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Educational Activity

Managing ADHD in the Presence of Comorbid Substance Use Disorder

Himanshu P. Upadhyaya, MBBS, MS

Published: June 15, 2007

Article Abstract

Patientswith attention-deficit/hyperactivity disorder (ADHD), especially adolescentsand young adults, commonly have comorbid conditions, including substance usedisorders (SUD). Patients with ADHD and SUD have an earlier age at onset of SUDand are likely to have continued problematic substance abuse, poorer outcomes,higher rates of other psychiatric comorbidities, and a longer time to remissionthan those with only ADHD or SUD. Evidence shows that patients with ADHD havehigh rates of misuse and diversion of stimulant medications, which raisesseveral safety concerns. Studies of pharmacotherapy for ADHD and comorbid SUDare limited but have shown that stimulant medications do not exacerbate theSUD. Clinical recommendations for treating this dual diagnosis include usingnonstimulant agents or extended-release stimulant formulations in conjunctionwith psychosocial therapies to treat both the ADHD and the SUD.

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