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Current Psychiatry Reports
Published in: Current Psychiatry Reports 3/2014

01-03-2014 | Child and Adolescent Disorders (T Benton, Section Editor)

The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders

Authors: Courtney A. Zulauf, Susan E. Sprich, Steven A. Safren, Timothy E. Wilens

Published in: Current Psychiatry Reports | Issue 3/2014

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Abstract

Adolescents and young adults with substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD) are increasingly presenting in clinical practice. The overlap and role of treatment for these co-occurring disorders remains unclear. A review of the literature was conducted to highlight and update recent evidence on the overlap of ADHD and SUD, the role of ADHD medication on later SUD, and the treatment of ADHD and SUD in adolescents and young adults. Recent work continues to highlight the high risk for comorbid ADHD in patients with SUD; and conversely, the high risk for SUD developing in ADHD across the lifespan, particularly in the context of comorbid conduct disorder. Although the data remains discordant, it appears that ADHD pharmacotherapy does not increase the risk for SUD. Medication treatment alone does not appear to be particularly effective in treating SUD in currently active substance abusing individuals with ADHD. Structured therapies may be effective in treating adolescents and young adults with ADHD and SUD. Further controlled trials evaluating the sequence and effect of structured psychotherapies and/or ADHD pharmacotherapy on SUD relapse in these groups are warranted.
Literature
1.•
Merikangas KR et al. Service utilization for lifetime mental disorders in U.S. adolescents: results of the National Comorbidity Survey-Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2011;50(1):32–45.PubMedCrossRef
2.
Polanczyk G et al. The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry. 2007;164(6):942–8.PubMedCrossRef
3.
Merikangas KR et al. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010;49(10):980–9.PubMedCentralPubMedCrossRef
4.
5.
Biederman J et al. Adult psychiatric outcomes of girls with attention deficit hyperactivity disorder: 11-year follow-up in a longitudinal case-control study. Am J Psychiatry. 2010;167(4):409–17.PubMedCrossRef
6.•
Wilens TE et al. Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. J Am Acad Child Adolesc Psychiatry. 2011;50(6):543–53.PubMedCentralPubMedCrossRef
7.
8.
Brook JS et al. Longitudinally predicting late adolescent and young adult drug use: childhood and adolescent precursors. J Am Acad Child Adolesc Psychiatry. 1995;34(9):1230–8.PubMedCrossRef
9.
Johnson BA et al. Age of onset as a discriminator between alcoholic subtypes in a treatment-seeking outpatient population. Am J Addict. 2000;9(1):17–27.PubMedCrossRef
10.
Brook JS et al. Young adult drug use and delinquency: childhood antecedents and adolescent mediators. J Am Acad Child Adolesc Psychiatry. 1996;35(12):1584–92.PubMedCrossRef
11.
Kandel DB et al. Psychiatric comorbidity among adolescents with substance use disorders: findings from the MECA study. J Am Acad Child Adolesc Psychiatry. 1999;38(6):693–9.PubMedCrossRef
12.
Lewinsohn PM, Gotlib IH, Seeley JR. Adolescent psychopathology: IV. Specificity of psychosocial risk factors for depression and substance abuse in older adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34(9):1221–9.PubMedCrossRef
13.
Frodl T. Comorbidity of ADHD and Substance Use Disorder (SUD): a neuroimaging perspective. J Atten Disord. 2010;14(2):109–20.PubMedCrossRef
14.
Dennis M et al. The Cannabis Youth Treatment (CYT) Study: main findings from two randomized trials. J Subst Abus Treat. 2004;27(3):197–213.CrossRef
15.•
van Emmerik-van Oortmerssen K et al. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend. 2012;122(1-2):11–9.PubMedCrossRef
16.•
van de Glind G et al. The International ADHD in Substance Use Disorders Prevalence (IASP) study: background, methods and study population. Int J Methods Psychiatr Res. 2013. doi:10.​1002/​mpr.​1397.PubMed
17.
McAweeney M et al. Symptom prevalence of ADHD in a community residential substance abuse treatment program. J Atten Disord. 2010;13(6):601–8.PubMedCrossRef
18.
Barkley RA et al. Young adult follow-up of hyperactive children: antisocial activities and drug use. J Child Psychol Psychiatry. 2004;45(2):195–211.PubMedCrossRef
19.•
20.•
Charach A et al. Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. J Am Acad Child Adolesc Psychiatry. 2011;50(1):9–21.PubMedCrossRef
21.•
Chang Z, Lichtenstein P, Larsson H. The effects of childhood ADHD symptoms on early-onset substance Use: A swedish twin study. J Abnorm Child Psychol. 2012;40(3):425–35.PubMedCrossRef
22.•
Groenman AP et al. Substance use disorders in adolescents with attention deficit hyperactivity disorder: a 4-year follow-up study. Addiction. 2013;108(8):1503–11.PubMedCrossRef
23.
Ercan ES et al. Childhood attention deficit/hyeractivity disorder and alcohol dependence: a 1-year follow-up. Alcohol Alcohol. 2003;38(4):352–6.PubMedCrossRef
24.
Biederman J et al. Is cigarette smoking a gateway drug to subsequent alcohol and illicit drug use disorders? A controlled study of youths with and without ADHD. Biol Psychiatry. 2006;59:258–64.PubMedCrossRef
25.
Trauth JA, Seidler FJ, Slotkin TA. Persistent and delayed behavioral changes after nicotine treatment in adolescent rats. Brain Res. 2000;880(1–2):167–72.PubMedCrossRef
26.•
Wilens TE et al. Do executive function deficits predict later substance use disorders among adolescents and young adults? J Am Acad Child Adolesc Psychiatry. 2011;50(2):141–9.PubMedCentralPubMedCrossRef
27.
King VL et al. Attention deficit hyperactivity disorder and treatment outcome in opioid abusers entering treatment. J Nerv Ment Dis. 1999;187(8):487–95.PubMedCrossRef
28.
Riggs PD et al. A randomized controlled trial of pemoline for attention-deficit/hyperactivity disorder in substance-abusing adolescents. J Am Acad Child Adolesc Psychiatry. 2004;43(4):420–9.PubMedCrossRef
29.
Riggs PD. Clinical approach to treatment of ADHD in adolescents with substance use disorders and conduct disorder. J Am Acad Child Adolesc Psychiatry. 1998;37(3):331–2.PubMedCrossRef
30.•
Kousha M, Shahrivar Z, Alaghband-Rad J. Substance use disorder and ADHD: is ADHD a particularly "specific" risk factor? J Atten Disord. 2012;16(4):325–32.PubMedCrossRef
31.
Biederman J et al. Is ADHD a risk for psychoactive substance use disorder? Findings from a four year follow-up study. J Am Acad Child Adolesc Psychiatry. 1997;36:21–9.PubMedCrossRef
32.
Wilens T et al. Do individuals with ADHD self-medicate with cigarettes and substances of abuse? Results from a controlled family study of ADHD. Am J Addict. 2007;16 Suppl 1:14–23.PubMedCrossRef
33.
Wilens TE, Decker MW. Neuronal nicotinic receptor agonists for the treatment of attention-deficit/hyperactivity disorder: focus on cognition. Biochem Pharmacol. 2007;74(8):1212–23.PubMedCentralPubMedCrossRef
34.
Casey BJ, Jones RM. Neurobiology of the adolescent brain and behavior: implications for substance use disorders. J Am Acad Child Adolesc Psychiatry. 2010;49(12):1189–201. quiz 1285.PubMedCentralPubMed
35.•
36.
Biederman J et al. Familial risk analyses of attention deficit hyperactivity disorder and substance use disorders. Am J Psychiatry. 2008;165(1):107–15.PubMedCrossRef
37.
Faraone SV, Biederman J. Neurobiology of attention deficit hyperactivity disorder. In: Charney DS, Nestler EJ, editors. Neurobiology of mental illness. 2nd ed. New York, NY: Oxford University Press; 2004.
38.•
Yule AM et al. Does exposure to parental substance use disorders increase substance use disorder risk in offspring? A 5-year follow-up study. Am J Addict. 2013;22(5):460–5.PubMedCrossRef
39.
Bhatara V, Loudenberg R, Ellis R. Association of attention deficit hyperactivity disorder and gestational alcohol exposure: an exploratory study. J Atten Disord. 2006;9(3):515–22.PubMedCrossRef
40.
Schmitz M et al. Smoking during pregnancy and attention-deficit/hyperactivity disorder, predominantly inattentive type: a case-control study. J Am Acad Child Adolesc Psychiatry. 2006;45(11):1338–45.PubMedCrossRef
41.
Katusic SK et al. Substance abuse among ADHD cases: a population-based birth cohort study. Seattle: Pediatric Academic Society; 2003.
42.
Molina B, Pelham W. Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. J Abnorm Child Psychol. 2003;112(3):497–507.CrossRef
43.
Brook DW et al. Association between attention-deficit/hyperactivity disorder in adolescence and substance use disorders in adulthood. Arch Pediatr Adolesc Med. 2010;164(10):930–4.PubMedCentralPubMedCrossRef
44.
Flory K, Lynam DR. The relation between attention deficit hyperactivity disorder and substance abuse: what role does conduct disorder play? Clin Child Fam Psychol Rev. 2003;6(1):1–16.PubMedCrossRef
45.•
Lee SS et al. Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a meta-analytic review. Clin Psychol Rev. 2011;31(3):328–41.PubMedCentralPubMedCrossRef
46.
Elkins IJ, McGue M, Iacono WG. Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Arch Gen Psychiatry. 2007;64(10):1145–52.PubMedCrossRef
47.
Burke JD et al. Inattention as a key predictor of tobacco use in adolescence. J Abnorm Psychol. 2007;116(2):249–59.PubMedCrossRef
48.
Fergusson DM, Horwood LJ, Ridder EM. Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: results of a 25-year longitudinal study. Drug Alcohol Depend. 2007;88 Suppl 1:S14–26.PubMedCrossRef
49.
Szobot CM et al. Is attention-deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? A community-based case-control study. Addiction. 2007;102(7):1122–30.PubMedCrossRef
50.
Kollins SH. A qualitative review of issues arising in the use of psycho-stimulant medications in patients with ADHD and co-morbid substance use disorders. Curr Med Res Opin. 2008;24(5):1345–57.PubMedCrossRef
51.
Kuczenski R, Segal DS. Stimulant actions in rodents: implications for attention-deficit/hyperactivity disorder treatment and potential substance abuse. Biol Psychiatry. 2005;57(11):1391–6.PubMedCrossRef
52.•
53.
Wilens T et al. Does stimulant therapy of ADHD beget later substance abuse: a metanalytic review of the literature. Pediatrics. 2003;11(1):179–85.CrossRef
54.•
Hammerness P et al. Do stimulants reduce the risk for cigarette smoking in youth with attention-deficit hyperactivity disorder? A prospective, long-term, open-label study of extended-release methylphenidate. J Pediatr. 2012. doi:10.​1016/​j.​jpeds.​2012.​06.​046.PubMed
55.•
Hammerness P et al. Do Stimulants reduce the risk for alcohol and substance use in youth with ADHD? A secondary analysis of a prospective, 24-Month Open-Label Study of Osmotic-Release Methylphenidate. J Atten Disord. 2012;
56.•
57.•
Konstenius M et al. Methylphenidate for ADHD and drug relapse in criminal offenders with substance dependence: a 24-week randomized placebo-controlled trial. Addiction. 2013. doi:10.​1111/​add.​12369.
58.
Adler LD, Nierenberg AA. Review of medication adherence in children and adults with ADHD. Postgrad Med. 2010;122(1):184–91.PubMedCrossRef
59.••
Riggs PD et al. Randomized controlled trial of osmotic-release methylphenidate with cognitive-behavioral therapy in adolescents with attention-deficit/hyperactivity disorder and substance use disorders. J Am Acad Child Adolesc Psychiatry. 2011;50(9):903–14.PubMedCentralPubMedCrossRef
60.••
Tamm L et al. Predictors of treatment response in adolescents with comorbid substance use disorder and attention-deficit/hyperactivity disorder. J Subst Abus Treat. 2013;44(2):224–30.CrossRef
61.•
62.
National Institute on Drug Abuse, Treatment Approaches for Drug Addiction 2009: National Institute on Drug Abuse, National Institutes of Health.
63.•
American Academy of Pediatrics, Recommendations: Attention-Deficit/Hyperactivity Disorder, Center for Disease Control and Prevention, Editor 2013: USA.gov.
64.
National Institute on Drug Abuse, Principles of drug addiction treatment: A research-based guide 2000: National Institute on Drug Abuse, National Institutes of Health.
65.••
Antshel KM, Faraone SV and Gordon M. Cognitive behavioral treatment outcomes in adolescent ADHD. J Atten Disord. 2012.
66.
Bramham J et al. Evaluation of group cognitive behavioral therapy for adults with ADHD. J Atten Disord. 2009;12(5):434–41.PubMedCrossRef
67.••
Emilsson B et al. Cognitive behaviour therapy in medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. BMC Psychiatr. 2011;11:116.CrossRef
68.••
69.
Safren SA et al. Cognitive behavioral therapy vs relaxation with educational support for medication-treated adults with ADHD and persistent symptoms: a randomized controlled trial. JAMA. 2010;304(8):875–80.PubMedCentralPubMedCrossRef
70.
Wilens T, Morrison NR and Prince JB. An update on the pharmacotherapy of attention-deficit/hyperactivity disorder in adults. Expert Rev Neurother. 2011;11(10).
71.
Bukstein OG. Therapeutic challenges of attention-deficit hyperactivity disorder with substance use disorders. 2006.
72.
Wilens TE and Morrison NR. The intersection of attention-deficit/hyperactivity disorder and substance abuse. Curr Opin Psychiatr. 2011;
73.
Wilens TE. Attention -deficit/hyperactivity disorder and substance use disorders in adolescents. Psychiatr Times. 2006;XXV(1): 33–34.
74.
Wilens TE et al. Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders. Drug Alcohol Depend. 2008;96(1–2):145–54.PubMedCrossRef
75.
Adler L et al. Retrospective safety analysis of atomoxetine in adult ADHD patients with or without comorbid alcohol abuse and dependence. Am J Addict. 2009;18(5):393–401.PubMedCrossRef
76.
Thurstone C et al. Randomized, controlled trial of atomoxetine for attention-deficit/hyperactivity disorder in adolescents with substance use disorder. J Am Acad Child Adolesc Psychiatry. 2010;49(6):573–82.PubMedCentralPubMed
77.
McRae-Clark AL et al. A placebo-controlled trial of atomoxetine in marijuana-dependent individuals with attention deficit hyperactivity disorder. Am J Addict. 2010;19(6):481–9.PubMedCentralPubMedCrossRef
78.
Levin FR et al. Treatment of methadone-maintained patients with adult ADHD: Double-blind comparison of methylphenidate, bupropion and placebo. Drug Alcohol Depend. 2006;81:137–48.PubMedCrossRef
79.
Levin FR et al. Treatment of cocaine dependent treatment seekers with adult ADHD: double-blind comparison of methylphenidate and placebo. Drug Alcohol Depend. 2007;87(1):20–9.PubMedCrossRef
80.
Levin FR et al. Atomoxetine Treatment for Cocaine Abuse and Adult Attention-Deficit Hyperactivity Disorder (ADHD): a preliminary open trial. j dual diagn. 2009;5(1):41–56.PubMedCentralPubMedCrossRef
81.
Schubiner H et al. Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Exp Clin Psychopharmacol. 2002;10(3):286–94.PubMedCrossRef
82.•
Winhusen TM et al. Subjective effects, misuse, and adverse effects of osmotic-release methylphenidate treatment in adolescent substance abusers with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol. 2011;21(5):455–63.PubMedCrossRef
83.
Safren SA et al. Cognitive-behavioral therapy for ADHD in medication-treated adults with continued symptoms. Behavior Research and Therapy. 2005;43(7):831–42.CrossRef
84.
85.
Philipsen A et al. Structured group psychotherapy in adults with attention deficit hyperactivity disorder: results of an open multicentre study. J Nerv Ment Dis. 2007;195(12):1013–9.PubMedCrossRef
86.
Carroll KM et al. Psychotherapy and pharmacotherapy for ambulatory cocaine abusers. Arch Gen Psychiatry. 1994;51(3):177–87.PubMedCrossRef
87.
Kaminer Y et al. Psychotherapies for adolescent substance abusers: a pilot study. J Nerv Ment Dis. 1998;186(11):684–90.PubMedCrossRef
88.
Austin AM, Macgowan MJ, Wagner EF. Effective family-based interventions for adolescents with substance use problems: a systematic review. Res Soc Work Pract. 2005;15(2):67–83.CrossRef
89.
Waldron HB, Turner CW. Evidence-based psychosocial treatments for adolescent substance abuse. J Clin Child Adolesc Psychol. 2008;37(1):238–61.PubMedCrossRef
90.•
Wilens T, Zulauf C. ADHD, cigarette smoking, and substance abuse: intoxicating combination. Contemp Pediatr. 2012;29:48–59.
91.
Bates ME et al. Cognitive impairment influences drinking outcome by altering therapeutic mechanisms of change. Psychol Addict Behav. 2006;20(3):241–53.PubMedCentralPubMedCrossRef
92.
Miller WR, Sovereign RG, Krege B. Motivational interviewing with problem drinkers: II. The drinker's check-up as a preventive intervention. Behav Psychother. 1988;16(4):251–68.CrossRef
Metadata
Title
The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders
Authors
Courtney A. Zulauf
Susan E. Sprich
Steven A. Safren
Timothy E. Wilens
Publication date
01-03-2014
Publisher
Springer US
Published in
Current Psychiatry Reports / Issue 3/2014
Print ISSN: 1523-3812
Electronic ISSN: 1535-1645
DOI
https://doi.org/10.1007/s11920-013-0436-6