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Psychotherapy of Adults with Comorbid Attention-Deficit/Hyperactivity Disorder and Psychoactive Substance Use Disorder

Received September 6, 2000; revised February 9, 2001; accepted February 17, 2001. From the New York State Psychiatric Institute, New York, New York. Address correspondence to Dr. Aviram, New York State Psychiatric Institute, Division of Neuroscience-Unit 42, 1051 Riverside Drive, New York, NY 10032.

Psychotherapy for comorbid attention-deficit/ hyperactivity disorder (ADHD) and psychoactive substance use disorder (PSUD) is described. The authors suggest that relapse prevention is an appropriate initial treatment because it is well suited to manage both substance abuse and comorbid symptomatology such as impulsivity, distractibility, and avoidance associated with ADHD. Clinical vignettes describe typical interactions between patients and their therapists, highlighting opportunities for therapists to focus on overlapping symptoms. ADHD is one of the most common comorbid diagnoses with PSUD, and it is important that efficacious psychotherapies be developed to complement psychopharmacological approaches. Clinicians should consider psychotherapy as part of a multimodal treatment approach that includes medication and perhaps family therapy. Additional contributions from clinicians who have experience conducting psychotherapy with this population are needed in order to develop effective treatments.

Key Words: Attention-Deficit/Hyperactivity Disorder • Substance Use