{
  "abstract": "Background Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) often coexist. ADHD complicates the course of disease in SUD. While recommended in guidelines, ADHD medication for those with comorbid SUD remains controversial.Objective This study aims to explore how comorbid SUD affects ADHD medication discontinuation and reinitiation in individuals with ADHD.Methods Using a matched cohort design, we identified 9283 individuals with ADHD and SUD in Sweden between 2006 and 2020, who had ongoing ADHD medication at the time of their first SUD-related event. Controls with ADHD medication but no SUD (n=46 401) were matched 5:1 on sex and birth year. HRs for treatment discontinuation within 1 year from first SUD, and for treatment reinitiation within 1 year from the first discontinuation, were estimated using stratified Cox models.Findings Individuals with ADHD and SUD were nearly two times as likely to discontinue ADHD treatment within 1 year (HR: 1.99, 95% CI 1.92 to 2.07) and less likely to re-initiate ADHD treatment (HR: 0.82, 95% CI 0.76 to 0.89) compared with controls. Several factors, including male sex, adolescent to young adult age and lower stimulant medication dose, were associated with increased risk for treatment discontinuation, but only adolescent to young adult age was significantly associated with treatment reinitiation in those with ADHD and SUD.Conclusions The results suggest less treatment continuity and access for those with ADHD and comorbid SUD.Clinical implications Treatment providers need to consider the specific needs of individuals with ADHD and comorbid SUD, especially in young males, to improve treatment outcomes for vulnerable groups.",
  "authors": [
    {
      "affiliations": [
        "Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden"
      ],
      "name": "Andrea J Capusan"
    },
    {
      "affiliations": [
        "School of Public Health, Shenzhen University, Shenzhen, Guangzhou, People's Republic of China",
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Le Zhang"
    },
    {
      "affiliations": [
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden",
        "School of Medical Sciences, Örebro University, Örebro, Sweden"
      ],
      "name": "Henrik Larsson"
    },
    {
      "affiliations": [
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden",
        "Department of Biomedicine, Aarhus University, Aarhus, Denmark",
        "Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway"
      ],
      "name": "Isabell Brikell"
    },
    {
      "affiliations": [
        "Division on Substance Use Disorders, New York State Psychiatric Institute, New York, New York, USA",
        "Department of Psychiatry, Columbia University Irving Medical Center, New York, New York, USA"
      ],
      "name": "Diana Martinez"
    },
    {
      "affiliations": [
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden",
        "Department of Psychological and Brain Sciences, Indiana University Bloomington, Bloomington, Indiana, USA"
      ],
      "name": "Brian M D’Onofrio"
    },
    {
      "affiliations": [
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Paul Lichtenstein"
    },
    {
      "affiliations": [
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Ralf Kuja-Halkola"
    },
    {
      "affiliations": [
        "Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden"
      ],
      "name": "Zheng Chang"
    }
  ],
  "title": "Discontinuation and reinitiation of pharmacological treatment for ADHD among individuals with ADHD and substance use disorder",
  "uid": "775489e7-ad0d-5789-a525-1bdc861559c1"
}