapy. Treatment of ADHD in patients with SUD requires a comprehensive diagnostic assessment. It is recommendable to stabilize the addiction prior to treating the ADHD. In this talk, the recent literature for the treatment of adults with co-occurring ADHD and SUD will be reviewed.Disclosure of interestThe author has not supplied his declaration of competing interest.

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High prevalence of substance use disorders among adolescents who use marijuana and inhalants

Drug and Alcohol Dependence ◽

10.1016/j.drugalcdep.2004.08.025 ◽

2005 ◽

Vol 78 (1) ◽

pp. 23-32 ◽

Cited By ~ 25

Author(s):

Li-Tzy Wu ◽

Daniel J. Pilowsky ◽

William E. Schlenger

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

High Prevalence

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Integrated Treatment for Mood and Substance Use Disorders

Psychiatric Services ◽

10.1176/appi.ps.55.5.595 ◽

2004 ◽

Vol 55 (5) ◽

pp. 595-595

Author(s):

Robert E. Drake

Keyword(s):

Substance Use ◽

Substance Use Disorders ◽

Integrated Treatment

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When Research Meets Reality–-Lessons Learned from a Pragmatic Multisite Group-Randomized Clinical Trial on Psychosocial Interventions in the Psychiatric and Addiction Field

Substance Abuse Research and Treatment ◽

10.4137/sart.s9245 ◽

2012 ◽

Vol 6 ◽

pp. SART.S9245 ◽

Cited By ~ 1

Author(s):

Linda E. Wüsthoff ◽

Helge Waal ◽

Rolf W. Gråwe

Keyword(s):

Clinical Trial ◽

Substance Use ◽

Randomized Clinical Trial ◽

Substance Use Disorders ◽

Clinical Studies ◽

Psychosocial Interventions ◽

Integrated Treatment ◽

Lessons Learned ◽

Future Research ◽

New Challenges

Research on treatments for patients with co-occurring psychiatric and substance use disorders is of core importance and at the same time highly challenging as it includes patients that are normally excluded from clinical studies. Such research may require methodological adaptations which in turn create new challenges. However, the challenges that arise in such studies are insufficiently discussed in the literature. The aim of this methodology paper is, firstly, to discuss the methodological adaptations that may be required in such research; secondly, to describe how such adaptations created new challenges in a group-randomized clinical trial on Integrated Treatment amongst patients with co-occurring psychiatric and substance use disorders. We also discuss how these challenges might be understood and highlight lessons for future research in this field. Trial registration: NCT00447733.

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