SAN FRANCISCO, April 25 -- Given the high prevalence of substance abuse in patients with attention deficit hyperactivity disorder (ADHD), psychiatrists need to consider comorbidity in assessment of both conditions. Despite concerns over the role that stimulant drug treatment has in increasing the risk for substance abuse disorders among individuals with ADHD, treating early seems to serve a protective role, said Scott H. Kollins, Ph.D., of Duke University.
He presented clinical recommendations for assessing and treating such patients at the U.S. Psychiatric & Mental Health Congress regional extension meeting here.
In assessment of ADHD, Dr. Kollins suggested collecting a detailed substance abuse history, particularly for high-risk patients -- adolescents, those with a family history of substance abuse, and those with comorbid conduct disorder or antisocial personality disorder. Collection of detailed information about ADHD in childhood, using objective data sources when possible, is critical though challenging, he said.
In assessment of substance abuse, consider how withdrawal will affect existing ADHD symptoms and that "co-occurring ADHD can interfere with most treatment programs," he suggested.
When considering whether to attack the substance abuse or the ADHD first, the answer is almost always that substance abuse poses the most immediate risk to the patient but concurrent treatment is possible, Dr. Kollins said.