Spijkerman R, Crunelle C L, Özgen M H, Begeman A H A, Dom G, van de Glind G, Groenman A P, van Kernebeek M W, Matthys F, Post M, Schellekens A, Staal W, van den Brink W, Hendriks V M
Tijdschr Psychiatr. 2021;63(12):868-874.
Substance use disorder (SUD) is common among youths with attention-deficit/hyperactivity disorder (ADHD). Co-morbid ADHD and SUD in youths complicates screening, diagnosis, and treatment of both disorders and is associated with worse treatment prognosis. Limited research in youths with SUD and co-morbid ADHD provides insufficient basis for firm recommendations. To offer clinicians some guidance on this topic, we present the results of an international consensus procedure.
To summarize an international consensus on diagnosis and treatment of young people with comorbid ADHD and SUD.
In a modified Delphi-study, a multidisciplinary, international group of 55 experts strived to reach consensus on 37 recommendations.
Consensus was reached on 36 recommendations. Routine screening of ADHD and/or SUD is important. For the treatment of co-morbid SUD and ADHD in youths, both psychosocial and pharmacological treatment should be considered. Psychosocial treatment should preferably consist of psychoeducation, motivational interviewing (MI), and cognitive behavioral therapy (CBT) focused on SUD or both disorders. Long-acting stimulants are recommended as first choice pharmacotherapy, preferably embedded in psychosocial treatment. Experts did not agree on the precondition that patients need to be abstinent before starting stimulant treatment.
Clinicians and youths with co-morbid SUD and ADHD can use this international consensus to choose the best possible treatment.
物质使用障碍（SUD）在患有注意力缺陷多动障碍（ADHD）的青少年中很常见。青少年中ADHD与SUD共病会使这两种疾病的筛查、诊断和治疗变得复杂，并且与更差的治疗预后相关。对患有SUD和共病ADHD的青少年的研究有限，无法为明确的建议提供充分依据。为了给临床医生提供关于这个主题的一些指导，我们展示了一项国际共识程序的结果。
总结关于共病ADHD和SUD的青少年诊断和治疗的国际共识。
在一项改良的德尔菲研究中，一个由55名专家组成的多学科国际小组努力就37项建议达成共识。
就36项建议达成了共识。对ADHD和/或SUD进行常规筛查很重要。对于青少年共病SUD和ADHD的治疗，应同时考虑心理社会治疗和药物治疗。心理社会治疗最好包括心理教育、动机性访谈（MI）以及针对SUD或两种疾病的认知行为疗法（CBT）。推荐长效兴奋剂作为首选药物治疗，最好将其纳入心理社会治疗中。专家们对于患者在开始兴奋剂治疗前需要戒除物质这一前提条件未达成一致意见。
患有共病SUD和ADHD的临床医生和青少年可以利用这一国际共识来选择最佳治疗方案。
