Guidelines for Managing ADHD and Substance Use Disorders

Abstract

Guideline for managing ADHD and substance use disorders (SUD)

Frieda Matthys, MD, PhD.

Background

Despite the high prevalence of ADHD in adults with SUD and the availability of an approved guideline, under diagnosis and inadequate treatment still persist. This comorbidity associates with reduced treatment effectiveness, making successful treatment in adults with ADHD and SUD a challenge.

Methods

The guideline of 2010 for recognizing and treating adult ADHD in patients with SUD is updated in 2016, in cooperation with caregivers, of the addiction centers in Belgium and based on research literature and clinical experience. The english translation is discussed by an international group of clinicians and experts to result in a consensus statement via ICASA (International Collaboration on ADHD and Substance Abuse).

Results

This consensus presents a useful guide for the diagnosis and treatment of ADHD and SUD. Due to the lack of scientific evidence on some of the topics, the guide is a combination of evidence based and practice based recommendations.

Conclusion

The management of ADHD in patients with SUD remains a challenge. Diagnosis is complicated by SUD symptoms and by the skepticism associated with the recognition of ADHD in adults. The treatment is hampered by high relapse rates and reduced effectiveness of the currently available pharmacotherapies. Combining psycho-and pharmacotherapy in an integrated treatment that covers both ADHD and SUD, may help to keep these patients in treatment.

A Dutch manual for the integrated treatment of ADHD and SUD is being developed.

Disclosure of interest

Honorarium Lilly.

Advisory board Johnson&Johnson.