Expert Consensus
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Psychiatry. Mar 19, 2023; 13(3): 84-112
Published online Mar 19, 2023. doi: 10.5498/wjp.v13.i3.84
Identification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statement
Susan Young, Cyrus Abbasian, Zainab Al-Attar, Polly Branney, Bill Colley, Samuele Cortese, Sally Cubbin, Quinton Deeley, Gisli Hannes Gudjonsson, Peter Hill, Jack Hollingdale, Steve Jenden, Joe Johnson, Deborah Judge, Alexandra Lewis, Peter Mason, Raja Mukherjee, David Nutt, Jane Roberts, Fiona Robinson, Emma Woodhouse, Kelly Cocallis
Susan Young, Department of Psychology, Psychology Services Limited, Croydon CR9 7AE, United Kingdom
Susan Young, Department of Psychology, Reykjavik University, Reykjavik, Iceland
Cyrus Abbasian, Zainab Al-Attar, Psychiatry-UK Limited, Cornwall PL33 9ET, United Kingdom
Polly Branney, ADHD and Autism, Oxford ADHD & Autism Centre, Headington OX3 7BX, United Kingdom
Bill Colley, CLC Consultancy, Dunkeld PH8 0AY, United Kingdom
Samuele Cortese, Center for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton SO17 1BJ, United Kingdom
Sally Cubbin, Adult ADHD, Adult ADHD Clinic Ltd, Oxford OX3 7RP, United Kingdom
Quinton Deeley, Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology & Neuroscience, King's College London Institute of Psychiatry, London SE5 8AF, United Kingdom
Gisli Hannes Gudjonsson, Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
Peter Hill, Department of Psychiatry, University of London, London WC1E 7HU, United Kingdom
Jack Hollingdale, Department of Psychology, Compass Psychology Services Ltd, London BR1 9DX, United Kingdom
Steve Jenden, Deborah Judge, Birribi Ltd, Narberth SA67 7DU, United Kingdom
Joe Johnson, Halton and Knowsley Adult ADHD Team, Merseycare NHS Foundation Trust, Winwick WA2 9WA, United Kingdom
Alexandra Lewis, Department of Psychiatry, Fulbourn Hospital, Cambridge CB21 5EF, United Kingdom
Peter Mason, Department of Psychiatry, Dr Peter Mason ADHD & Psychiatry Services Limited, Liverpool L1 9AR, United Kingdom
Raja Mukherjee, Adult Neurodevelopmental Service, Horizon House, Epsom KT17 4QJ, United Kingdom
David Nutt, Department of Psychiatry, Imperial College London, London WS12 0NN, United Kingdom
Jane Roberts, Service User Representative, Gloucestershire GL1 3NN, United Kingdom
Fiona Robinson, Drug & Alcohol Services, Surrey & Borders Partnership Trust, Leatherhead KT22 7AD, United Kingdom
Emma Woodhouse, Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London SE5 8AF, United Kingdom
Kelly Cocallis, Wansbeck General Hospital, Northumbria Healthcare NHS Foundation Trust, Ashington NE63 9JJ, United Kingdom
Author contributions: Young S was responsible for the planning and scientific input of this consensus statement; all authors attended the consensus meeting; Cocallis K completed the first draft of the manuscript; It was substantially revised by Young S with further input from Nutt D, Mason P and Mukherjee R; The second draft was revised and circulated by Young S and Cocallis K to all authors for comment and endorsement of the consensus; Following further feedback and amendments by Young S and Cocallis K, the final draft was circulated once more; all authors have read and approved the final manuscript.
Conflict-of-interest statement: Young S, Abbasian C, Cubbin S, Branney P, Colley B, Deeley Q, Hill P, Hollingdale J, Judge D, Lewis A, Mason P, Johnson J and Woodhouse E are affiliated with consultancy firms/private practices. Over the past five years Young S has received honoraria for consultancy and educational talks years from Janssen, Medice and Takeda. She is author of the ADHD Child Evaluation (ACE) and ACE+ for adults; and lead author of R&R2 for ADHD Youths and Adults. Hill P received honoraria for consultancy and educational talks from Takeda and Flynn Pharma. Cortese S declares honoraria and reimbursement for travel and accommodation expenses for lectures from the following non-profit associations: Association for Child and Adolescent Central Health (ACAMH), Canadian ADHD Alliance Resource (CADDRA), British Association of Pharmacology (BAP), and from Healthcare Convention for educational activity on ADHD. Mason P has received honoraria for consultancy and educational talks from Takeda, Flynn Pharma and Lily. Nutt D has received honoraria for educational talks from Takeda and Janssen. Lewis A has received honoraria for consultancy to the Association for Child & Adolescent Mental Health (ACAMH) and Takeda and for educational talks to Forensic Treatment Division, Ministry of Justice, Republic of Korea. Mukherjee R has received honoraria for consultancy and talks related to ADHD from Takeda, Flynn Pharma and Janssen. Johnson J has received honoraria for consultancy and educational talks for Flynn Pharma, Takeda and Janssen. The remaining authors (Gudjonsson GH, Cocallis K, Roberts J, Al-Attar Z, Robinson F) declare that the meeting was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Susan Young, PhD, Professor, Department of Psychology, Psychology Services Limited, PO 1735, Croydon CR9 7AE, United Kingdom. suzyyoung@aol.com
Received: November 22, 2022
Peer-review started: November 22, 2022
First decision: January 3, 2023
Revised: February 19, 2023
Accepted: March 14, 2023
Article in press: March 14, 2023
Published online: March 19, 2023
Processing time: 115 Days and 4.9 Hours
Abstract

Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). Individuals with concurrent ADHD and SU/SUD can have complex presentations that may complicate diagnosis and treatment. This can be further complicated by the context in which services are delivered. Also, when working with young people and adults with co-existing ADHD and SU/SUD, there is uncertainty among healthcare practitioners on how best to meet their needs. In February 2022, the United Kingdom ADHD Partnership hosted a meeting attended by multidisciplinary experts to address these issues. Following presentations providing attendees with an overview of the literature, group discussions were held synthesizing research evidence and clinical experience. Topics included: (1) A review of substances and reasons for use/misuse; (2) identification, assessment and treatment of illicit SU/SUD in young people and adults with ADHD presenting in community services; and (3) identification, assessment and treatment of ADHD in adults presenting in SU/SUD community and inpatient services. Dis-cussions highlighted inter-service barriers and fragmentation of care. It was concluded that a multimodal and multi-agency approach is needed. The consensus group generated a table of practice recommendations providing guidance on: identification and assessment; pharmacological and psychological treatment; and multi-agency interventions.

Keywords: Attention-deficit/hyperactivity disorder; Substance use; Pharmacokinetics; Assessment; Treatment; Comorbidity

Core Tip: Attention-deficit/hyperactivity disorder (ADHD) often co-occurs with substance use (SU) and/or substance use disorder (SUD). The co-occurrence of ADHD and SU/SUD is associated with earlier onset and faster transition to more serious SUD, and reduced treatment effectiveness. This manuscript is the product of a consensus meeting of experts from ADHD and/or SUD services, across a range of clinical, academic, educational, occupational, and service-user sectors. A consensus was reached offering practical guidance to support practitioners working with young people and adults with ADHD and SU/SUD with recommendations for identification and assessment, pharmacological treatment, psychological treatment, and multi-agency interventions.