title: Comorbid attention deficit/hyperactivity disorder and substance use disorder: treatment considerations.
abstract: BACKGROUND
  Attention-deficit hyperactivity disorder (ADHD) is predominantly a diagnosis of childhood and adolescence but has also been recognized in adults. It is associated with high rates of comorbid psychiatric conditions, particularly substance use disorders (SUD).
  
  
  METHODS
  A review of the literature was conducted with a focus on ADHD, SUD, their comorbidity, and treatment considerations.
  
  
  RESULTS
  Literature suggests that the use of methylphenidate (MPH) in children does not increase SUD later in life, and may in fact reduce substance use and abuse in adolescence and adulthood. Concurrent treatment of ADHD-SUD, which may be supported theoretically, has yielded inconsistent data on clinical trials. While MPH use in adults with ADHDSUD may be effective in alleviating ADHD symptoms, the benefits on SUD are not clear and remain controversial. Studies suggest that adults with comorbid ADHD-SUD do not misuse or divert their medication, but MPH does not consistently improve substance use. However, data are lacking for substances other than cocaine and stimulants other than MPH. While the risk of stimulant abuse should not be ignored, it may be minimized by selecting medications that are not readily crushed and solubilized for parenteral administration, or by utilizing non-stimulant medications and/or psychotherapy.
  
  
  CONCLUSIONS
  While there are a lack of evidence-based guidelines for the concurrent treatment of ADHD and SUD, evidence to date suggests that stimulant medications should not necessarily be avoided for patients with comorbid ADHDSUD and that concurrent treatment may be a successful approach to improve ADHD outcomes without worsening SUD symptoms.
authors.affiliation: Eden Mental Health Centre, 1500 Pembina Ave., Winkler, Manitoba R6W 1T4, Canada. ljklassen@edenhealth.mb.ca
authors.forename: Larry J
authors.initials: LJ
authors.lastname: Klassen
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Bilkey
authors.forename: Martin A
authors.initials: MA
authors.lastname: Katzman
authors.forename: Pratap
authors.initials: P
authors.lastname: Chokka
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000628:therapy*; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D002648:Child; D017831:Diagnosis, Dual (Psychiatry); D006801:Humans; D008774:Methylphenidate / Q000009:adverse effects / Q000627:therapeutic use; D019966:Substance-Related Disorders / Q000150:complications / Q000534:rehabilitation*
chemical_list: D000697:Central Nervous System Stimulants; D008774:Methylphenidate