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Managing ADHD in the Presence of Comorbid Substance Use Disorder

J Clin Psychiatry 2007;68(6):e15

Patients with attention-deficit/hyperactivity disorder (ADHD), especially adolescents and young adults, commonly have comorbid conditions, including substance use disorders (SUD). Patients with ADHD and SUD have an earlier age at onset of SUD and are likely to have continued problematic substance abuse, poorer outcomes, higher rates of other psychiatric comorbidities, and a longer time to remission than those with only ADHD or SUD. Evidence shows that patients with ADHD have high rates of misuse and diversion of stimulant medications, which raises several safety concerns. Studies of pharmacotherapy for ADHD and comorbid SUD are limited but have shown that stimulant medications do not exacerbate the SUD. Clinical recommendations for treating this dual diagnosis include using nonstimulant agents or extended-release stimulant formulations in conjunction with psychosocial therapies to treat both the ADHD and the SUD.

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