Challenges of Treating ADHD with Comorbid Substance Use Disorder: Considerations for the Clinician
Open accessAbstract
Adults with attention deficit/hyperactivity disorder (ADHD) often present psychiatric comorbidities and, in particular, substance use disorder (SUD). ADHD-SUD comorbidity is characterized by greater severity of both disorders, earlier age of onset, higher likelihood of polydrug-abuse and suicidal behaviors, more hospitalizations, and lower treatment adherence. At the present stage, research focused on the pharmacological management of ADHD with comorbid SUD in both adolescents and adults is still lacking. Furthermore, while the short-term effects of stimulants are well studied, less is known about the chronic effects of these drugs on dopamine signaling. Current available evidence is consistent in reporting that high doses of stimulant medications in ADHD-SUD subjects have a mild to moderate efficacy on ADHD symptoms. Some data suggest that pharmacological treatment with stimulants may be beneficial for both ADHD symptoms and comorbid cocaine or amphetamine use. However, in the long run, stimulant medications may have a potential risk for misuse. For the absence of potential misuse, atomoxetine is often recommended for ADHD with comorbid cocaine or amphetamine use disorder. However, its efficacy in reducing addictive behavior is not demonstrated. In subjects with other subtypes of SUD, both atomoxetine and stimulant drugs seem to have scarce impact on addictive behavior, despite the improvement in ADHD symptomatology. In this population, ADHD treatment should be combined with SUD-specific strategies.
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Treatment of ADHD-particularly with stimulants or atomoxetine-may attenuate depressive symptoms and reduce relapse risk in mood and anxiety disorders.
“Treatment of ADHD—particularly with stimulants or atomoxetine—may attenuate depressive symptoms and reduce relapse risk in mood and anxiety disorders [113].”
From ADHD in Adulthood: Clinical Presentation, Comorbidities, and Treatment Perspectives (2025) · cites this paper as [113]
Section 7 (no page available) reports that some naturalistic studies suggest ADHD medications may help prevent depression in adulthood. It does not report that stimulants or atomoxetine attenuate existing depressive symptoms or reduce relapse risk in mood and anxiety disorders. The relapse discussion concerns substance use, not mood or anxiety disorders. (LLM, conf=0.82)
Experimental — accuracy not yet measuredInitial studies suggest that higher doses of specific stimulants may be beneficial for a subset of individuals with comorbid ADHD and stimulant use disorder.
“initial studies suggest that higher doses of specific stimulants may be beneficial for a subset of individuals with comorbid ADHD and stimulant use disorder”
From Navigating the Complex Intersection of Substance Use and Psychiatric Disorders: A Comprehensive Review (2024) · cites this paper as [74]
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Flagged first, then by citations
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Evolution of methylphenidate prescriptions in the region of Occitanie, France, from 2013 to 2021
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A relação entre o TDAH e Transtorno por Uso de Substâncias em adultos
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- Authors
- Barbuti, M., Maiello, M., Spera, V., Pallucchini, A., Brancati, G., Maremmani, A., Perugi, G., & Maremmani, I.
- Affiliations
- University of Pisa (IT)
- Section of Psychiatry, Department of Psychiatry and Addictions, North-Western Tuscany Local Health Unit, Tuscany NHS, Versilia Zone, Via Aurelia 335, 55041 Lido di Camaiore, Italy
- Corresponding author
- Maremmani, Icro
- ORCID
- Venue
- Journal of Clinical Medicine
- Publisher
- MDPI AG
- Published
- 2023-04-24
- Volume
- 12
- Issue
- 9
- Pages
- 3096
- ISSN
- 2077-0383 (ISSN-L)
- PMC
- PMC10179386
- OpenAlex
- W4366990531
- Cited by
- 47
- References
- 102
- Citations by year
- 2026: 14 · 2025: 17 · 2024: 14 · 2023: 2
- FWCI
- 2.15
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Journal of Clinical Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Life Sciences › Neuroscience › Cellular and Molecular Neuroscience › Neurotransmitter Receptor Influence on Behavior
- Keywords
- attention deficit hyperactivity disorder, substance use disorders, comorbidities, stimulant medication, atomoxetine, cocaine dependence, amphetamine use disorder, dopamine signaling, medication adherence, polydrug abuse, suicidal behavior, psychiatric comorbidity
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