Attention deficit hyperactivity disorder and comorbid substance abuse

This chapter reviews the relationship between adolescent attention deficit/hyperactivity disorder and substance use disorders and discusses issues related to their identification and clinical management in primary care settings. Data were selected from articles published from 1990 to 2009 using the search terms attention deficit hyperactivity disorder, substance abuse, and adolescents. The cited publications include both reviews of the literature as well as original data articles published in English. Existing epidemiological evidence strongly suggests that adolescent attention deficit/hyperactivity disorder (ADHD) and substance use disorders (SUD) are disorders that co-occur at rates higher than would be expected if these disorders were independent. Clinicians in primary care diagnose and manage the majority of adolescents with comorbid ADHD/SUD. As the identification of emerging SUD in the context of existing ADHD could be challenging, diagnostic guidelines, practice parameters, and screening instruments have been develop to assist primary care clinicians in diagnosing SUD in youth with ADHD. In addition, the development of a variety of effective treatments for ADHD including FDA approved stimulant and non-stimulant agents as well as off-label agents constitute the basis for an expanding treatment armamentarium that offers safe and efficacious options for the management of patients with comorbid ADHD/SUD and may minimize the risk for addiction relapse.