Teens with ADHD Should Be Regularly Screened for Substance Use Disorder: International Consensus Reached

July 17, 2020

Substance use disorder (SUD) is more common in adolescents and young adults with attention deficit hyperactivity disorder (ADHD or ADD), according to research that also found earlier use of alcohol and drugs among teens with ADHD than among their neurotypical peers.¹ “Early onset SUD increases the likelihood of academic failure, suicidal behavior, and incarceration,” yet scant conclusive research exists on whether effective ADHD treatment helps to prevent adolescent SUD. This lack of sufficient data to justify treatment recommendations led researchers to recently craft an international consensus statement for diagnosing and treating adolescents with comorbid ADHD and SUD.

Published in the European Research Addiction Journal,² this consensus comprises 36 statements, including the following:

1. Routine ADHD screenings should be conducted for adolescent patients undergoing treatment for substance abuse. Likewise, teens with ADHD should be screened for SUD in mental healthcare settings with privacy prioritized.
2. Long-acting stimulants should be the first-line treatment of ADHD in adolescents with comorbid SUD, and pharmacotherapy should be preferably combined with psychosocial treatment.
3. In adolescents with ADHD and SUD, no studies have been conducted that provide convincing evidence for a beneficial effect of dietary interventions, computerized cognitive training programs for ADHD, neurofeedback for ADHD, mindful meditation, physical exercise, or “traditional and/or herbal medicine.” Therefore, these alternative treatments are not recommended.

The only point on which was consensus was not reached was regarding whether adolescent patients should abstain from all substance use for some period of time 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.

Using a modified Delphi process, researchers reviewed existing literature to draft 37 statements, which were rated by 55 experts on a scale of 1-5 (strongly disagree – strongly agree). Consensus was defined a priori as at least 95% of all the ratings being greater than or equal to 3 (strongly agree, agree, and neutral).

Consensus was easily reached in the first round for 64% of the statements and – after adaptations of the original statements – this percentage mounted to 92% in the second and 97% in the third round, ending with consensus on 36 of 37 statements. The 37 statements can be viewed in Table 1 of the full study.

Clinicians, patients, and caregivers can use this set of consensus statements to aid the decision making process when choosing the most appropriate treatments for adolescents with ADHD and SUD. Researchers caution that these findings should not replace more high-quality studies, such as RCTs and long-term naturalistic follow-up studies.

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