Managing Comorbid Attention Deficit Hyperactivity Disorder (ADHD) in Adults With Substance Use Disorder (SUD): What the Addiction Specialist Needs to Know

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.