Consensus International sur le dépistage, le diagnostic et le traitement des patients avec troubles de l'usage de substances en cas de comorbidité avec un trouble du déficit de l'attention avec ou sans hyperactivité

Background: Attention deficit disorder with or without hyperactivity (ADHD) in adults is often associated with substance use disorders (SUD), which have an early onset and more severe development, with less effective treatment. There are no recommendations in French on the identification, diagnosis and management of these comorbid situations. Methods: We used the modified Delphi method and literature review to arrive at a consensus statement regarding the screening, diagnosis and treatment of ADHD in subjects with SUD. Results: ADHD screening tools are useful in adults with SUD. They should be used routinely for SUD, but followed by diagnostic confirmation of ADHD as soon as possible. Simultaneous and integrated treatment of ADHD and SUD, combining psychotherapy and pharmacotherapy, is recommended, including methylphenidate and amphetamines in their extended-release forms, as well as atomoxetine. High doses may be considered for patients who do not respond to standard dosing. Discussion: Diagnostic and therapeutic tools are available for the management of ADHD in the context of SUD. Pharmacological treatments are in the process of final approval in France. In subjects with ADHD, psychiatric and non-psychiatric comorbidities other than SUD are common, but should not delay multimodal management.