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Irish adolescents with ADHD and comorbid substance use disorder

Published online by Cambridge University Press:  13 June 2014

Osamede Edokpolo ,
Nnamdi Nkire  and
Bobby P Smyth
Osamede Edokpolo*
Affiliation:
Youth Drug and Alcohol Service, HSE Addiction Services, Tallaght, Dublin 24, Ireland
Nnamdi Nkire
Affiliation:
Drug Treatment Centre Board, Pearse Street, Dublin 2, Ireland
Bobby P Smyth
Affiliation:
Youth Drug and Alcohol Service, HSE Addiction Services, Tallaght, Dublin 24, Ireland and Department of Public Health and Primary Care, Trinity College Dublin, Ireland
*
*Correspondence E-mail: [email protected]
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Abstract

Objectives:

To examine the literature for drug treatment of attention deficit hyperactivity disorder (ADHD) in adolescents with co-occurring substance use disorder (SUD), the challenges posed by this, and make recommendations taking into account current trend in Ireland.

Methods:

Articles published from 1992-2008 were identified using OVID-MEDLINE search using the search terms attention deficit hyperactivity disorder and substance use disorder. Studies cited include review articles, epidemiological studies, experimental researches, open and controlled trials of drugs in ADHD with comorbid SUD and clinical guidelines. No non-English language papers were included.

Results:

Thirty-six studies were examined. A number of the papers reported on the link between ADHD and SUD, that they frequently co-occur, and there is evidence that treating ADHD can reduce the risk of future SUD. Some of the studies reviewed demonstrated the safety and effectiveness of ADHD medication on the ADHD symptoms but less so on the SUD. Concerns around stimulant abuse and diversion are valid. Although there is no current evidence of frequent diversion of ADHD medications in Ireland, this practice is prevalent in the US. Consequently psychiatrists should remain vigilant to the possibility of such diversions and take measures to address them if identified.

Conclusions:

The available evidence suggests that medication is not hazardous in ADHD comorbid with SUD. Pharmacological treatment of ADHD, following consideration of potential risks and benefits, is justified in the presence of SUD. Both methylphenidate and atomoxetine can be used. Stabilisation of serious SUD before pharmacotherapy is preferable, and it is advisable to provide psychological treatment to address SUD in these patients.

Keywords

Attention deficit hyperactivity disorder
Type
Review
Information
Irish Journal of Psychological Medicine , Volume 27 , Issue 3 , September 2010 , pp. 148 - 151
Copyright
Copyright © Cambridge University Press 2010

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