Predictors of treatment response in adolescents with comorbid substance use disorder and attention-deficit/hyperactivity disorder

J Subst Abuse Treat. 2013 Feb;44(2):224-30. doi: 10.1016/j.jsat.2012.07.001. Epub 2012 Aug 11.


Attention-Deficit/Hyperactivity Disorder (ADHD) frequently co-occurs with substance use disorder (SUD) and is associated with poor substance-use treatment outcomes. A trial evaluating osmotic-release oral system methylphenidate (OROS-MPH) for adolescents with ADHD and SUD, concurrently receiving behavioral therapy, revealed inconsistent medication effects on ADHD or SUD. Clinical care for this population would be advanced by knowledge of treatment outcome predictors. Data from the randomized placebo-controlled trial (n = 299) were analyzed. Significant treatment predictors included: 1) Substance use severity, associated with poorer ADHD and SUD outcomes, 2) ADHD severity, associated with better ADHD and SUD outcomes, 3) comorbid conduct disorder, associated with poorer ADHD outcomes, and 4) court-mandated status, associated with better SUD outcomes but poorer treatment completion. An interaction effect showed that OROS-MPH improved SUD outcomes in adolescents with comorbid conduct disorder compared to placebo. While severe SUD may require more intensive psychosocial treatment, OROS-MPH may improve substance treatment outcomes in adolescents with co-morbid attention and conduct problems.

Trial registration: NCT00264797.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Administration, Oral
  • Adolescent
  • Attention Deficit Disorder with Hyperactivity / drug therapy*
  • Behavior Therapy / methods
  • Central Nervous System Stimulants / administration & dosage
  • Central Nervous System Stimulants / therapeutic use*
  • Conduct Disorder / complications
  • Diagnosis, Dual (Psychiatry)
  • Drug Delivery Systems
  • Female
  • Humans
  • Male
  • Mandatory Programs
  • Methylphenidate / administration & dosage
  • Methylphenidate / therapeutic use*
  • Osmosis
  • Severity of Illness Index
  • Substance-Related Disorders / rehabilitation*
  • Treatment Outcome


  • Central Nervous System Stimulants
  • Methylphenidate

Associated data