Managing Attention-Deficit/Hyperactivity Disorder in the Presence of Substance Use Disorder.

Patients with attention-deficit/hyperactivity disorder (ADHD), especially adolescents and youngadults, commonly have comorbid conditions, including substance use disorder (SUD), which cancomplicate the treatment and management of both illnesses. Patients with ADHD and SUD have anearlier age at onset of SUD, may take longer to achieve remission than those with only SUD, and arelikely to have a longer course, poorer outcome, and higher rates of other psychiatric comorbidities.There is evidence of misuse and diversion with stimulant medications, which raises several safetyconcerns. Studies of pharmacotherapy for ADHD and comorbid SUD are limited but have shown thatstimulant medications probably do not exacerbate the SUD. Nonstimulant medications for ADHD andextended-release stimulant formulations are available and may be less likely to be misused or diverted.Understanding the motives for drug use and misuse is important in treating patients withADHD and comorbid SUD. A number of tools are available to the clinician to detect substance useproblems in patients with ADHD, including drug and alcohol screening questionnaires and toxicologyscreens. Clinical recommendations for treating this dual diagnosis include using nonstimulant agentsor extended-release stimulant formulations in conjunction with psychosocial therapies to treat boththe ADHD and the SUD.