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Cited by 32Attention Deficit Hyperactivity DisorderSubstance Abuse Treatment and OutcomesSchizophrenia research and treatment

The Clinical Dilemma of Using Medications in Substance-Abusing Adolescents and Adults with Attention-Deficit/Hyperactivity Disorder: What Does the Literature Tell Us?

Wilens, Timothy E., Monuteaux, Michael C., Snyder, Lindsey E., Moore, Hadley, Whitley, Julia, Gignac, Martin·2005·Journal of Child and Adolescent Psychopharmacology
DOI 10.1089/cap.2005.15.787
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Abstract

OBJECTIVE: Adolescents and adults with attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD) are increasingly recognized in clinical practice. The role of pharmacological treatment for ADHD in these comorbid individuals remains unclear. METHODS: A systematic review of the medical literature was conducted through PubMed, supplemented with data from scientific presentations, to evaluate the role of medication treatment of ADHD in substance abusing individuals with ADHD. Meta-analysis was used to evaluate the effects of medication therapy on ADHD and SUD outcomes in general, while specifically addressing trial design, trial duration, retention, class of medication, age group, concurrent psychotherapy, and outcome in both SUD and ADHD domains. RESULTS: Four studies in adolescents and five studies in adults with ADHD plus SUD were identified (two controlled and seven open studies; n = 222 subjects). The standard mean difference (SMD) indicated statistically significant improvements in ADHD and SUD that were not maintained when evaluating controlled studies only. Albeit limited by power, trial duration, retention rate, and age group did not influence outcome. No worsening of SUD or drug-drug interactions were observed in any of the studies. The results could not be accounted for by any single study or by publication bias. CONCLUSION: Treating ADHD pharmacologically in individuals with ADHD plus SUD has a moderate impact on ADHD and SUD that is not observed in controlled trials and does not result in worsening of SUD or adverse interactions specific to SUD. Further controlled trials evaluating the effect of novel combinations of psychotherapy and ADHD pharmacotherapy on SUD relapse in these groups are warranted.

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  • ADHD is considered an important factor in the aetiology of substance use disorders because substances are often used for self-medication and may relieve symptoms like restlessness, inattention, impulsivity, and sleep problems, or may be taken as part of stimulus-seeking traits associated with ADHD.

    “With respect to substance use disorders, ADHD is considered an important factor in its aetiology as the substances are often used for self-medication and may relieve symptoms like restlessness, inattention, impulsivity and sleep problems [207,249-251]; or may be taken as part of stimulus seeking (novelty seeking) traits that are also associated with ADHD.”

    From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [251]

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Authors
Wilens, T. E., Monuteaux, M. C., Snyder, L. E., Moore, H., Whitley, J., & Gignac, M.
Affiliations
Harvard University (US)
ORCID
Venue
Journal of Child and Adolescent Psychopharmacology
Publisher
SAGE Publications
Published
2005-11
Volume
15
Issue
5
Pages
787-798
ISSN
  • 1044-5463 (ISSN-L)
  • 1557-8992
DOI
10.1089/cap.2005.15.787
OpenAlex
W2031077099
Cited by
32
References
57
Citations by year
2019: 1 · 2017: 1 · 2016: 1 · 2014: 3 · 2012: 4
FWCI
2.42
Type
journal article
Language
en
Open access
closed
Licence
www.liebertpub.com/nv/resources-tools/text-and-data-mining-policy/121/ (tdm)
Locations
  • Journal of Child and Adolescent Psychopharmacology (publishedVersion)
  • PubMed (publishedVersion)
Funders
National Institute on Drug Abuse (DA14419, K24DA016264, R01DA014419)
Topics
  • Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
  • Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
  • Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
Keywords
attention deficit hyperactivity disorder, substance use disorders, comorbidities, ADHD medication, stimulant medication, adolescents, adults, drug-drug interactions, psychotherapy, treatment outcomes
MeSH terms
Adolescent, Adult, Attention Deficit Disorder with Hyperactivity, Clinical Trials as Topic, Humans, Substance-Related Disorders

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