Clinical practice gaps, uncertainties and need for guidance
People with ADHD who have co-occurring substance use disorders are an important subgroup requiring individual consideration. It is well established that ADHD is a risk factor for the development of substance use disorders and, conversely, that people presenting with substance use disorders have an increased risk of having ADHD, as noted in section 1.2 of the guideline (Groenman et al., 2013; van Emmerik-van Oortmerssen et al., 2012)(see also (Faraone et al., 2021; Ozgen et al., 2020).
Considerable debate exists internationally regarding the diagnosis and treatment of substance use disorders in individuals with ADHD and vice versa (Ozgen et al., 2020; Young, Bellgrove, & Arunogiri, 2021). Legitimate concerns exist regarding the diversion or misuse potential of stimulant medications in those with ADHD and substance use disorders. Although the GDG acknowledged that available evidence is insufficient to permit robust treatment recommendations in this group, it also recognised that guidance is warranted given the significant morbidity associated with people with substance use disorders.
Given the lack of strong empirical evidence, the International Collaboration on ADHD and Substance Abuse (ICASA) developed a consensus statement for the screening, diagnosis and treatment of ADHD and SUD (Ozgen et al., 2020). This statement comprised 37 statements, with the consensus reached for 36 of these.
This narrative review and the accompanying recommendations refer closely to this consensus statement, in combination with other available evidence.