NCJ Number
215622
Journal
Journal of the American Academy of Child & Adolescent Psychiatry Volume: 45 Issue: 9 Dated: September 2006 Pages: 1138-1141
Date Published
September 2006
Length
4 pages
Annotation
Two professional treatment providers offer their recommendations for the use of medicines in treating a 16-year-old boy diagnosed with attention-deficit/hyperactivity disorder (ADHD) 7 years ago and who reports smoking marijuana regularly for the past few months; to date, the parents have chosen not to authorize treatment.
Abstract
The boy has prominent inattention and distractibility, with complaints of internal restlessness. Grades have declined from Bs to Ds. He reports being "down at times." One of the treatment specialists advises that before beginning a pharmacological treatment plan, more information is needed, which includes the severity of marijuana use/abuse, the extent of mood symptoms, and verification of the ADHD. He advises that current clinical guidelines, partially supported by data, show that for active substance abusers, the addiction should be addressed prior to the ADHD, although the ADHD treatment should be integrated into the complete treatment plan. Once the addiction is addressed, treatment with medicine should begin rapidly. For reasons of potential diversion or misuse, nonstimulants are preferred for the treatment of ADHD, including atomoxetine and bupropion. After nonstimulants, extended-release or transdermal stimulants would be reasonable for the ADHD, alone or in combination with other treatments for the concurrent mood and/or anxiety, if it exists. The second treatment specialist notes that the emerging consensus among clinicians and researchers is that the ADHD and co-occurring substance use disorder should be treated simultaneously instead of sequentially. Medications should have low abuse potential and improve depressive symptoms. A trial of bupropion is recommended. If this medication is ineffective or is not well tolerated, atomoxetine is suggested. Stimulants should not be completely excluded, given emerging evidence that some have lower abuse potential. 18 references