Substance Use Disorders in Children and Adolescents With Attention-Deficit/Hyperactivity Disorder: Implications for Treatment and the Role of the Primary Care Physician
Prim Care Companion J Clin Psychiatry 2008;10(3):211-221
© Copyright 2016 Physicians Postgraduate Press, Inc.
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
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. Psychostimulants 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. Psychostimulants 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.