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Addressing Dual Diagnosis Patients Suffering from Attention-Deficit Hyperactivity Disorders and Comorbid Substance Use Disorders: A Review of Treatment Considerations

Martinez-Raga, Jose MD, PhD*,†,‡; Knecht, Carlos MD*,§; de Alvaro, Raquel MD; Szerman, Nestor MD*,¶; Ruiz, Pedro MD#

Addictive Disorders & Their Treatment: December 2013 - Volume 12 - Issue 4 - p 213–230
doi: 10.1097/ADT.0b013e318277060c
Original Articles

Objective: To provide an updated, thorough, and critical review of the current status of the pharmacological and psychosocial treatments of patients with attention-deficit hyperactivity disorder (ADHD) and a comorbid substance use disorder (SUD).

Methods: Comprehensive and systematic search of relevant databases (Medline, PubMed, Embase, and the Cochrane Library of systematic reviews and clinical trials) was carried out until January 31, 2012.

Results: Treatment of patients with ADHD and a comorbid SUD is based on a multimodal and integrated approach, requiring the adequate management of the comorbid disorders, with psychosocial and pharmacological treatments. Regarding the pharmacotherapies for ADHD, prescription psychostimulants, particularly methylphenidate and atomoxetine, have all been assessed in dually diagnosed patients, for treating the symptoms of ADHD or for managing the comorbid SUD. Overall, medications are safe, well tolerated, and provide short-term and long-term benefits in patients with ADHD and comorbid SUD.

Conclusions: Studies assessing the efficacy of pharmacotherapies for ADHD have shown that they are equally efficacious and well tolerated, generally in combination with psychological interventions, in patients with a comorbid SUD. In addition, psychostimulant treatment of children with ADHD appears to have a protective effect on the subsequent risk for SUD.

*Sociedad Española de Patología Dual (Spanish Society of Dual Pathology), Madrid

Psychiatry Department, Hospital Universitario Doctor Peset

Teaching Unit of Psychiatry and Psychological Medicine, Department of Medicine, University of Valencia

RPMD Carlet, Departamento de Salud de Alzira, Conselleria de Justicia y Bienestar Social, Valencia

§Unidad de Salud Mental de Vila-Real, Departamento de Salud de La Plana, Agencia Valenciana de Salut, Castellón

Hospital General Universitario Gregorio Marañón, Madrid, Spain

#Department of Psychiatry and Behavioural Sciences, Miller School of Medicine, University of Miami, FL.

The authors declare no conflict of interest.

Reprints: Jose Martinez-Raga, MD, PhD, Psychiatry Department, Hospital Universitario Doctor Peset, Avda. Gaspar Aguilar, 90, Valencia 46017, Spain (e-mail:

© 2013 by Lippincott Williams & Wilkins