Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use

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Publicated to:Adicciones. 34 (2): 168-178 - 2022-01-01 34(2), DOI: 10.20882/adicciones.1569

Authors: Cunill, Ruth; Castells, Xavier; Gonzalez-Pinto, Ana; Arrojo, Manuel; Bernardo, Miquel; Saiz, Pilar A; Florez, Gerardo; Torrens, Marta; Tirado-Munoz, Judit; Fonseca, Francia; Arranz, Belen; Garriga, Marina; Manuel Goikolea, Jose; Zorrilla, Inaki; Becona, Elisardo; Lopez, Ana; San, Luis

Affiliations

Addiction Research Group, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, Barcelona, Spain - Author

CIBERSAM, Parc Sanitari St Joan de Deu, Barcelona, Spain - Author

Complejo Hosp Ourense, Unidad Conductas Adict, CIBERSAM, Orense, Spain - Author

EOXI Santiago Compostela, Serv Psiquiatria, Santiago De Compostela, Spain - Author

Grupo de investigación TransLab, Departamento de Ciencias Médicas, Universitat de Girona, Spain - Author

Hospital Clinic, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERSAM, Barcelona, Spain - Author

IMIM Inst Hosp del Mar Invest Med, Addict Res Grp, Barcelona, Spain - Author

Inst Invest Biomed August Pi i Sunyer IDIBAPS, CIBERSAM, Hosp Clin, Barcelona, Spain - Author

Institut de Neuropsiquiatria i Adiccions (INAD)-Parc de Salut Mar, RTA, Barcelona, Spain - Author

Instituto de Investigación Sanitaria BIOARABA, OSI Araba, Hospital Universitario, CIBERSAM, UPV/EHU, Vitoria, Spain - Author

Parc Salut Mar, RTA, Inst Neuropsiquiatria & Adicc INAD, Barcelona, Spain - Author

Parc Sanitari Sant Joan de Deu, CIBERSAM, Barcelona, Spain - Author

Servicio de Psiquiatría, EOXI de Santiago de Compostela, Spain - Author

Unidad de Conductas Adictivas, Complejo Hospitalario de Ourense, CIBERSAM, Ourense, Spain - Author

Unidad de Tabaquismo y Trastornos Adictivos, Facultad de Psicología, Universidad de Santiago de Compostela, Santiago de Compostela, Spain - Author

Univ Basque Country, CIBERSAM, Hosp Univ, Inst Invest Sanitaria BIOARABA,OSI Araba, Vitoria, Spain - Author

Univ Girona, Dept Ciencias Med, Grp Invest TransLab, Girona, Spain - Author

Univ Oviedo, CIBERSAM, Inst Invest Sanitaria Principado Asturias ISPA, Serv Salud Principado Asturias SESPA, Oviedo, Spain - Author

Univ Santiago de Compostela, Unidad Tabaquismo & Trastornos Adict, Fac Psicol, Santiago De Compostela, Spain - Author

Universidad de Oviedo, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain - Author

Abstract

Substantial evidence has confirmed the high comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and a substance use disorder (SUD). This review synthesizes the pharmacological and psychosocial interventions conducted in ADHD and SUDs, and provides clinical recommendations using the GRADE approach. Our results suggest: 1) In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms (weak recommendation) and alcohol craving (weak recommendation). 2) In patients with ADHD and cannabis use disorder, atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to reduce cannabis use (weak recommendation). 3) In patients with ADHD and cocaine use disorder, methylphenidate is not recommended to improve ADHD symptoms or to reduce cocaine use (weak recommendation). 4) In patients with ADHD and comorbid nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms (weak recommendation). Psychoestimulants, such as methylphenidate or lisdexamfetamine dimesylate, are not recommended to reduce nicotine use (weak recommendation). 5) Regarding patients with ADHD and any SUD, the use of psychostimulants is recommended to improve ADHD symptoms (weak recommendation), not to reduce substance use (weak recommendation) or to improve retention to treatment (strong recommendation). In these patients, the use of atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to decrease substance use (weak recommendation) or to improve retention to treatment (strong recommendation). Atomoxetine and psychostimulants appear to be safe in patients with any SUD (strong recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite and conclusive evidence. © 2022, Edita Socidrogalcohol. All rights reserved.

Keywords

AbuseAdhdAdultAlcoholAtomoxetineAtomoxetine hydrochlorideAttention deficit disorder with hyperactivityAttention deficit hyperactivity disorderAttention-deficit/hyperactivity disorderCannabisCentral nervous system stimulantsCentral stimulant agentCocaineComorbidityComplicationDeficit/hyperactivity disorderDouble-blindDrug dependenceHumanHumansLisdexamfetamine dimesylateMeta-regressionMetaanalysisMethylphenidateNicotinePlacebo-controlled trialPsychostimulantsSmokingSubstance useSubstance-related disorders

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Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal Adicciones due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine (Miscellaneous).

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 2.08, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions May 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-05-21, the following number of citations:

WoS: 4
Scopus: 5
OpenCitations: 4

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