管理患有物质使用障碍(SUD)的成人并发注意力缺陷多动障碍(ADHD):成瘾专家需要知道的

Joe Johnson, Sarah Morris, Sanju George
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引用次数: 2

摘要

注意力缺陷多动障碍(ADHD)和物质使用障碍(SUD)通常共存,两者之间的联系是双向的,在SUD人群中发现的ADHD症状发生率较高,在ADHD人群中也发现的SUD发生率较高。一些可能解释ADHD患者患SUD风险增加的机制包括自我用药,ADHD和SUD都是由一个或多个多巴胺能回路的失调引起的,遗传因素以及暴露于父母的SUD。鉴于多动症和SUD之间的复杂关系,那些在SUD服务机构工作的人应该警惕多动症作为可能的合并症诊断,并在适当的情况下向专业的多动症服务机构进行进一步评估。在详细的临床评估的基础上,必须决定是否应该优先治疗SUD或ADHD,或者两者是否都应该;在任何一种情况下,ADHD和SUD治疗服务必须协同工作。对于患有多动症的青少年和成人,推荐的一线药物治疗方案是一种刺激性药物,非刺激性药物被保留为二线或三线药物。在这篇简短的综述文章中,作者进一步讨论了治疗多动症的各种药物,治疗SUD患者多动症的益处和风险,讨论了专业多动症治疗服务的作用,并通过2个匿名病例小插曲来说明这些。
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Managing Comorbid Attention Deficit Hyperactivity Disorder (ADHD) in Adults With Substance Use Disorder (SUD): What the Addiction Specialist Needs to Know
Attention deficit hyperactivity disorder (ADHD) and substance use disorder (SUD) often co-exist and the link between the 2 is bidirectional, with higher rates of ADHD symptoms found in the SUD population and higher rates of SUD found among the ADHD population. Some possible mechanisms which could explain the increased risk of developing a SUD in those who have ADHD include self-medication, both ADHD and SUD arising from dysregulation of 1 or more of the dopaminergic circuits, genetic factors as well exposure to parental SUD. Given the complex relationship between ADHD and SUD, those working in SUD services should be vigilant to ADHD as a possible comorbid diagnosis and refer to a specialist ADHD service for further assessment where appropriate. On the basis of a detailed clinical assessment, it has to be decided whether SUD or ADHD should be the priority for treatment or if they both ought to be; in either case, ADHD and SUD treatment services must work collaboratively. The recommended first line pharmacological treatment option for adolescents and adults with ADHD is a stimulant medication, with nonstimulants being reserved as a second or third line option. In the brief review paper, the authors further discuss the various medications for treatment of ADHD, the benefits and risks of treating ADHD in those with SUD, discuss the role of specialist ADHD treatment services, and illustrate these with the help of 2 anonymized case vignettes.
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期刊介绍: Addictive Disorders & Their Treatment is a quarterly international journal devoted to practical clinical research and treatment issues related to the misuses of alcohol and licit and illicit drugs and the study and treatment of addictive disorders and their behaviors. The journal publishes broad-spectrum, patient-oriented coverage of all aspects of addiction, directed toward an audience of psychiatrists, clinical psychologists, psychopharmacologists, and primary care practitioners. Original articles help clinicians make more educated, effective decisions regarding optimal patient management and care. In-depth reviews examine current understanding, diagnosis, and treatment of addiction disorders.
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