International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder

Özgen, Heval; Spijkerman, Renske; Noack, Moritz; Holtmann, Martin; Schellekens, Arnt S.A.; van de Glind, Geurt; Banaschewski, Tobias; Barta, Csaba; Begeman, Alex; Casas, Miguel; Crunelle, Cleo L.; Daigre Blanco, Constanza; Dalsgaard, Søren; Demetrovics, Zsolt; den Boer, Jacomine; Dom, Geert; Eapen, Valsamma; Faraone, Stephen V.; Franck, Johan; González, Rafael A.; ... (2020). International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder. European addiction research, 26(4-5), pp. 223-232. Karger 10.1159/000508385

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frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations.

Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience.

Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD.

Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent 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.

Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > University Psychiatric Services > University Hospital of Psychiatry and Psychotherapy > Translational Research Center
04 Faculty of Medicine > University Psychiatric Services > University Hospital of Child and Adolescent Psychiatry and Psychotherapy
07 Faculty of Human Sciences > Institute of Psychology > Clinical Psychology and Psychotherapy

UniBE Contributor:

Kaess, Michael and Moggi, Franz

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1022-6877

Publisher:

Karger

Language:

English

Submitter:

Franz Moggi

Date Deposited:

01 Oct 2020 12:03

Last Modified:

29 Apr 2021 10:46

Publisher DOI:

10.1159/000508385

PubMed ID:

32634814

Uncontrolled Keywords:

Adolescents; Attention-deficit/hyperactivity disorder; Consensus statement; Substance use disorder

BORIS DOI:

10.7892/boris.146768

URI:

https://boris.unibe.ch/id/eprint/146768

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