Attention-deficit/hyperactivity disorder, substance abuse, and posttraumatic stress disorder: A case study with implications for harm reduction

Substance abuse occurs in approximately half of adults who have childhood-onset attention-deficit/hyperactivity disorder (ADHD), and in many individuals who exhibit symptoms of posttraumatic stress disorder (PTSD). This article provides clinical guidelines for working with this population. The case presented illustrates how a harm reduction approach to substance use and a “come-as-you-are” stance regarding both occasional use and characteristic ADHD symptoms may better serve the ADHD adult, and individuals with PTSD, than the traditional insistence on complete abstinence from substance use as a prerequisite to psychotherapy. © 1998 John Wiley & Sons, Inc.