Summary

For those with co-occurring ADHD and AOD use, reviews of the evidence recommend an integrated, multimodal approach, with components of individual and/or group psychotherapy, psychoeducation, as well as peer and family support [9, 884, 893–895]. The use of structured psychotherapies, including CBT with a focus on goals, with active AOD worker involvement and effective social support, is likely to be the most beneficial [884, 892] and, as with the treatment of other co-occurring disorders, treating both conditions concurrently is more likely to produce a positive treatment outcome than treating either disorder alone [102, 896, 922].

Box 14 illustrates such a multimodal approach through the continuation of case study A, after Sam's ADHD was identified.

Box 14: Case study A: Treating co-occurring ADHD and AOD use: Sam’s story continued

Case study A: Sam’s story continued

Based on Sam’s symptoms, the AOD worker thought it would be beneficial for her to see a psychiatrist who specialised in adult ADHD, and asked Sam if she would be willing to see a psychiatrist who would be able to assess her further and help develop a treatment plan. The AOD worker told Sam that they would be happy to keep seeing her and liaise with both her GP and the psychiatrist. Sam thought this was a good plan and consented to the sharing of information between these services.

The AOD worker helped Sam make an appointment to see the psychiatrist and her GP, and helped Sam put these appointments into her phone calendar, setting reminders. Sam also organised a follow-up appointment to see the AOD worker after her appointments with the GP and psychiatrist. With Sam’s permission, the AOD worker invited Sam’s partner into the consultation room and let them know about the upcoming appointments so they could remind Sam and help her arrive on time. Sam had agreed to the AOD worker discussing her condition with her partner, as she understood they would be able to provide additional information about her condition and be helpful and supportive of her ongoing treatment.

The psychiatrist who assessed Sam diagnosed her with ADHD, and noted the range of inattention, hyperactivity and impulsivity symptoms that were present. The psychiatrist also mentioned that the way Sam responded to her use of Ritalin and methamphetamines, where she did not experience a ‘high’ but instead felt calm and relaxed, was significant. The psychiatrist explained that psychostimulants are one of the primary treatments for ADHD which are carefully prescribed and monitored. After Sam’s GP conducted a thorough medical assessment, the psychiatrist prescribed her with psychostimulant medication and advised Sam that it was important for her not to use any other substances, because of the possibility of interactions between drugs. The AOD worker told Sam she would be available for a phone or Zoom call every day during Sam’s first week taking the psychostimulants, to see how she was going.

Sam continued with her treatment and recommenced NRT. In addition to regular monitoring and some minor adjustments to the psychostimulant dosage, Sam attended individual sessions with her AOD worker, where she was provided with a range of evidence-based interventions to help her with her alcohol, methamphetamine and cannabis use. These began with psychoeducation and information about the substances Sam had been using, focusing on the way in which they affected her ADHD and how her ADHD symptoms impacted on her substance use. The AOD worker also suggested some relaxation exercises for occasions when she became tense, that Sam began to practice and enjoy.

Sam also re-enrolled in a part-time TAFE course, and started working part-time in a fabric shop, which aligned well with her studies in design. An important component of her treatment plan was helping Sam organise activities which were part of her everyday life. The AOD worker helped Sam set up a daily calendar, and use different functions on her smartphone (i.e., setting alarms for important events, scheduling meetings and appointments). Sam’s partner also helped her keep a schedule and maintain reminders and appointments in her phone.

Key Points

Treatment for ADHD and AOD use should be concurrent and multimodal.
Providing education about the nature of the ADHD, AOD use and their relationship, is essential – for both the client, friends and family.
Treatment requires long-term planning and follow-up and more general efforts at rehabilitation, including further education.