Psychotherapy is recommended as a critical component of a multimodal approach targeted towards co-occurring ADHD and AOD use [884, 894, 902]. Evidence suggests that CBT is the most effective psychological approach for ADHD, when delivered in conjunction with pharmacotherapy [781, 884, 892, 903]; however, positive outcomes have also been associated with the use of other approaches, such as meta-cognitive group therapy [904, 905], structured skills training [906, 907], virtual remediation therapy [908], and cognitive remediation, both as therapist-led programs [909] and self-directed interventions [910].
Common therapeutic elements include psychoeducation, a focus on problem solving and planning, strategies to improve attention, impulsivity management, and cognitive restructuring [893, 903]. Evidence suggests that a structured format of repetitive skills practising and reinforcement of coping strategies for core ADHD symptoms are key components for the effective treatment of ADHD [911, 912]. However, these interventions have yet to be evaluated among people with co-occurring AOD use. DBT-based skills training may be a promising treatment for co-occurring ADHD and AOD use. In a small feasibility study conducted among Swedish men in compulsory care for severe AOD use disorders, self-reported ADHD symptoms, general wellbeing, and externalising behaviours improved after six weeks of manualised, structured skills training groups [913]. While the lack of control group and low treatment acceptability and feasibility suggest more research is needed, these findings are encouraging.
To date, only one integrated psychotherapeutic approach for co-occurring ADHD and AOD use has been rigorously evaluated, which compared CBT for AOD use with an integrated CBT program for ADHD and AOD use [914]. The integrated CBT program consisted of motivational therapy, coping skills training and relapse prevention for AOD use, planning and problem-solving skills, and dealing with emotions; whereas the CBT for AOD use focused only on AOD use. While those in the integrated CBT group demonstrated greater reductions in ADHD symptoms compared to those who received CBT for AOD use alone, there was no difference between groups in relation to AOD use or other outcomes [914]. While more research is needed to support conclusive recommendations, these findings are promising.
Lastly, there is preliminary evidence to support the use of behavioural interventions focused on academic training for adolescents with ADHD and AOD use disorders, but further research is needed [875].