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
Revista:
Adicciones: Revista de socidrogalcohol

ISSN: 0214-4840

Ano de publicación: 2022

Volume: 34

Número: 2

Páxinas: 168-178

Tipo: Artigo

DIALNET GOOGLE SCHOLAR lock_openAcceso aberto editor

Outras publicacións en: Adicciones: Revista de socidrogalcohol

Resumo

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

Referencias bibliográficas

  • Arranz, B., Garriga, M., Bernardo, M., Gonzalez-Pinto, A., Arrojo, M., Torrens, M.,… San, L. (2022). Clinical practice guideline on pharmacological and psychological management of adult patients with schizophrenia spectrum disorders and a comorbid substance use. Adicciones, 34, 110-127. doi:10.20882/adicciones.1504.
  • Biederman, J., Wilens, T. E., Mick, E., Faraone, S. V. y Spencer, T. (1998). Does attention-deficit hyperactivity disorder impact the developmental course of drug and alcohol abuse and dependence? Biological Psychiatry, 44, 269–273. doi:10.1016/s0006-3223(97)00406-x.
  • Carpentier, P. J., De Jong, C. A. J., Dijkstra, B. A. G., Verbrugge, C. A. G. y Krabbe, P. F. M. (2005). A controlled trial of methylphenidate in adults with attention deficit/hyperactivity disorder and substance use disorders. Addiction, 100, 1868–1874. doi:10.1111/j.1360-0443.2005.01272.x.
  • Castells, X., Ramos-Quiroga, J. A., Bosch, R., Nogueira, M. y Casas, M. (2011a). Amphetamines for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database of Systematic Reviews, 6, CD007813. doi:10.1002/14651858.CD007813.pub2.
  • Castells, X., Ramos-Quiroga, J. A., Rigau, D., Bosch, R., Nogueira, M., Vidal, X. y Casas, M. (2011b). Efficacy of methylphenidate for adults with attention-deficit hyperactivity disorder: A meta-regression analysis. CNS Drugs, 25, 157–169. doi:10.2165/11539440-000000000-00000.
  • Collins, S. L., Levin, F. R., Foltin, R. W., Kleber, H. D. y Evans, S. M. (2006). Response to cocaine, alone and in combination with methylphenidate, in cocaine abusers with ADHD. Drug and Alcohol Dependence, 82, 158–167. doi:10.1016/j.drugalcdep.2005.09.003.
  • Cunill, R., Castells, X., Tobias, A. y Capellà, D. (2015). Pharmacological treatment of attention deficit hyperactivity disorder with co-morbid drug dependence. Journal of Psychopharmacology, 29, 15–23. doi:10.1177/0269881114544777.
  • Cunill, R. y Castells, X. (2016a). The treatment of dual ADHD: A drop in the ocean. Adicciones, 28, 131–135. doi:10.20882/adicciones.836.
  • Cunill, R., Castells, X., Tobias, A. y Capellà, D. (2016b). Efficacy, safety and variability in pharmacotherapy for adults with attention deficit hyperactivity disorder: A meta-analysis and meta-regression in over 9000 patients. Psychopharmacology, 233, 187-197. doi:10.1007/s00213-015-4099-3.
  • Dalsgaard, S., Ostergaard, S, D., Leckman, J. F., Mortensen, P. B. y Pedersen, M. G. (2015). Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: A nationwide cohort study. Lancet, 385, 2190-2196. doi:10.1016/S0140-6736(14)61684-6.
  • Gopalakrishna, G., Langendam, M. W., Scholten, R. J., Bossuyt, P. M. y Leeflang, M. M. (2013). Guidelines for guideline developers: A systematic review of grading systems for medical tests. Implementation Science, 8, 78. doi:10.1186/1748-5908-8-78.
  • Guyatt, G. H., Oxman, A. D., Kunz, R., Falck-Ytter, Y., Vist, G. E., Liberati, A. y Schünemann, H. J. (2008). Going from evidence to recommendations. British Medical Journal (Clinical Research Ed.), 336, 1049–1051. doi:10.1136/bmj.39493.646875.AE.
  • Humfleet, G. L., Prochaska, J. J., Mengis, M., Cullen, J., Muñoz, R., Reus, V. y Hall, S. M. (2005). Preliminary evidence of the association between the history of childhood attention-deficit/hyperactivity disorder and smoking treatment failure. Nicotine y Tobacco Research, 7, 453–460. doi:10.1080/14622200500125310.
  • Khantzian, E. J. (1985). The self-medication hypothesis of addictive disorders: Focus on heroin and cocaine dependence. American Journal of Psychiatry, 142, 1259–1264. doi:10.1176/ajp.142.11.1259.
  • Kollins, S. H., English, J. S., Itchon-Ramos, N., Chrisman, A. K., Dew, R., O’Brien, B. y McClernon, F. J. (2014). A pilot study of lis-dexamfetamine dimesylate (LDX/SPD489) to facilitate smoking cessation in nicotine-dependent adults with ADHD. Journal of Attention Disorders, 18, 158–168. doi:10.1177/1087054712440320.
  • Lambert, N. M. y Hartsough, C. S. (1998). Prospective study of tobacco smoking and substance dependencies among samples of ADHD and non-ADHD participants. Journal of Learning Disabilities, 31, 533–544. doi:10.1177/002221949803100603.
  • Levin, F. R., Evans, S. M., Brooks, D. J. y Garawi, F. (2007). Treatment of cocaine dependent treatment seekers with adult ADHD: Double-blind comparison of methylphenidate and placebo. Drug and Alcohol Dependence, 87, 20–29. doi:10.1016/j.drugalcdep.2006.07.004.
  • Mannuzza, S., Klein, R., Truong, N., Moulton, J., Roizen, E., Howell, K. y Castellanos, F. (2010). Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: Prospective follow-up into adulthood. American Journal of Psychiatry, 165, 604–609. doi:10.1176/appi.ajp.2008.07091465.
  • McRae-Clark, A. L., Carter, R. E., Killeen, T. K., Carpenter, M. J., White, K. G. y Brady, K. T. (2010). A placebo-controlled trial of atomoxetine in marijuana-dependent individuals with attention deficit hyperactivity disorder. American Journal on Addictions, 19, 481–489. doi:10.1111/j.1521-0391.2010.00076.x.
  • Oxman, A. D., Schünemann, H. J. y Fretheim, A. (2006). Improving the use of research evidence in guideline development: 2. Priority setting. Health Research Policy and Systems, 4, 14. doi:10.1186/1478-4505-4-14.
  • Pérez de Los Cobos, J., Siñol, N., Puerta, C., Cantillano, V., López Zurita, C. y Trujols, J. (2011). Features and prevalence of patients with probable adult attention deficit hyperactivity disorder who request treatment for cocaine use disorders. Psychiatry Research, 185, 205–210. doi:10.1016/j.psychres.2009.03.019.
  • Perez De Los Cobos, J., Siñol, N., Perez, V. y Trujols, J. (2014). Pharmacological and clinical dilemmas of prescribing in co-morbid adult attention-deficit/hyperactivity disorder and addiction. British Journal of Clinical Pharmacology, 77, 337–356. doi:10.1111/bcp.12045.
  • Pomerleau, O. F., Downey, K. K., Stelson, F. W. y Pomerleau, C. S. (1995). Cigarette smoking in adult patients diagnosed with attention deficit hyperactivity disorder. Journal of Substance Abuse, 7, 373–378. doi:10.1016/0899-3289(95)90030-6.
  • San, L. y Arranz, B. (2016). Clinical guideline for the treatment of dual pathology in the adult population. Adicciones, 28, 3-5. doi:10.20882/adicciones.784.
  • Schubiner, H., Saules, K. K., Arfken, C. L., Johanson, C. E., Schuster, C. R., Lockhart, N.,… Pihlgren, E. (2002). Double-blind placebo-controlled trial of methylphenidate in the treatment of adult ADHD patients with comorbid cocaine dependence. Experimental and Clinical Psychopharmacology, 10, 286–294. doi:10.1037/1064-1297.10.3.286.
  • Torgersen, T., Gjervan, B. y Rasmussen, K. (2006). ADHD in adults: A study of clinical characteristics, impairment and comorbidity. Nordic Journal of Psychiatry, 60, 38–43. doi:10.1080/08039480500520665.
  • Urcelay, G. P. y Dalley, J. W. (2012). Linking ADHD, impulsivity, and drug abuse: A neuropsychological perspective. Current Topics in Behavioral Neurosciences, 9, 173–197. doi:10.1007/7854_2011_119.
  • van Emmerik-van Oortmerssen, K., van de Glind, G., van den Brink, W., Smit, F., Crunelle, C. L., Swets, M.,… Schoevers, R. A. (2012). Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: A meta-analysis and meta-regression analysis. Drug and Alcohol Dependence, 122, 11–19. doi:10.1016/j.drugalcdep.2011.12.007.
  • Wilens, T. E., Biederman, J., Mick, E., Faraone, S. V y Spencer, T. (1997). Attention deficit hyperactivity disorder (ADHD) is associated with early onset substance use disorders. Journal of Nervous and Mental Disease, 185, 475–482.
  • Wilens, T. E. (2004). Attention-deficit/hyperactivity disorder and the substance use disorders: The nature of the relationship, subtypes at risk, and treatment issues. Psychiatric Clinics of North America, 27, 283–301. doi:10.1016/S0193-953X(03)00113-8.
  • Wilens, T. E., Adamson, J., Sgambati, S., Whitley, J., Santry, A., Monuteaux, M. C. y Biederman, J. (2007). Do individuals with ADHD self-medicate with cigarettes and substances of abuse? Results from a controlled family study of ADHD. American Journal on Addictions,
  • (Supl. 1), 14–23. doi:10.1080/10550490601082742.
  • Wilens, T. E., Adler, L. A., Adams, J., Sgambati, S., Rotrosen, J., Sawtelle, R.,… Fusillo, S. (2008a). Misuse and diversion of stimulants prescribed for ADHD: A systematic review of the literature. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 21–31. doi:10.1097/chi.0b013e31815a56f1.
  • Wilens, T. E., Adler, L. A., Weiss, M. D., Michelson, D., Ramsey, J. L., Moore, R. J.,… Levine, L. R. (2008b). Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders. Drug and Alcohol Dependence, 96, 145–154. doi:10.1016/j.drugalcdep.2008.02.009.
  • Winhusen, T. M., Somoza, E. C., Brigham, G. S., Liu, D. S., Green, C. A., Covey, L. S.,… Dorer, E. M. (2010). Impact of attention-deficit/hyperactivity disorder (ADHD) treatment on smoking cessation intervention in ADHD smokers: A randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry, 71, 1680–1688. doi:10.4088/JCP.09m05089gry.
Fonte de datos: Dialnet