International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder

Cleo L Crunelle; Wim van den Brink; Franz Moggi; Maija Konstenius; Johan Franck; Frances R Levin; Geurt van de Glind; Zsolt Demetrovics; Corné Coetzee; Mathias Luderer; Arnt Schellekens; ICASA consensus group; Frieda Matthys

doi:10.1159/000487767

International Consensus Statement on Screening, Diagnosis and Treatment of Substance Use Disorder Patients with Comorbid Attention Deficit/Hyperactivity Disorder

Eur Addict Res. 2018;24(1):43-51. doi: 10.1159/000487767. Epub 2018 Mar 6.

Authors

Affiliations

¹ Department of Psychiatry, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
² Toxicological Center, Antwerp University, Antwerp, Belgium.
³ Amsterdam Institute of Addiction Research (AIAR), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
⁴ University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
⁵ Karolinska Institutet, Stockholm, Sweden.
⁶ Columbia University, New York State Psychiatric Institute, New York, New York, USA.
⁷ ICASA Foundation, University of Amsterdam, Amsterdam, the Netherlands.
⁸ Eötvös Loránd University, Budapest, Hungary.
⁹ Department of Pharmacy, University of Limpopo, Sovenga, South Africa.
¹⁰ Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Heidelberg, Germany.
¹¹ Department of Psychiatry, Radboudumc, Donders Institute for Brain, Cognition and Behavior, Nijmegen Institute for Scientist Practitioners in Addiction (NISPA), Nijmegen, the Netherlands.

Abstract

Adult attention deficit/hyperactivity disorder (ADHD) often co-occurs with substance use disorders (SUD) and is associated with early onset and more severe development of SUD and with reduced treatment effectiveness. Screening tools allow for a good recognition of possible ADHD in adults with SUD and should be used routinely, followed by an ADHD diagnostic process initiated as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, using a combination of pharmaco- and psychotherapy, is recommended. Long-acting methylphenidate, extended-release amphetamines, and atomoxetine with up-titration to higher dosages may be considered in patients unresponsive to standard doses. This paper includes evidence- and consensus-based recommendations developed to provide guidance in the screening, diagnosis and treatment of patients with ADHD-SUD comorbidity.

Keywords: Attention deficit/hyperactivity disorder; Consensus; Diagnosis; Substance use disorders; Treatment.

MeSH terms

Adult
Attention Deficit Disorder with Hyperactivity / diagnosis*
Attention Deficit Disorder with Hyperactivity / epidemiology
Attention Deficit Disorder with Hyperactivity / therapy*
Central Nervous System Stimulants / administration & dosage
Comorbidity*
Consensus*
Humans
Internationality*
Mass Screening
Methylphenidate / administration & dosage
Psychotherapy / methods
Risk Factors
Substance-Related Disorders / diagnosis*
Substance-Related Disorders / epidemiology
Substance-Related Disorders / therapy*
Treatment Outcome

Substances

Central Nervous System Stimulants
Methylphenidate

Grants and funding

K24 DA029647/DA/NIDA NIH HHS/United States