Pharmacological treatment of attention deficit hyperactivity disorder with co-morbid drug dependence. (January 2015)

• Record Type: Journal Article
• Authors: Cunill, R; Castells, X; Tobias, A; Capellà, D
• Is Part Of: Journal of psychopharmacology. Volume 29:Number 1(2015:Jan.)
• Page Start: 15
• Page End: 23
• Publication Date: 2015-01
• Subjects: Attention deficit hyperactivity disorder -- substance use disorder -- meta-analysis -- efficacy -- safety; Psychopharmacology -- Periodicals; 615.78
• DOI: 10.1177/0269881114544777
• Languages: English
• ISSNs: 0269-8811

Abstract

Background: Drug dependence is frequent in patients with attention deficit hyperactivity disorder (ADHD). Nevertheless, the efficacy and safety of pharmacological treatments in this population are unclear. Methods: A systematic review with meta-analysis was performed. Randomised placebo-controlled clinical trials investigating the efficacy of pharmacological treatment in patients with co-occurring ADHD and substance use disorder (SUD) were included. ADHD symptom severity, drug abstinence and all-cause treatment discontinuation were the primary study endpoints. The effects of patient-, intervention- and study-related covariates over the primary outcomes were investigated by means of meta-regression. Results: Thirteen studies were included, enrolling a total of 1, 271 patients. A small to moderate reduction of ADHD symptoms was found. Meta-regression analysis identified the presence of a lead-in period as a covariate associated with reduced efficacy. Conversely, no beneficial effect was observed either on drug abstinence or treatment discontinuation. The efficacy on ADHD symptoms was smaller in studies with a lead-in period. A positive correlation between the efficacy for ADHD and that for SUD was found. Conclusions: The efficacy of pharmacological interventions for co-occurring ADHD and SUD has been little investigated. Mixed results were obtained: while pharmacological interventions improved ADHD symptoms, no beneficial effect on drug abstinence or on treatment discontinuation was noted. The strength of the recommendation of pharmacological treatment for co-occurring ADHD and SUD is therefore modest. The study was registered with the international prospective register of systematic reviews (PROSPERO): CRD 4212003414.