Abstract
Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for the development of substance abuse and substance use disorders (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment, and is associated with poor treatment outcomes. In this study, we provide a systematic review of controlled studies on the effectiveness of pharmacological, psychosocial, and complementary treatments of ADHD in adolescents with and without comorbid SUD. In addition, we review the longitudinal association between pharmacotherapy for childhood ADHD and the development of SUD in adolescence and early adulthood. We conducted a systematic review of the research literature published since 2000 using Medline, PsycINFO, and the Cochrane Database of Systematic Reviews databases to select randomized clinical trials, observational studies, and meta-analyses. The quality of the evidence from each study was rated using the SIGN grading system. Based on the limited evidence available, strong clinical recommendations are not justified, but provisionally, we conclude that stimulant treatment in children with ADHD may prevent the development of SUD in adolescence or young adulthood, that high-dose stimulant treatment could be an effective treatment for adolescents with ADHD and SUD comorbidity, that cognitive behavior therapy might have a small beneficial effect in these patients, and that alternative treatments are probably not effective. More studies are needed to draw definitive conclusions that will allow for strong clinical recommendations.
Highlights
Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for early substance use initiation and the development of substance use disorders (SUD) in adolescence and adulthood [1,2]
We identified 16 randomized controlled trials (RCTs) on pharmacological treatment that met the selection criteria of our literature search: four placebo-controlled randomized trials in adolescents with concurrent ADHD and SUD (458 enrolled patients; Table 1), and 12 placebo-controlled randomized trials in adolescents with ADHD but without SUD comorbidity (2675 patients; Table 1), with three of them comparing two active medications with placebo [33,34]
Med. 2021, 10, x FOR PEER REaVdIEdWition, we found one systematic review with a meta-analysis pertaining to the e5fofifc3a4cy and safety of the pharmacological treatment of patients with concurrent ADHD and SUD [35]
Summary
Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for early substance use initiation and the development of substance use disorders (SUD) in adolescence and (early) adulthood [1,2]. We know little about the prevalence of co-occurring ADHD and SUD among adolescents in the general population [3,4], researchers have found high comorbidity rates among adolescents in mental health and substance abuse treatment [5,6]. A meta-analysis on pooled data of nearly 4000 adolescents in substance abuse treatment revealed that 24% of these adolescents were diagnosed with ADHD [4]. The reverse relationship—in which substance use results in ADHD—is unlikely, given that ADHD generally develops before initial alcohol or drug use [13,14]
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