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Irish adolescents with ADHD and comorbid substance use disorder

Published online by Cambridge University Press:  13 June 2014

Osamede Edokpolo ,
Nnamdi Nkire  and
Bobby P Smyth
Osamede Edokpolo*
Affiliation:
Youth Drug and Alcohol Service, HSE Addiction Services, Tallaght, Dublin 24, Ireland
Nnamdi Nkire
Affiliation:
Drug Treatment Centre Board, Pearse Street, Dublin 2, Ireland
Bobby P Smyth
Affiliation:
Youth Drug and Alcohol Service, HSE Addiction Services, Tallaght, Dublin 24, Ireland and Department of Public Health and Primary Care, Trinity College Dublin, Ireland
*
*Correspondence E-mail: [email protected]
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Abstract

Objectives:

To examine the literature for drug treatment of attention deficit hyperactivity disorder (ADHD) in adolescents with co-occurring substance use disorder (SUD), the challenges posed by this, and make recommendations taking into account current trend in Ireland.

Methods:

Articles published from 1992-2008 were identified using OVID-MEDLINE search using the search terms attention deficit hyperactivity disorder and substance use disorder. Studies cited include review articles, epidemiological studies, experimental researches, open and controlled trials of drugs in ADHD with comorbid SUD and clinical guidelines. No non-English language papers were included.

Results:

Thirty-six studies were examined. A number of the papers reported on the link between ADHD and SUD, that they frequently co-occur, and there is evidence that treating ADHD can reduce the risk of future SUD. Some of the studies reviewed demonstrated the safety and effectiveness of ADHD medication on the ADHD symptoms but less so on the SUD. Concerns around stimulant abuse and diversion are valid. Although there is no current evidence of frequent diversion of ADHD medications in Ireland, this practice is prevalent in the US. Consequently psychiatrists should remain vigilant to the possibility of such diversions and take measures to address them if identified.

Conclusions:

The available evidence suggests that medication is not hazardous in ADHD comorbid with SUD. Pharmacological treatment of ADHD, following consideration of potential risks and benefits, is justified in the presence of SUD. Both methylphenidate and atomoxetine can be used. Stabilisation of serious SUD before pharmacotherapy is preferable, and it is advisable to provide psychological treatment to address SUD in these patients.

Keywords

Attention deficit hyperactivity disorder
Type
Review
Information
Irish Journal of Psychological Medicine , Volume 27 , Issue 3 , September 2010 , pp. 148 - 151
Copyright
Copyright © Cambridge University Press 2010

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References

1.Kaminer, Y.Clinical implications of the relationship between attention deficit hyperactivity disorder and psychoactive substance use disorders. Am J Addictions 1992; 1(3): 257–264.Google Scholar
2.Wilens, TE, Biederman, J, Spencer, TJ, Frances, RJ.Comorbidity of attention deficit hyperactivity and psychoactive substance use disorders. Hosp Comm Psychiatry 1994; 45(5): 421–435.Google ScholarPubMed
3.Gordon, SM, Tulak, F, Troncale, J.Prevalence and characteristics of adolescent patients with co-occurring ADHD and substance dependence. J Addictive Dis 2004; 23: 31–40.CrossRefGoogle ScholarPubMed
4.Dennis, M, Godley, SH, Diamond, Get al.The Cannabis Youth Treatment (CYT) Study: main findings from two randomised trials. J Subs Abuse Treat 2004; 27: 197–213.CrossRefGoogle Scholar
5.Katusic, SK, Barbaresi, WJ, Colligan, RC, Weaver, AL, Leibson, CL, Jacobsen, SJ.Psychostimulant treatment and risk and risk for substance abuse among young adults with a history of attention-deficit/hyperactivity disorder: A population-based, birth cohort study. J Child Adol Psychopharmacol 2005; 15(5): 764–776.CrossRefGoogle ScholarPubMed
6.National Institute of Clinical Excellence (NICE). Guidelines for Attention deficit hyperactivity disorder, November 2008.Google Scholar
7.Pliszka, Set al.Practice Parameters for the Assessment and Treatment Children and Adolescents with Attention-Deficit/Hyperactivity Disorder. J Am Acad Child Adol Psychiatry 2007; 46(7): 894–921.CrossRefGoogle ScholarPubMed
8.American Psychiatric Association. Diagnostic and statistical Manual of mental Disorders, 4th Ed. American Psychiatric Association, Washington, DC, 1994.Google Scholar
9.Polanczyk, G, Lima, MS, Horta, BL, Biederman, J, Rohde, LA.The worldwide prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-regression analyses. Am J Psychiatry 2007; 164: 942–948.CrossRefGoogle Scholar
10.Young, SE, Corley, RP, Stallings, MC, Rhee, SH, Crowley, TJ, Hewitt, JK.Substance use, abuse and dependence in adolescence: prevalence, symptom profiles and correlates. Drug Alcohol Dep 2002; 68: 309–322.CrossRefGoogle ScholarPubMed
11.Hibell, B, Andersson, Bet al.European School Survey Project on Alcohol and other Drugs (ESPAD). Summary of the 2003 findings. 2004.Google Scholar
12.Cleary, A, Nixon, E, Fitzgerald, M.Psychological health and well being among young Irish adults. Ir J Psychol Med 2007; 24: 139–144.CrossRefGoogle ScholarPubMed
13.Barkley, RA, Fischer, M, Edelbrock, CS, Smallish, L.The adolescent outcome of hyperactive children diagnosed by research criteria: An 8-year prospective follow-up study. J Am Acad Child Adol Psychiatry 1990; 29(4): 546–557.CrossRefGoogle ScholarPubMed
14.McGough, JJ, Smalley, SL, McCracken, JTet al.Psychiatric comorbidity in adult attention deficit hyperactivity disorder: Findings from multiplex families. Am J Psychiatry 2005; 162(9): 1621–1627.CrossRefGoogle ScholarPubMed
15.Milberger, S, Biederman, J, Faraone, S, Chen, L, Jones, J.ADHD is associated with early initiation of cigarette smoking in children and adolescents. J Am Acad Child Adol Psychiatry 1997; 36(1): 37–34.CrossRefGoogle ScholarPubMed
16.Biederman, J, Wilens, T, Mick, E, Spencer, T, Faraone, SV.Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. Paediatrics 1999; 104: e20.CrossRefGoogle ScholarPubMed
17.Wilens, TE, Biederman, J, Mick, E.Does ADH D affect the course of substance abuse? Findings from a sample of adults with and without ADHD. Am J Addictions 1998; 7: 156–163.Google Scholar
18.Wilens, TE, Biederman, J, Mick, E, Faraone, SV, Spencer, T.Attention deficit hyperactivity disorder is associated with early onset substance use disorder. J Nerv Ment Dis 1997; 185: 475–482.CrossRefGoogle Scholar
19.White, AM, Jordan, JD, Schroeder, KMet al.Predictors of relapse during treatment and treatment completion among marijuana-dependent adolescents in an intensive outpatient substance abuse program. Substance Abuse 2004; 25(1): 53–59.CrossRefGoogle Scholar
20.Grella, CE, Hser, Y, Joshi, V, Rounds-Bryant, J.Drug treatment outcomes for adolescents with comorbid mental and substance use disorders. J Nerv Ment Dis 2001; 189: 384–392.CrossRefGoogle ScholarPubMed
21.Pliszka, SR, Crimson, ML, Hughes, CWet al.Texas Children's Medication Algorithm Project: revision of the algorithm for pharmacotherapy of attention-deficit/hyperactivity disorder. J Am Acad Child Adol Psychiatry 2006; 45(6): 642–657.CrossRefGoogle ScholarPubMed
22.Wilens, TE, Faraone, SV, Biederman, J, Gunarwardene, S.Does stimulant therapy of attention deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Paediatrics 2003; 111: 179–185.CrossRefGoogle ScholarPubMed
23.Wilens, TE, Adamson, J, Monuteaux, MCet al.Effect of prior stimulant treatment for attention-deficit hyperactivity disorder for subsequent risk for smoking and alcohol and drug use disorders in adolescents. Arch Paed Adol Med 2008; 162(10): 916–921.CrossRefGoogle ScholarPubMed
24.Faraone, SV, Spencer, TJ, Aleadri, M, Pagano, C, Biederman, J.Comparing the efficacy of medications used for ADHD using meta-analysis. Presented at the 156th Annual meeting of the American Psychiatric Association, San Francisco, May 2003.Google Scholar
25.Bukstein, OG.Therapeutic challenges of attention-deficit hyperactivity disorder with substance use disorders. Expert Rev. Neurotherapeutics 2006; 6(4): 541–549.CrossRefGoogle ScholarPubMed
26. Addiction Research Foundation. The Ontario Study Drug Use Survey: 1995-1997 Toronto, Ontario. Arkansas, Canada.Google Scholar
27.Bellerose, D, Carew, AM, Lyons, S, Long, J.Treated problem drug use in Ireland: Figures for 2007 from the Nation Drug Treatment Reporting System. Health Research Board; Dublin 2009.Google Scholar
28.Riggs, PD, Hall, SK, Mikulich-Gilbertson, SK, Lohman, M, Kayser, A.A randomised controlled trial of Pemoline for ADHD in substance abusing adolescents. J Am Acad Child Adol Psychiatry 2004; 43: 420–429.CrossRefGoogle ScholarPubMed
29.Riggs, PD, Leon, SL, Mikulich, SK, Pottle, LC.An Open Trial of Bupropion for ADHD in Adolescents with Substance Use Disorders and Conduct Disorders. J Am Acad Child Adol Psychiatry 1998; 37(12): 1271–1278.CrossRefGoogle Scholar
30.Szobot, CM, Rohde, LA, Katz, Bet al.A randomised crossover clinical study showing that methylphenidate-SODAS improves Attention-deficit/Hyperactivity Disorder symptoms in adolescents with Substance Use Disorders. Braz J Med Biol Res 2008; 41(3): 250–257.CrossRefGoogle Scholar
31.Carpentier, PJ, de Jong, CA, Dijkstra, BA, Verbrugge, CA, Krabbe, PRA controlled trial of methylphenidate in adults with attention deficit/hyperactivity disorder and substance use disorders. Addiction 2005; 100(12): 1868–1874.CrossRefGoogle ScholarPubMed
32.Schubiner, H, Saules, KK, Arfken, CLet al.Double-Blind Placebo-Controlled Trial of Methylphenidate in the Treatment of Adult ADHD Patients with Comorbid Cocaine Dependence. Experimental Clin Psychopharmacol 2002; 10(3): 286–294.CrossRefGoogle ScholarPubMed
33.Szobot, CM, Shih, MC, Schaefer, Tet al.Methylphenidate DAT binding in adolescents with Attention-deficit/Hyperactivity Disorder comorbid with substance use disorder- a single photon Emission Computed Tomography with (Tc 99m) TRODAT-1 study. J Neuroimaging 2008; 40(3): 1195–1201.CrossRefGoogle ScholarPubMed
34.Kollins, SH.Comparing the abuse potential of methylphenidate versus other stimulants: a review of available evidence and relevance to the ADHD patient. J Clin Psychiatry 2003; 64(11): 14–18.Google Scholar
35.Volkow, ND, Ding, Y, Fowler, JSet al.Is methylphenidate like cocaine? Studies on their pharmacokinetics and distribution in the human brain. Arch Gen Psychiatry 1995; 52: 456–463.CrossRefGoogle ScholarPubMed
36.Volkow, ND, Wang, GJ, Fowler, JSet al.Therapeutic doses of oral methylphenidate significantly increase extracellular dopamine in human brain. J Neurosciences 2001; 21: 1–5.Google ScholarPubMed
37.Grabowski, J, Roache, JD, Schmitz, JM, Rhoades, H, Creson, D, Korszun, A.Replacement medication for cocaine dependence. Methylphenidate. J Clin Psychopharmacol 1997; 17(6): 485–488.CrossRefGoogle ScholarPubMed
38.Shearer, J, Wodak, A, Mattick, Ret al.Pilot randomised controlled study of dexamphetamine substitution for amphetamine dependence. Addiction 2000; 96, 1289–1296.CrossRefGoogle Scholar
39.Johnson, J and Clark, AF.Prescribing of unlicensed medicines or licensed medicines for unlicensed applications in child and adolescent psychiatry. Psychiatric Bull 2001; 25: 465–466.CrossRefGoogle Scholar
40.Kollins, SH.ADHD, Substance Use Disorders, and Psychostimulant Treatment: Current literature and treatment guidelines. J Attention Dis 2008; 12(2): 115–125.CrossRefGoogle ScholarPubMed
41.Riggs, PD, Levin, F, Green, Al, Vocci, F.Comorbid Psychiatric and Substance Abuse Disorders: Recent Treatment Research. Substance Abuse 2008. 29(3): 51–63.CrossRefGoogle ScholarPubMed