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The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders
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Adolescents and young adults with substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD) are increasingly presenting in clinical practice. The overlap and role of treatment for these co-occurring disorders remains unclear. A review of the literature was conducted to highlight and update recent evidence on the overlap of ADHD and SUD, the role of ADHD medication on later SUD, and the treatment of ADHD and SUD in adolescents and young adults. Recent work continues to highlight the high risk for comorbid ADHD in patients with SUD; and conversely, the high risk for SUD developing in ADHD across the lifespan, particularly in the context of comorbid conduct disorder. Although the data remains discordant, it appears that ADHD pharmacotherapy does not increase the risk for SUD. Medication treatment alone does not appear to be particularly effective in treating SUD in currently active substance abusing individuals with ADHD. Structured therapies may be effective in treating adolescents and young adults with ADHD and SUD. Further controlled trials evaluating the sequence and effect of structured psychotherapies and/or ADHD pharmacotherapy on SUD relapse in these groups are warranted.
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“overuse of drug testing is more common in minoritized populations with SUD.199,200”
From The ASAM/AAAP Clinical Practice Guideline on the Management of Stimulant Use Disorder (2024) · cites this paper as [200]
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“Because drug testing is known to introduce potential bias against minoritized populations”
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“Crude model 1.82 (0.55, 6.05) 1.96 (0.93, 4.14) 2.48 (1.19, 5.16)∗ 4.63 (2.15, 10.00)∗∗∗ Adj for comorbidity2 1.44 (0.41, 5.11) 1.88 (0.86, 4.11) 2.19 (1.02, 4.71)∗ 3.54 (1.58, 7.92)∗∗ +Adj for SES+sex+age 0.73 (0.08, 6.29) 1.68 (0.51, 5.47) 2.12 (0.69, 6.55) 6.90 (2.25, 21.17)∗∗ ADHD (n = 154) Crude model 0.85 (0.40,…”
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“The core symptoms of ADHD may not only result in academic and occupational underachievement, interpersonal conflict, and strained familial relationships [3] but also increase the risk of suicide [4], traumatic brain injury [5], bone fracture [6], sexually transmitted infection [7], depression [8], and substance abuse…”
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“The risk of SUD has been proven to be double among ADHD people and four times higher among those with ADHD and comorbid conduct disorder [50].”
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“On the other hand, ADHD in individuals with SUD complicates the diagnosis and treatment [19].”
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“Co-occurring conduct or bipolar disorders (with ADHD) confer the highest risk for SUD.[33] It is a matter of concern that ADHD and its other comorbidities, remain underidentified and undertreated in addiction treatment centres, leading to greater recidivism.”
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“On the other hand, both ADHD and problematic substance use share some neurophysiological deficits (Kozak et al., 2019; Ortal et al., 2015; Zulauf et al., 2014).”
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“ADHD did not differ from AUD regarding selfreported hyperactivity, implicating that increased hyperactivity is a possible pathway from childhood ADHD to development of AUD later in adolescence or early adulthood, probably to reduce unpleasant hyperactivity or restlessness (46).”
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Metadata
- Authors
- Zulauf, C. A., Sprich, S. E., Safren, S. A., & Wilens, T. E.
- Affiliations
- Massachusetts General Hospital (US)
- Corresponding author
- Wilens, Timothy E.
- Venue
- Current Psychiatry Reports
- Published
- 2014-02-15
- Volume
- 16
- Issue
- 3
- Pages
- 436-436
- ISSN
- 1523-3812 (ISSN-L)
- 1535-1645
- PMC
- PMC4414493
- OpenAlex
- W2025736977
- Cited by
- 214
- References
- 94
- Citations by year
- 2026: 9 · 2025: 27 · 2024: 24 · 2023: 19 · 2022: 15 · 2021: 13 · 2020: 42 · 2019: 13 · 2018: 14 · 2017: 16 · 2016: 13 · 2015: 5 · 2014: 4
- FWCI
- 1.75
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Licence
- www.springer.com/tdm (tdm)
- Locations
- Current Psychiatry Reports (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- National Institute of Mental Health (K24MH094214)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Opioid Use Disorder Treatment
- Keywords
- attention deficit hyperactivity disorder, substance use disorders, comorbidities, adolescents, young adults, ADHD medication, conduct disorder, psychotherapy, relapse prevention
- MeSH terms
- Adolescent, Antidepressive Agents, Attention Deficit Disorder with Hyperactivity, Central Nervous System Agents, Clinical Trials as Topic, Humans, Psychotherapy, Risk Factors, Diagnosis, Dual (Psychiatry), Adrenergic Uptake Inhibitors, Substance-Related Disorders, Young Adult
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