A multidisciplinary group of 55 experts from 17 countries reached a high level of consensus on 36 of 37 statements for the screening, diagnosis, and treatment of adolescents with concurrent attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD). The group published its consensus statement online in the journal European Addiction Research.
“The effect of treatment of childhood ADHD on the development of adolescent SUD and the screening, diagnosis, and treatment of concurrent ADHD and SUD in adolescents has received little attention in research and in treatment guidelines. The evidence-base on these issues is limited and not robust enough for strong clinical recommendations,” the authors explained.
“At the same time, adolescent patients with ADHD and concurrent SUD are in serious need of treatment to improve clinical and psychosocial outcomes and to prevent chronicity.”
The effort was an initiative of the International Collaboration on ADHD and Substance Abuse to provide a consensus paper, based on available scientific data and clinical experience, to guide clinicians and patients. Experts rated a set of statements in 3 rounds in a modified Delphi process. They reached consensus on 64% of statements in the first round. After rewrites, consensus was achieved for 92% of statements in the second round and for 97% in the third round.
Experts agreed on routine screening for ADHD in adolescents in substance abuse treatment, and for routine SUD screening in adolescents with ADHD in mental health care settings. They also agreed that long-acting stimulants should be first-line ADHD treatment for adolescents with ADHD and concurrent SUD. Furthermore, they concurred that pharmacotherapy should be embedded in psychosocial treatment.
However, they disagreed on a statement requiring abstinence or reduced/stabilized substance use before starting psychostimulant treatment in adolescents with ADHD and SUD.
“In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion” due to a lack of evidence of its effect and the risk of bupropion-induced seizures, the paper explained.
Existing national guidelines on the treatment of ADHD in children and adolescents also contain opposing views on these issues, the authors noted.
Özgen H, Spijkerman R, Noack M, et al. International consensus statement for the screening, diagnosis, and treatment of adolescents with concurrent attention-deficit/hyperactivity disorder and substance use disorder. European Addiction Research. 2020 July 7;[Epub ahead of print].