Neurodevelopmental Disorders

Attention deficit hyperactivity disorder (ADHD) appears common in people attending alcohol treatment settings.  One randomised controlled trial (RCT) supports the use of integrated cognitive behaviour therapy (CBT) for ADHD and alcohol use disorder over CBT for alcohol at least in the short term with no worse alcohol outcomes. CBT for ADHD is likely to include problem solving strategies, strategies for improved attention, and to reduce impulsivity and unhelpful thinking patterns.  

The following summarises the recommendations for ADHD from the comorbidity guidelines. Pharmacotherapies for ADHD including psychostimulants (e.g., methylphenidate & dexamphetamine) and noradrenaline reuptake inhibitors (atomoxetine) have been shown to be beneficial in people with ADHD and comorbid substance use. Their effect is not as large for people with comorbidity compared to those only experiencing ADHD. It is recommended they be used in combination with psychotherapy because of greater effectiveness.  A thorough medical assessment to rule out cardiovascular and other contraindications for psychostimulant prescribing is recommended. While psychostimulants are more effective than other pharmacotherapies it is necessary to carefully weigh their benefits against the potential risk for diversion and misuse and include risks of suboptimal treatment of ADHD.  

The UK NICE Guidelines on ADHD (National Institute for Health and Care Excellence, 2019) recommend that titration of ADHD medication dose be slower and monitoring more frequent in those with “substance misuse”.