TY - JOUR
T1 - International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder
AU - Özgen, Heval
AU - Spijkerman, Renske
AU - Noack, Moritz
AU - Holtmann, Martin
AU - Schellekens, Arnt S A
AU - van de Glind, Geurt
AU - Banaschewski, Tobias
AU - Barta, Csaba
AU - Begeman, Alex
AU - Casas, Miguel
AU - Crunelle, Cleo L
AU - Daigre Blanco, Constanza
AU - Dalsgaard, Søren
AU - Demetrovics, Zsolt
AU - den Boer, Jacomine
AU - Dom, Geert
AU - Eapen, Valsamma
AU - Faraone, Stephen V
AU - Franck, Johan
AU - González, Rafael A
AU - Grau-López, Lara
AU - Groenman, Annabeth P
AU - Hemphälä, Malin
AU - Icick, Romain
AU - Johnson, Brian
AU - Kaess, Michael
AU - Kapitány-Fövény, Máté
AU - Kasinathan, John G
AU - Kaye, Sharlene S
AU - Kiefer, Falk
AU - Konstenius, Maija
AU - Levin, Frances R
AU - Luderer, Mathias
AU - Martinotti, Giovanni
AU - Matthys, Frieda I A
AU - Meszaros, Gergely
AU - Moggi, Franz
AU - Munasur-Naidoo, Ashmita P
AU - Post, Marianne
AU - Rabinovitz, Sharon
AU - Ramos-Quiroga, J Antoni
AU - Sala, Regina
AU - Shafi, Abu
AU - Slobodin, Ortal
AU - Staal, Wouter G
AU - Thomasius, Rainer
AU - Truter, Ilse
AU - van Kernebeek, Michiel W
AU - Velez-Pastrana, Maria C
AU - Vollstädt-Klein, Sabine
AU - Vorspan, Florence
AU - Young, Jesse T
AU - Yule, Amy
AU - van den Brink, Wim
AU - Hendriks, Vincent
N1 - © 2020 S. Karger AG, Basel.
PY - 2020/8/1
Y1 - 2020/8/1
N2 - BACKGROUND: 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.OBJECTIVE: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience.METHOD: 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.RESULTS: 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.CONCLUSION: 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.
AB - BACKGROUND: 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.OBJECTIVE: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience.METHOD: 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.RESULTS: 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.CONCLUSION: 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.
UR - http://www.scopus.com/inward/record.url?scp=85089204278&partnerID=8YFLogxK
U2 - 10.1159/000508385
DO - 10.1159/000508385
M3 - Article
C2 - 32634814
VL - 26
SP - 223
EP - 232
JO - European Addiction Research
JF - European Addiction Research
SN - 1022-6877
IS - 4-5
ER -