title: Pharmacological treatment of attention deficit hyperactivity disorder with co-morbid drug dependence.
abstract: BACKGROUND
  Drug dependence is frequent in patients with attention deficit hyperactivity disorder (ADHD). Nevertheless, the efficacy and safety of pharmacological treatments in this population are unclear.
  
  
  METHODS
  A systematic review with meta-analysis was performed. Randomised placebo-controlled clinical trials investigating the efficacy of pharmacological treatment in patients with co-occurring ADHD and substance use disorder (SUD) were included. ADHD symptom severity, drug abstinence and all-cause treatment discontinuation were the primary study endpoints. The effects of patient-, intervention- and study-related covariates over the primary outcomes were investigated by means of meta-regression.
  
  
  RESULTS
  Thirteen studies were included, enrolling a total of 1,271 patients. A small to moderate reduction of ADHD symptoms was found. Meta-regression analysis identified the presence of a lead-in period as a covariate associated with reduced efficacy. Conversely, no beneficial effect was observed either on drug abstinence or treatment discontinuation. The efficacy on ADHD symptoms was smaller in studies with a lead-in period. A positive correlation between the efficacy for ADHD and that for SUD was found.
  
  
  CONCLUSIONS
  The efficacy of pharmacological interventions for co-occurring ADHD and SUD has been little investigated. Mixed results were obtained: while pharmacological interventions improved ADHD symptoms, no beneficial effect on drug abstinence or on treatment discontinuation was noted. The strength of the recommendation of pharmacological treatment for co-occurring ADHD and SUD is therefore modest. The study was registered with the international prospective register of systematic reviews (PROSPERO): CRD 4212003414.
authors.affiliation: Unitat d'Hospitalització Psiquiàtrica Penitenciaria (UHHP), Parc Sanitari Sant Joan de Déu, Barcelona, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Cunill
authors.affiliation: Department of Medical Sciences, Universitat de Girona, Girona, Spain TransLab Research Group, Universitat de Girona, Girona, Spain xavier.castells@udg.edu.
authors.forename: X
authors.initials: X
authors.lastname: Castells
authors.affiliation: Institute of Environmental Assessment and Water Research (IDAEA), Spanish Council for Scientific Research (CSIC), Barcelona, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Tobias
authors.affiliation: Department of Medical Sciences, Universitat de Girona, Girona, Spain TransLab Research Group, Universitat de Girona, Girona, Spain.
authors.forename: D
authors.initials: D
authors.lastname: Capellà
mesh_terms: D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications* / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000627:therapeutic use*; D017831:Diagnosis, Dual (Psychiatry); D006801:Humans; D019966:Substance-Related Disorders / Q000150:complications*; D016896:Treatment Outcome
chemical_list: D000697:Central Nervous System Stimulants
keywords: Attention deficit hyperactivity disorder; efficacy; meta-analysis; safety; substance use disorder