Australian & New Zealand Journal of Psychiatry | 2021
Don’t put the cart before the horse: Response to Young et al. ‘assessment of ADHD in people with substance use disorder’
Abstract
In their article in this issue of the Australian & New Zealand Journal of Psychiatry, Young et al. make an aspirational call to address unmet need for attention deficit hyperactivity disorder (ADHD) assessment and treatment in people with a coexisting substance use disorder (SUD). They argue that ADHD can be reliably diagnosed during periods of active substance use, and that treatment of ADHD in this context improves outcomes. In our response, we argue that active ADHD cannot be easily and reliably diagnosed among people with current SUD. Even if ADHD can be diagnosed and treated in this setting, the mental health and addiction sector cannot currently meet this need. The cart must not come before the horse: before creating an expectation that services should expand into this complex area, we need better evidence on the safety and efficacy of stimulant treatment in people with active SUD, clear local practice guidelines and a workforce that can meet the demand for treatment.