Fluyau Dimy, Revadigar Neelambika, Pierre Christopher G
Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, Georgia.
Psychiatry and Behavioral Sciences, Columbia University, New York, New York.
Am J Addict. 2021 Mar;30(2):110-121. doi: 10.1111/ajad.13133. Epub 2020 Dec 8.
Treating substance use disorder (SUD) in patients with co-occurring attention deficit hyperactivity disorder (ADHD) and SUD may lower medical, psychiatric, and social complications. We conducted a systematic review with meta-analysis to investigate the clinical benefits of pharmacological interventions to treat SUD in patients with ADHD.
Articles were searched on Cochrane Central Register of Controlled Trials, PubMed, EBSCO, Google Scholar, Embase, Web of Science, and Ovid MEDLINE from 1971 to 2020. Data for SUD treatment as primary study endpoints and ADHD symptoms management as secondary outcomes were synthesized using random-effects model meta-analysis. Studies (N = 17) were included. The principal measure of effect size was the standardized mean difference (SMD). PROSPERO registration: CRD42020171646.
The pooled effect of pharmacological interventions compared with placebo was small for the reduction in substance use (SMD = 0.405, 95% confidence interval [CI]: [0.252, 0.557], P < .001), abstinence (SMD = 0.328, 95% CI: [0.149, 0.507], P < .001), craving (SMD = 0.274, 95% CI: [0.103, 0.446], P = .002), and the 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).
The magnitude of benefits for pharmacological interventions varies. Despite some limitations, it was positive. This meta-analysis is the first to appraise the benefits of medications to treat SUD in ADHD. It is the groundwork for treatment and risk mitigation. (Am J Addict 2020;00:00-00).
治疗同时患有注意力缺陷多动障碍（ADHD）和物质使用障碍（SUD）的患者，可能会降低医疗、精神和社会方面的并发症。我们进行了一项系统评价和荟萃分析，以研究药物干预治疗ADHD患者SUD的临床益处。
在Cochrane对照试验中央注册库、PubMed、EBSCO、谷歌学术、Embase、科学网和Ovid MEDLINE上检索1971年至2020年的文章。以SUD治疗作为主要研究终点，ADHD症状管理作为次要结果的数据，采用随机效应模型荟萃分析进行综合。纳入了17项研究。效应大小的主要测量指标是标准化均值差（SMD）。PROSPERO注册号：CRD42020171646。
与安慰剂相比，药物干预在减少物质使用（SMD = 0.405，95%置信区间[CI]：[0.252, 0.557]，P <.001）、戒断（SMD = 0.328，95% CI：[0.149, 0.507]，P <.001）、渴望（SMD = 0.274，95% CI：[0.103, 0.446]，P =.002）以及减少ADHD症状频率（SMD = 0.420，95% CI：[0.259, 0.582]，P <.001）方面的合并效应较小。在管理戒断症状（SMD = 0.577，95% CI：[0.389, 0.764]，P =.001）和降低ADHD症状严重程度（SMD = 0.533，95% CI：[0.393, 0.672]，P <.001）方面，合并效应为中等。
药物干预的益处程度各不相同。尽管存在一些局限性，但结果是积极的。这项荟萃分析首次评估了药物治疗ADHD患者SUD的益处。它是治疗和降低风险的基础。（《美国成瘾杂志》2020年；00：00 - 00）
