Pharmacological treatment of attention deficit hyperactivity disorder with co-morbid drug dependence

• Published in: Journal of psychopharmacology (Oxford) Vol. 29; no. 1; p. 15
• Main Authors: Cunill, R, Castells, X, Tobias, A, Capellà, D
• Format: Journal Article
• Language: English
• Published: United States 01.01.2015
• Subjects: Attention Deficit Disorder with Hyperactivity - complications; Attention Deficit Disorder with Hyperactivity - drug therapy; Central Nervous System Stimulants - therapeutic use; Diagnosis, Dual (Psychiatry); Humans; Substance-Related Disorders - complications; Treatment Outcome; meta-analysis; substance use disorder; Attention deficit hyperactivity disorder; safety; efficacy
• DOI: 10.1177/0269881114544777

Drug dependence is frequent in patients with attention deficit hyperactivity disorder (ADHD). Nevertheless, the efficacy and safety of pharmacological treatments in this population are unclear. A systematic review with meta-analysis was performed. Randomised placebo-controlled clinical trials investigating the efficacy of pharmacological treatment in patients with co-occurring ADHD and substance use disorder (SUD) were included. ADHD symptom severity, drug abstinence and all-cause treatment discontinuation were the primary study endpoints. The effects of patient-, intervention- and study-related covariates over the primary outcomes were investigated by means of meta-regression. Thirteen studies were included, enrolling a total of 1,271 patients. A small to moderate reduction of ADHD symptoms was found. Meta-regression analysis identified the presence of a lead-in period as a covariate associated with reduced efficacy. Conversely, no beneficial effect was observed either on drug abstinence or treatment discontinuation. The efficacy on ADHD symptoms was smaller in studies with a lead-in period. A positive correlation between the efficacy for ADHD and that for SUD was found. The efficacy of pharmacological interventions for co-occurring ADHD and SUD has been little investigated. Mixed results were obtained: while pharmacological interventions improved ADHD symptoms, no beneficial effect on drug abstinence or on treatment discontinuation was noted. The strength of the recommendation of pharmacological treatment for co-occurring ADHD and SUD is therefore modest. The study was registered with the international prospective register of systematic reviews (PROSPERO): CRD 4212003414.