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Özgen H, Spijkerman R, Noack M, Holtmann M, Schellekens ASA, van de Glind G, Banaschewski T, Barta C, Begeman A, Casas M, Crunelle CL, Daigre Blanco C, Dalsgaard S, Demetrovics Z, den Boer J, Dom G, Eapen V, Faraone SV, Franck J, González RA, Grau-López L, Groenman AP, Hemphälä M, Icick R, Johnson B, Kaess M, Kapitány-Fövény M, Kasinathan JG, Kaye SS, Kiefer F, Konstenius M, Levin FR, Luderer M, Martinotti G, Matthys FIA, Meszaros G, Moggi F, Munasur-Naidoo AP, Post M, Rabinovitz S, Ramos-Quiroga JA, Sala R, Shafi A, Slobodin O, Staal WG, Thomasius R, Truter I, van Kernebeek MW, Velez-Pastrana MC, Vollstädt-Klein S, Vorspan F, Young JT, Yule A, van den Brink W, Hendriks V. [International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder]. Z Kinder Jugendpsychiatr Psychother 2021; 50:54-67. [PMID: 34397296 DOI: 10.1024/1422-4917/a000828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Abstract. Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.
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Affiliation(s)
- Heval Özgen
- Diese Autor_innen haben zu gleichen Teilen zu diesem Beitrag beigetragen.,Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Den Haag, Niederlande.,Curium, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Niederlande
| | - Renske Spijkerman
- Diese Autor_innen haben zu gleichen Teilen zu diesem Beitrag beigetragen.,Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Den Haag, Niederlande
| | - Moritz Noack
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Hamm, Deutschland
| | - Martin Holtmann
- LWL-Universitätsklinik Hamm der Ruhr-Universität Bochum, Hamm, Deutschland
| | - Arnt S A Schellekens
- Department of Psychiatry, Donders institute, Radboud UMC, Nijmegen, Niederlande.,Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud UMC, Nijmegen, Niederlande
| | - Geurt van de Glind
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud UMC, Nijmegen, Niederlande.,International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, Nijmegen, Niederlande
| | - Tobias Banaschewski
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Zentralinstitut für Seelische Gesundheit, Mannheim, Deutschland
| | - Csaba Barta
- Department of Medical Chemistry, Molecular Biology and Pathobiochemistry, Semmelweis University, Budapest, Ungarn.,Institute of Psychology, Faculty of Humanities and Social Sciences, Pázmány Péter Catholic University, Budapest, Ungarn
| | | | - Miguel Casas
- Department of Psychiatry and Legal Medicine, Autonomous University of Barcelona, Barcelona, Spanien
| | - Cleo L Crunelle
- Department of Psychiatry, University Hospital Brussels, Brüssel, Belgien
| | - Constanza Daigre Blanco
- Department of Psychiatry, Mental Health and Addictions, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spanien.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spanien.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spanien
| | - Søren Dalsgaard
- Department of Economics and Business Economics, Aarhus University, Aarhus, Dänemark
| | - Zsolt Demetrovics
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Ungarn
| | | | - Geert Dom
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), Antwerp University (UA), Antwerpen, Belgien
| | - Valsamma Eapen
- Academic Unit of Infant, Child, Adolescent Psychiatry South West Sydney, University of New South Wales, Sydney, New South Wales, Australien
| | - Stephen V Faraone
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Johan Franck
- Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Schweden
| | - Rafael A González
- Centre for Mental Health, Division of Brain Sciences, Department of Medicine, Imperial College London, London, Vereinigtes Königreich.,East London NHS Foundation Trust, Child and Adolescent Mental Health Service (CAMHS) - ADHD clinic, London, Vereinigtes Königreich
| | - Lara Grau-López
- Department of Psychiatry, Mental Health and Addictions, Addiction and Dual Diagnosis Section, Hospital Universitari Vall d'Hebron, Barcelona, Spanien.,Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spanien.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spanien.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spanien
| | - Annabeth P Groenman
- Department of Psychology, University of Amsterdam, Amsterdam, Niederlande.,Department of Child and Adolescent Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, Niederlande
| | - Malin Hemphälä
- Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Schweden
| | - Romain Icick
- Assistance Publique-Hôpitaux de Paris (AP-HP), Groupe Hospitalier Saint-Louis - Lariboisière - Fernand Widal, Paris, Frankreich.,INSERM U1144, Paris, Frankreich.,Inserm UMR-S1144, Université de Paris, Paris, Frankreich
| | - Brian Johnson
- Department of Psychiatry, SUNY Upstate Medical University, Syracuse, New York, USA
| | - Michael Kaess
- Universitätsklinik für Kinder- und Jugendpsychiatrie und Psychotherapie, Universität Bern, Bern, Schweiz.,Klinik für Kinder- und Jugendpsychiatrie, Zentrum für psychosoziale Medizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland
| | - Máté Kapitány-Fövény
- Faculty of Health Sciences, Semmelweis University, Budapest, Ungarn.,Drug Outpatient Centre, Nyírő Gyula National Institute of Psychiatry and Addictions, Budapest, Ungarn
| | - John G Kasinathan
- Adolescent Mental Health, Justice Health and Forensic Mental Health Network, Sydney, New South Wales, Australien
| | - Sharlene S Kaye
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, New South Wales, Australien
| | - Falk Kiefer
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - Maija Konstenius
- Child- and Adolescent Department, Piteå Hospital, Region Norrbotten, Piteå, Schweden
| | - Frances R Levin
- Department of Psychiatry, Columbia University, New York State Psychiatric Institute, New York, New York, USA
| | - Mathias Luderer
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie, Universitätsklinikum Frankfurt, Goethe Universität, Frankfurt am Main, Deutschland
| | - Giovanni Martinotti
- Department of Neuroscience, Imaging, Clinical Sciences, University "G. d'Annunzio", Chieti-Pescara, Chieti, Italien
| | - Frieda I A Matthys
- Department of Psychiatry, UZ Brussel, Vrije Universiteit Brussel (VUB), Brüssel, Belgien
| | - Gergely Meszaros
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Ungarn
| | - Franz Moggi
- Universitätsklinik für Psychiatrie, Universität Bern, Bern, Schweiz
| | - Ashmita P Munasur-Naidoo
- Department of Pharmacy, Nelson Mandela University, Port Elizabeth, Südafrika.,Cipla Medpro Pharmaceuticals, Durban, Südafrika
| | - Marianne Post
- Brijder Youth Addiction Treatment, Parnassia Psychiatric Institute, Den Haag, Niederlande
| | - Sharon Rabinovitz
- School of Criminology and The Unit for Excellence in Research & Study of Addiction (ERSA), The Center for Rehabilitation Research, University of Haifa, Haifa, Israel
| | - J Antoni Ramos-Quiroga
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Spanien.,Biomedical Network Research Centre on Mental Health (CIBERSAM), Barcelona, Spanien.,Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, Barcelona, Spanien.,Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Spanien
| | - Regina Sala
- Centre for Psychiatry, Wolfson Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London, London, Vereinigtes Königreich
| | - Abu Shafi
- East London NHS Foundation Trust, London, Vereinigtes Königreich
| | - Ortal Slobodin
- Department of Education, Ben-Gurion University, Beer-Sheva, Beer-Sheva, Israel
| | - Wouter G Staal
- Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Niederlande.,Karakter Child and Adolescent Psychiatry University Centre, Nijmegen, Niederlande
| | - Rainer Thomasius
- Deutsches Zentrum für Suchtfragen des Kindes- und Jugendalters, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Ilse Truter
- Drug Utilization Research Unit (DURU), Department of Pharmacy, Nelson Mandela University, Port Elizabeth, Südafrika
| | - Michiel W van Kernebeek
- Department of Psychiatry, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brüssel, Belgien
| | | | - Sabine Vollstädt-Klein
- Klinik für Abhängiges Verhalten und Suchtmedizin, Zentralinstitut für seelische Gesundheit, Mannheim, Deutschland
| | - Florence Vorspan
- INSERM U1144, Paris, Frankreich.,Département de Psychiatrie et de Médecine Addictologique, Hôpital Fernand Widal, Paris, Frankreich.,Faculté de Médecine, Université de Paris, Paris, Frankreich.,FHU NOR-SUD Network of Research in Substance Use Disorders, Paris, Frankreich
| | - Jesse T Young
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australien.,Murdoch Children's Research Institute, Melbourne, Victoria, Australien.,School of Population and Global Health, The University of Western Australia, Perth, Washington, Australien.,National Drug Research Institute, Curtin University, Perth, Washington, Australien
| | - Amy Yule
- Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Wim van den Brink
- International Collaboration on ADHD and Substance Abuse (ICASA) Foundation, Nijmegen, Niederlande.,Amsterdam University Medical Centers, location Academic Medical Center, Amsterdam, Niederlande
| | - Vincent Hendriks
- Parnassia Addiction Research Centre (PARC), Parnassia Psychiatric Institute, Den Haag, Niederlande.,Curium, Department of Child and Adolescent Psychiatry, Leiden University Medical Center, Leiden, Niederlande
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