ADHD with comorbid substance use disorder: review of treatment

Attention-deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that affects 3–7% of children (Wilens 2004). Prospective longitudinal studies show persistence of the disorder in 10–20% of adults diagnosed with ADHD in childhood, and a further 40–60% of patients experience partial remission, with persistence of some symptoms and significant clinical impairments (Barkley 2008). Population studies estimate the prevalence of adult ADHD at between 3.4 and 4.4% (Kessler 2006). The DSM-IV (American Psychiatric Association 1994) and the ICD-10 (World Health Organization 1993) criteria are widely used to diagnose ADHD in adults. The 2008 National Institute for Health and Clinical Excellence (NICE) guidelines provide evidence for the validity of ADHD diagnosis in children and adults and make recommendations for its diagnosis and management. Detailed description of clinical diagnosis and management of adult ADHD is given elsewhere (Weiss 2003). Substance use disorders are common in adults with ADHD (Kessler 2006; Box 1). Prospective studies (Molina 2003) and population-based surveys (Kessler 2006) clearly demonstrate a higher prevalence of substance use disorder in individuals with ADHD. Likewise, the prevalence of ADHD is substantially higher in adolescents and adults seeking treatment for substance use disorder (Schubiner 2000).