Original ArticlesManaging Comorbid Attention Deficit Hyperactivity Disorder (ADHD) in Adults With Substance Use Disorder (SUD): What the Addiction Specialist Needs to KnowJohnson, Joe MBBS, FRCPSych*; Morris, Sarah MPharm†; George, Sanju MBBS, FRCPSych‡Author Information *NW Boroughs Adult ADHD Service, North West Lead for UKAAN (UK Adult ADHD Network) North West Boroughs Partnership NHS Foundation Trust, Hollins Park Hospital †North West Boroughs Healthcare NHS Foundation Trust, Hollins Park Hospital, Warrington, Liverpool, UK ‡Rajagiri School of Behavioural Sciences and Research, Rajagiri College of Social Sciences (Autonomous), Kalamassery, Kochi, Kerala, India J.J. runs a service for patients with ADHD and is a consultant for the North West Boroughs NHS Foundation Trust. He has received honoraria for talks at training events supported by the following pharmaceutical companies: Janssen, Flynn & Takeda/Shire. S.M. works with J.J. as a pharmacist independent prescriber in both NHS and private practice adult ADHD clinics. She has been on an advisory board for Shire Pharmaceuticals and received honoraria for doing a talk on the treatment of ADHD for Flynn Pharmaceuticals. She has also received sponsorship from both companies to attend educational and training events on adult ADHD. S.G. declares no conflict of interest. Correspondence to: Sanju George, MBBS, FRCPSych, Rajagiri School of Behavioural Sciences and Research, Rajagiri College of Social Sciences (Autonomous), Kalamassery, Kochi, Kerala 683 104, India (e-mail: [email protected]). Addictive Disorders & Their Treatment: September 2021 - Volume 20 - Issue 3 - p 181-188 doi: 10.1097/ADT.0000000000000237 Buy Metrics Abstract Attention deficit hyperactivity disorder (ADHD) and substance use disorder (SUD) often co-exist and the link between the 2 is bidirectional, with higher rates of ADHD symptoms found in the SUD population and higher rates of SUD found among the ADHD population. Some possible mechanisms which could explain the increased risk of developing a SUD in those who have ADHD include self-medication, both ADHD and SUD arising from dysregulation of 1 or more of the dopaminergic circuits, genetic factors as well exposure to parental SUD. Given the complex relationship between ADHD and SUD, those working in SUD services should be vigilant to ADHD as a possible comorbid diagnosis and refer to a specialist ADHD service for further assessment where appropriate. On the basis of a detailed clinical assessment, it has to be decided whether SUD or ADHD should be the priority for treatment or if they both ought to be; in either case, ADHD and SUD treatment services must work collaboratively. The recommended first line pharmacological treatment option for adolescents and adults with ADHD is a stimulant medication, with nonstimulants being reserved as a second or third line option. In the brief review paper, the authors further discuss the various medications for treatment of ADHD, the benefits and risks of treating ADHD in those with SUD, discuss the role of specialist ADHD treatment services, and illustrate these with the help of 2 anonymized case vignettes. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.