Substance Use Disorders in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Implications for Treatment and the Role of the Primary Care Physician
Open accessAbstract
OBJECTIVES: Review the association between attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) in children and adolescents. Discuss treatment implications and the role of the primary care physician in the management of this comorbidity. DATA SOURCES: Articles published from 1991 to 2007 were identified through a MEDLINE search using the search terms attention-deficit/hyperactivity disorder and substance use disorder. STUDY SELECTION: Publications cited include reviews of substance use disorders in children and adolescents with ADHD, manuals of diagnostic tests, and 69 studies of substance use disorders in children and adolescents with ADHD. No non-English-language publications were identified. DATA SYNTHESIS: Recent reports identify SUD in a high proportion of respondents with ADHD and ADHD in a high proportion of respondents with many types of SUD. Factors that appear to increase the risk for SUD include comorbid psychiatric disorders, particularly conduct disorder. Pharmacotherapy for ADHD appears not to increase the risk for subsequent SUD. Guidelines for the evaluation and treatment of patients with comorbid ADHD and SUD are outlined. Psycho-stimulants carry the risk for misuse by both patients and family members through diversion. Although nonstimulants such as atomoxetine have low abuse potential, they appear to be less efficacious than stimulants. Formulations that have the potential to lower the abuse liability of stimulants are being developed. These include a transdermal form of methylphenidate that has been shown to be efficacious in the treatment of ADHD and a prodrug stimulant, lisdexamfetamine, recently approved for the treatment of ADHD. Clinical data indicate that lisdexamfetamine is efficacious, and significantly lower likability scores were seen with lisdexamfetamine than with equivalent oral doses of d-amphetamine sulfate. CONCLUSIONS: Pharmacotherapy may reduce the risk for SUD in patients with ADHD. Psycho-stimulants remain the first-line therapy for the core symptoms of ADHD. New formulations of pharmacologic agents with a reduced potential for abuse are being developed.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
A bidirectional link between ADHD and substance use disorder is reported, with ADHD symptoms overrepresented in SUD populations and SUD overrepresented in ADHD populations.
“A bidirectional link between ADHD and SUD is reported [142,200] with ADHD symptoms over represented in SUD populations [201] and SUD in ADHD populations [202].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [200]
Atomoxetine may be an alternative to stimulant treatment in substance abuse patients with ADHD, although studies showing superiority over stimulants in this population are still lacking.
“The non stimulant atomoxetine may be an alternative to treatment with stimulants in substance abuse patients with ADHD, although studies showing superiority over stimulants in this difficult patient population are still lacking [200,284-286].”
From European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD (2010) · cites this paper as [200]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 95 · Cited by 31
Research works printed but not linked: 5
- [1]1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, DC: American Psychiatric Association; 2000
- [25]25. J Addict Dis 2004;23:31-40
- [43]43. McGue M, Elkins I, Iacono WG. Genetic and environmental influences on adolescent substance use and abuse. Am J Med Genet 2000;96: 671-677
- [64]64. Knight JR, Goodman E, Pulerwitz T, et al. Reliability of the Problem Oriented Screening Instrument for Teenagers (POSIT) in adolescent medical practice. J Adolesc Health 2001;29:125-130
- [75]75. Lopez FA. ADHD: new pharmacological treatments on the horizon. J Dev Behav Pediatr 2006;27:410-416
- Authors
- Upadhyaya, H. P.
- Affiliations
- Medical University of South Carolina (US)
- Corresponding author
- Upadhyaya, Himanshu P.
- Venue
- The Primary Care Companion to The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2008-06-16
- Volume
- 10
- Issue
- 03
- Pages
- 211-221
- ISSN
- 1523-5998 (ISSN-L)
- PMC
- PMC2446489
- OpenAlex
- W1975343712
- Cited by
- 31
- References
- 95
- Citations by year
- 2025: 1 · 2024: 1 · 2022: 1 · 2021: 2 · 2020: 2 · 2019: 1 · 2018: 6 · 2017: 2 · 2016: 2 · 2015: 2 · 2013: 1 · 2012: 7
- FWCI
- 0.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- The Primary Care Companion to The Journal of Clinical Psychiatry (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Eli Lilly and Company
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Health Sciences › Medicine › Epidemiology › Substance Abuse Treatment and Outcomes
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Keywords
- attention deficit hyperactivity disorder, substance use disorders, comorbidities, children and adolescents, conduct disorder, atomoxetine, lisdexamfetamine, methylphenidate, abuse liability, primary care management, pharmacotherapy
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
