dual-diagnosis patients

A narrative systematic review (Özgen et al., 2021) investigated the treatment options of adolescents with attention-deficit/hyperactivity disorder (ADHD) and comorbid substance use disorders (SUD) and overall found that there is very limited evidence of treatments for this comorbidity and does not allow for strong recommendations. Specifically:

• pharmacological treatment - none of the trials in this comorbid adolescent population showed a robust between-group effect of treatment on either ADHD or SUD
• psychosocial treatment - no randomized trials or meta-analyses have been conducted to date in youth with concurrent ADHD and SUD

Psychotherapy interventions (individual (CBT, IPSRT, family focused therapy) and group interventions) were found in a systematic review (Crowe et al., 2021, 7 studies) to have no conclusive effects in:

• improving mental health and treatment outcomes (i.e. improving mood outcomes and reducing use)

Contingency management in psychotic patients with Substance Use Disorders (SUD) was found in a systematic review with meta analysis (Destoop et al., 2021) to be effective compared to standard care in:

• Improving abstinence rates of drug use, measured by:
  • self-reported lower number of days using substance (SMD = −0.52, 95% CI −0.98 to −0.06; p = 0.03
  • tendency to more negative breath or urine samples for substance use (OR 2.13, 95% CI 0.97 to 4.69; p = 0.06)

However no differences among retention in treatment (RR 1.15, 95% CI 0.90 to 1.45; p = 0.26).

Technology-based (web or computer) motivational and psycho-education interventions and cognitive enhancement therapy were found in a systematic review without meta-analysis (Tatar et al, 2020, 8 studies) to have no significant effect in:

• reducing cannabis use, abstinence or dependence severity in patients with psychosis

Computer-based interventions (CBIs) were found in a narrative systematic review (Dudgale et al., 2020, N = 14 279) to be effective in:

• improving substance misuse and mental health outcomes for those completing CBIs from baseline to postintervention and to follow-up at 6 months

Mood stabilizers (namely anticonvulsants) were found in a systematic review (Coles et al., 2019) to have promising but not conclusive effects in:

• improving treatment outcomes (reducing use and improving mood outcomes)

Dialectical behavioural therapy was found in a comprehensive review (EMCDDA 2015) to be effective in:

• reducing both eating disorders and substance use disorders

Psychosocial treatments (delivered alone or in combination with pharmacotherapy) were analysed in a systematic review (Hides et al., 2020) that found no significant effect compared with no treatment or treatment as usual in:

• the treatment of comorbid depression and substance use disorders.

 Although some significant effects were found between different phychotherapies, these were inconsistent and small and the evidence of poor quality.

A comprehensive review (EMCDDA 2015) found that:

• there is no evidence that any pharmacotherapy is particularly beneficial in the comorbidity of personality disorders with substance use disorders

The current literature on pharmacological interventions of SUD in ADHD patients involves norepinephrine, dopamine, and nicotinic acetylcholine receptors as prime neurotransmitters. The same neurotransmitters are addressed purposefully at stabilizing ADHD symptoms. The mindset is that medications that manage ADHD symptoms should also help to decrease the risk of developing SUD.

Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) was found in a systematic review with meta-analysis (Fluyau et al., 2020, 17 studies, N = 2155) to have small but positive pooled effect compared to placebo in:

• reducing in substance use (SMD = 0.405, 95% confidence interval [CI]: [0.252, 0.557], P < .001),
• progression toward abstinence (SMD = 0.328, 95% CI: [0.149, 0.507], P < .001),
• reducing craving (SMD = 0.274, 95% CI: [0.103, 0.446], P = .002),
• decrease in the severity of ADHD symptoms (SMD = 0.533, 95% CI: [0.393, 0.672], P < .001),
• reduction in the frequency of ADHD symptoms (SMD = 0.420, 95% CI: [0.259, 0.582], P < .001).

The pooled effect was moderate for the management of withdrawal symptoms (SMD = 0.577, 95% CI: [0.389, 0.764], P = .001]) and the decrease in the severity of ADHD symptoms (SMD = 0.533, 95% CI: [0.393, 0.672], P < .001).

There were differences among different substances (tobacco, cocaine, amphetamine or cannabis) in the different outcomes when considered individually and not pooled together.