The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders

  • Courtney A. Zulauf
  • Susan E. Sprich
  • Steven A. Safren
  • Timothy E. Wilens
Child and Adolescent Disorders (T Benton, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Child and Adolescent Disorders


Adolescents and young adults with substance use disorders (SUD) and attention deficit/hyperactivity disorder (ADHD) are increasingly presenting in clinical practice. The overlap and role of treatment for these co-occurring disorders remains unclear. A review of the literature was conducted to highlight and update recent evidence on the overlap of ADHD and SUD, the role of ADHD medication on later SUD, and the treatment of ADHD and SUD in adolescents and young adults. Recent work continues to highlight the high risk for comorbid ADHD in patients with SUD; and conversely, the high risk for SUD developing in ADHD across the lifespan, particularly in the context of comorbid conduct disorder. Although the data remains discordant, it appears that ADHD pharmacotherapy does not increase the risk for SUD. Medication treatment alone does not appear to be particularly effective in treating SUD in currently active substance abusing individuals with ADHD. Structured therapies may be effective in treating adolescents and young adults with ADHD and SUD. Further controlled trials evaluating the sequence and effect of structured psychotherapies and/or ADHD pharmacotherapy on SUD relapse in these groups are warranted.


Adolescence Substance use disorders Attention deficit/hyperactivity disorder Stimulants comorbidity Cognitive-behavioral therapy 


Compliance with Ethics Guidelines

Conflict of Interest

Courtney A. Zulauf declares that she has no conflict of interest.

Susan E. Sprich has received royalties from Oxford University Press.

Steven A. Safren has received royalties from Oxford University Press and board membership of K24MH094214.

Dr. Timothy Wilens receives or has received grant support from the following sources: NIH(NIDA) and Shire. Dr. Wilens is or has been a consultant for: Euthymics, NIH (NIDA), Shire, Tris and Theravance. Dr. Wilens has a published book with Guilford Press. Straight Talk About Psychiatric Medications for Kids. Dr. Wilens is a consultant to the US National Football League (ERM Associates), U.S. Minor/Major League Baseball and Bay Cove Human Services (Clinical Services).

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance.

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Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Courtney A. Zulauf
    • 1
  • Susan E. Sprich
    • 2
  • Steven A. Safren
    • 3
  • Timothy E. Wilens
    • 1
    • 4
    • 5
  1. 1.Clinical and Research Programs in Pediatric Psychopharmacology and Adult ADHDMassachusetts General HospitalBostonUSA
  2. 2.Cognitive-Behavioral Therapy ProgramMassachusetts General HospitalBostonUSA
  3. 3.Department of Behavioral MedicineMassachusetts General HospitalBostonUSA
  4. 4.Center for Addiction MedicineMassachusetts General HospitalBostonUSA
  5. 5.YAW 6A, Massachusetts General HospitalBostonUSA

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