Treat comorbid attention-deficit hyperactivity disorder and substance use disorder with both pharmacotherapy and psychotherapy for best results

Attention-deficit hyperactivity disorder (ADHD) co-occurring with substance use disorder (SUD) is highly prevalent and is associated with poor prognosis and negative treatment outcomes. Comprehensive management of ADHD-SUD comorbidity involves pharmacotherapy integrated with psychotherapy to enhance treatment retention and success. Psychostimulants are the mainstay of ADHD pharmacotherapy and do not exacerbate SUD symptoms; however, psychostimulants are associated with an inherent risk of misuse, abuse and diversion. Cognitive behavioural therapy is a first-line behavioural intervention that teaches patients harm reduction and coping skills while addressing affective and environmental risks for substance use.