CPG on ADHD

7.5.5. In children and adolescents with ADHD: What must be donewith comorbid substance abuse?The answer is based on the reviews by Kollins (2008) 340 , Upadhyaya (2007) 341 and Wilens, et al.(2003, 2005) 317,318 .Scientific evidenceKollins (2008) 340 indicates that the abuse and inadequate use of the prescriptionof stimulants are especially concerning when treating adolescents and children.Short-term stimulants may have a greater potential for abuse or inadequate use,although more data are required to confirm this observation.Experts’opinion 4Treatment with non-stimulant drugs may be considered for ADHD in patientswith a high risk of substance abuse or improper use of stimulants.The review by Upadhyaya (2007) 341 indicates that patients with ADHD andsubstance use disorder start to use substances at a younger age, they may takelonger to reach remission, they have a longer course, worse results and higherrates of other psychiatric comorbidities.There is scientific evidence of the incorrect use of stimulant medication, whichsuggests safety concerns.The pharmacological treatment studies for ADHDcomorbid to substance abuse are limited, but they have shown that stimulantmedication does not favour the use of substances.Narrativereview 3Non-stimulant medication for ADHD and long-term stimulant formulas areavailable and using them incorrectly is less likely.According to these authors, the clinical recommendations to treat this dualdiagnosis include the use of non-stimulants or long-term formulas combinedwith psychosocial therapy to treat ADHD and substance use disorder.Wilens, et al. (2005) 317 performed a MA to assess the role of medication to treatADHD in individuals with ADHD and substance abuse.9 studies were included (4 of adolescents and 5 of adults, n = 222).The authors’ conclusions suggest that the pharmacological treatment (stimulantor non-stimulant) in ADHD comorbid to substance use has a moderate impacton the result of both disorders.This improvement has not been observed incontrolled tests with placebo.From the safety perspective, there is no scientific evidence of a worsening ofthe substance use or adverse interactions with the drug.Wilens, et al. (2003) 318 performed a MA with 6 long-term studies (prospectiveand retroprospective) that assessed children with ADHD (n = 1034) treated withand without medication to evaluate the results of substance use in adolescentsor adults.These authors’ conclusion suggests that stimulant therapy in childhood isassociated with the reduction of the risk of disorders caused by the abuse ofsubstances, alcohol and cigarettes, and that it has a greater protective effect(Wilens, 2008) 342 .MA ofopen-endedstudies andRCT 1+, 1++MA of cohortstudies 2++150 CLINICAL PRACTICE GUIDELINE ON ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) IN CHILDREN AND ADOLESCENTS