After participating in this activity, learners should be better able to:• Evaluate pharmacologic treatment of attention deficit/hyperactivity disorder (ADHD) in patients with substance use disorder (SUD) • Assess the causes of the diminished efficacy of ADHD medication in patients with comorbid SUD
Substance use disorder (SUD) and attention-deficit/hyperactivity disorder (ADHD) frequently co-occur, and the presence of ADHD complicates the treatment of the addiction. Pharmacotherapy is a potent intervention in childhood and adult ADHD, but findings have been mixed in adolescent and adult ADHD patients with SUDs. This review focuses on several contributing factors and possible explanations, with implications both for future research and for clinical practice.
This systematic review examined all randomized, placebo-controlled trials of pharmacotherapy for ADHD in adult and adolescent SUD patients.
The number of studies is limited, and several studies are hampered by qualitative flaws. The results, in general, are inconclusive for most medications studied, but more recent trials using psychostimulants in robust dosing have demonstrated significantly positive results.
In reviewing these trials, possible explanations relating to the particular characteristics and problems of this complex patient group are discussed. Several factors, including ADHD symptom severity, psychiatric comorbidity, persistent drug use, choice of medication, and concomitant psychosocial intervention, influence study results. Taking these factors into account may improve the likelihood of detecting significant effects in future research, as the recent positive trials have indicated, and may help in the appropriate selection of pharmacotherapy in clinical practice.
From the Reinier van Arkel Psychiatric Institute, ’s-Hertogenbosch, the Netherlands (Dr. Carpentier); Department of Psychiatry, College of Physicians and Surgeons, Columbia University (Dr. Levin); Division of Substance Abuse, New York State Psychiatric Institute, New York, NY (Dr. Levin).
Original manuscript received 26 July 2015; revised manuscripts received 29 November 2015 and 20 February 2016, accepted for publication subject to revision 15 March 2016; revised manuscript received 4 April 2016.
Correspondence: Pieter-Jan Carpentier, MD, PhD, Reinier van Arkel, ‘s-Hertogenbosch, Netherlands. Email: firstname.lastname@example.org
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