Treating Comorbid ADHD and Substance Use Disorder: From Screening to Pharmacotherapy

Abstract

After completing this activity, participants should be able to: Apply a two-step approach to ADHD case finding in adults entering addiction treatment, using a validated screener such as the ASRS Part A followed by a clinical assessment that leans on childhood and drug-free-period history rather than a current symptom picture confounded by intoxication or withdrawal. Explain why it is reasonable to begin ADHD treatment in parallel with addiction treatment rather than waiting for abstinence, and describe realistic expectations for what ADHD pharmacotherapy may and may not do for substance use outcomes. Select and adjust ADHD pharmacotherapy in patients with substance use disorders, weighing long-acting stimulants against non-stimulants, distinguishing undertreatment from tolerance or misuse when a patient asks for a higher dose, and identifying the limited circumstances that warrant stopping treatment.