International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder.
Journal: European addiction research
Volume: 26
Issue: 4-5
Year of Publication: 2021
Affiliated Institutions:
Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, The Hague, The Netherlands, m.h.ozgen@parnassiagroep.nl.
Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, The Hague, The Netherlands.
Department of Child and Adolescent Psychiatry, LWL-University Hospital, Ruhr-University Bochum, Hamm, Germany.
Department of Psychiatry, Donders institute, RadboudUMC, Nijmegen, The Netherlands.
Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), RadboudUMC, Nijmegen, The Netherlands.
Department of Child and Adolescent Psychiatry, Central Institute of Mental Health Mannheim (CIMH), Heidelberg University, Mannheim, Germany.
Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Hungary.
De Hoop GGZ, Dordrecht, The Netherlands.
Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spain.
Department of Psychiatry, University Hospital Brussels, Brussels, Belgium.
Department of Psychiatry, Mental Health and Addictions, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark.
Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary.
Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerp, Belgium.
Academic Unit of Infant, Child, Adolescent Psychiatry South West Sydney, University of New South Wales, Sydney, New South Wales, Australia.
Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA.
Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Sweden.
Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, London, United Kingdom.
Department of Psychology, University of Amsterdam, Amsterdam, The Netherlands.
Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, France.
University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.
Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australia.
National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australia.
Department of Addictive Behaviour and Addiction Medicine, Central Institute of Mental Health, Mannheim, Germany.
Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York, USA.
Department of Psychiatry, Psychosomatic Medicine and Psychotherapy, University Hospital, Goethe University, Frankfurt, Germany.
Department of Neuroscience, Imaging, Clinical Sciences, University "G.d'Annunzio", Chieti-Pescara, Chieti, Italy.
Department of Psychiatry, UZ Brussel, Vrije Universiteit Brussel (VUB), Brussels, Belgium.
Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary.
University Hospital of Psychiatry, University of Bern, Bern, Switzerland.
Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa.
Brijder Youth Addiction Treatment, Parnassia Psychiatric Institute, The Hague, The Netherlands.
School of Criminology and The Unit for Excellence in Research & Study of Addiction (ERSA), The Center for Rehabilitation Research, University of Haifa, Haifa, Israel.
Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spain.
Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, United Kingdom.
East London NHS Foundation Trust, London, United Kingdom.
Department of Education, Ben-Gurion University, Beer-Sheva, Beer-Sheva, Israel.
Department of Psychiatry, Radboud University Medical Centre, Nijmegen, The Netherlands.
German Centre for Addiction Research in Childhood and Adolescence, University Medical Centre Hamburg-Eppendorf, Hamburg, Germany.
Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, South Africa.
Department of Psychiatry, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium.
PhD Program in Clinical Psychology, Universidad Carlos Albizu, San Juan, Puerto Rico.
INSERM U, Paris, France.
Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia.
Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA.
International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, Nijmegen, The Netherlands.
Abstract summary
Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations.The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience.A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD.After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence 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.This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.
Authors & Co-authors:
Özgen Heval H
Spijkerman Renske R
Noack Moritz M
Holtmann Martin M
Schellekens Arnt S A ASA
van de Glind Geurt G
Banaschewski Tobias T
Barta Csaba C
Begeman Alex A
Casas Miguel M
Crunelle Cleo L CL
Daigre Blanco Constanza C
Dalsgaard Søren S
Demetrovics Zsolt Z
den Boer Jacomine J
Dom Geert G
Eapen Valsamma V
Faraone Stephen V SV
Franck Johan J
González Rafael A RA
Grau-López Lara L
Groenman Annabeth P AP
Hemphälä Malin M
Icick Romain R
Johnson Brian B
Kaess Michael M
Kapitány-Fövény Máté M
Kasinathan John G JG
Kaye Sharlene S SS
Kiefer Falk F
Konstenius Maija M
Levin Frances R FR
Luderer Mathias M
Martinotti Giovanni G
Matthys Frieda I A FIA
Meszaros Gergely G
Moggi Franz F
Munasur-Naidoo Ashmita P AP
Post Marianne M
Rabinovitz Sharon S
Ramos-Quiroga J Antoni JA
Sala Regina R
Shafi Abu A
Slobodin Ortal O
Staal Wouter G WG
Thomasius Rainer R
Truter Ilse I
van Kernebeek Michiel W MW
Velez-Pastrana Maria C MC
Vollstädt-Klein Sabine S
Vorspan Florence F
Young Jesse T JT
Yule Amy A
van den Brink Wim W
Hendriks Vincent V
Study Outcome
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