Ruth Cunill, Xavier Castells, Ana González-Pinto, Manuel Arrojo, Miquel Bernardo, Pilar A Sáiz, Gerardo Flórez, Marta Torrens, Judit Tirado-Muñoz, Francia Fonseca, Belén Arranz, Marina Garriga, Jose Manuel Goikolea, Iñaki Zorrilla, Elisardo Becoña, Ana López, Luis San
{"title":"成人注意缺陷多动障碍及合并症药物使用的药理学和心理管理临床实践指南。","authors":"Ruth Cunill, Xavier Castells, Ana González-Pinto, Manuel Arrojo, Miquel Bernardo, Pilar A Sáiz, Gerardo Flórez, Marta Torrens, Judit Tirado-Muñoz, Francia Fonseca, Belén Arranz, Marina Garriga, Jose Manuel Goikolea, Iñaki Zorrilla, Elisardo Becoña, Ana López, Luis San","doi":"10.20882/adicciones.1569","DOIUrl":null,"url":null,"abstract":"<p><p>Substantial evidence has confirmed the high comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and a substance use disorder (SUD). This review synthesizes the pharmacological and psychosocial interventions conducted in ADHD and SUDs, and provides clinical recommendations using the GRADE approach. Our results suggest: 1) In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms (weak recommendation) and alcohol craving (weak recommendation). 2) In patients with ADHD and cannabis use disorder, atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to reduce cannabis use (weak recommendation). 3) In patients with ADHD and cocaine use disorder, methylphenidate is not recommended to improve ADHD symptoms or to reduce cocaine use (weak recommendation). 4) In patients with ADHD and comorbid nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms (weak recommendation). Psychoestimulants, such as methylphenidate or lisdexamfetamine dimesylate, are not recommended to reduce nicotine use (weak recommendation). 5) Regarding patients with ADHD and any SUD, the use of psychostimulants is recommended to improve ADHD symptoms (weak recommendation), not to reduce substance use (weak recommendation) or to improve retention to treatment (strong recommendation). In these patients, the use of atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to decrease substance use (weak recommendation) or to improve retention to treatment (strong recommendation). Atomoxetine and psychostimulants appear to be safe in patients with any SUD (strong recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite and conclusive evidence.</p>","PeriodicalId":55560,"journal":{"name":"Adicciones","volume":"34 2","pages":"168-178"},"PeriodicalIF":2.2000,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"2","resultStr":"{\"title\":\"Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use.\",\"authors\":\"Ruth Cunill, Xavier Castells, Ana González-Pinto, Manuel Arrojo, Miquel Bernardo, Pilar A Sáiz, Gerardo Flórez, Marta Torrens, Judit Tirado-Muñoz, Francia Fonseca, Belén Arranz, Marina Garriga, Jose Manuel Goikolea, Iñaki Zorrilla, Elisardo Becoña, Ana López, Luis San\",\"doi\":\"10.20882/adicciones.1569\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><p>Substantial evidence has confirmed the high comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and a substance use disorder (SUD). 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Psychoestimulants, such as methylphenidate or lisdexamfetamine dimesylate, are not recommended to reduce nicotine use (weak recommendation). 5) Regarding patients with ADHD and any SUD, the use of psychostimulants is recommended to improve ADHD symptoms (weak recommendation), not to reduce substance use (weak recommendation) or to improve retention to treatment (strong recommendation). In these patients, the use of atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to decrease substance use (weak recommendation) or to improve retention to treatment (strong recommendation). Atomoxetine and psychostimulants appear to be safe in patients with any SUD (strong recommendation). 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Clinical practice guideline on pharmacological and psychological management of adult patients with attention deficit and hyperactivity disorder and comorbid substance use.
Substantial evidence has confirmed the high comorbidity between Attention-Deficit/Hyperactivity Disorder (ADHD) and a substance use disorder (SUD). This review synthesizes the pharmacological and psychosocial interventions conducted in ADHD and SUDs, and provides clinical recommendations using the GRADE approach. Our results suggest: 1) In patients with ADHD and alcohol use, atomoxetine is recommended to reduce ADHD symptoms (weak recommendation) and alcohol craving (weak recommendation). 2) In patients with ADHD and cannabis use disorder, atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to reduce cannabis use (weak recommendation). 3) In patients with ADHD and cocaine use disorder, methylphenidate is not recommended to improve ADHD symptoms or to reduce cocaine use (weak recommendation). 4) In patients with ADHD and comorbid nicotine use disorder, methylphenidate is recommended to improve ADHD symptoms (weak recommendation). Psychoestimulants, such as methylphenidate or lisdexamfetamine dimesylate, are not recommended to reduce nicotine use (weak recommendation). 5) Regarding patients with ADHD and any SUD, the use of psychostimulants is recommended to improve ADHD symptoms (weak recommendation), not to reduce substance use (weak recommendation) or to improve retention to treatment (strong recommendation). In these patients, the use of atomoxetine is recommended to improve ADHD symptoms (weak recommendation), not to decrease substance use (weak recommendation) or to improve retention to treatment (strong recommendation). Atomoxetine and psychostimulants appear to be safe in patients with any SUD (strong recommendation). Our review suggests the need for more research in this area and for larger, multisite, randomized studies to provide more definite and conclusive evidence.
期刊介绍:
Adicciones publica artículos originales sobre el tratamiento, la prevención, estudios básicos y descriptivos en el campo de las adicciones, como son las drogas ilegales, el alcohol, el tabaco o cualquier otra adicción, procedentes de distintas disciplinas (medicina, psicología, investigación básica, investigación social, etc.). Todos los artículos son seleccionados después de pasar un proceso de revisión anónimo hecho por expertos en ese tema.