Psychotherapy is recommended as a critical component of a multimodal approach targeted towards comorbid ADHD and AOD use [478]. There is evidence from the broader ADHD literature to suggest that an approach that combines CBT and pharmacotherapy may result in better outcomes for ADHD symptoms than pharmacotherapy alone [490, 491]. Although CBT has been found to be the most effective psychological approach for ADHD (when delivered in conjunction with pharmacotherapy) [492], positive outcomes have also been associated with the use of other approaches, such as meta-cognitive group therapy [493], structured skills training [494, 495], and cognitive remediation, both as therapist-led programs [496] and self-directed interventions [497].
Common therapeutic elements include psychoeducation, a focus on problem solving, strategies to improve attention, impulsivity management, and cognitive restructuring [492]. It has been suggested that a structured format of repetitive skill practising and reinforcement of coping strategies for core ADHD symptoms are key components for the effective treatment of ADHD [498, 499]. However, these interventions have yet to be evaluated among people with comorbid AOD use.
To date only one integrated psychotherapeutic approach for comorbid ADHD and AOD has been evaluated [500]. The intervention represents is an integration of the primary elements of the CBT programs for both ADHD and AOD, and includes planning and organisational skills, MI, skills training, and relapse prevention [501]. The results from this trial are yet to be published, but two case presentations with early alcohol and ADHD outcomes from the study indicate that this may be a promising treatment [502].