Guía de práctica clínica para el tratamiento farmacológico y psicológico de los pacientes adultos con trastorno por déficit de atención con hiperactividad y un diagnóstico comórbido de trastorno por uso de sustancias

  1. Ruth Cunill
  2. Xavier Castells
  3. Ana González-Pinto
  4. Manuel Arrojo
  5. Miquel Bernardo
  6. Pilar A. Sáiz
  7. Gerardo Flórez
  8. Marta Torrens
  9. Judit Tirado-Muñoz
  10. Francina Fonseca
  11. Belén Arranz
  12. Marina Garriga
  13. José Manuel Goikolea
  14. Iñaki Zorrilla
  15. Elisardo Becoña
  16. Ana López
  17. Luis San
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Ano de publicación: 2022

Volume: 34

Número: 2

Páxinas: 168-178

Tipo: Artigo

Outras publicacións en: Adicciones: Revista de socidrogalcohol


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

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