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Fortschr Neurol Psychiatr 2017; 85(06): 336-344
DOI: 10.1055/s-0043-100763
Übersicht
© Georg Thieme Verlag KG Stuttgart · New York

ADHS im Erwachsenenalter und substanzbezogene Störungen – Prävalenz, Diagnostik und integrierte Behandlungskonzepte

ADHD in Adults and Comorbid Substance Use Disorder: Prevalence, Clinical Diagnostics and Integrated Therapy
Henrike Dirks
1   Klinik für abhängiges Verhalten und Suchtmedizin, LVR-Klinikum Essen, Klinik und Institut der Universität Duisburg-Essen
,
Norbert Scherbaum
1   Klinik für abhängiges Verhalten und Suchtmedizin, LVR-Klinikum Essen, Klinik und Institut der Universität Duisburg-Essen
,
Bernhard Kis
2   Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Göttingen
,
Christian Mette
3   Klinik für Psychiatrie und Psychotherapie, LVR-Klinikum Essen, Kliniken und Institut der Universität Duisburg-Essen
› Author Affiliations
Further Information

Publication History

Publication Date:
23 June 2017 (online)

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Zusammenfassung

Substanzbezogene Störungen (SUD) sind nach Angst- und affektiven Störungen die psychischen Störungen mit der höchsten Prävalenz in der erwachsenen Allgemeinbevölkerung. Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) zählt zu den häufigsten psychischen Störungen bei Kindern und Jugendlichen und persistiert bei einem Teil der Patienten bis in das Erwachsenenalter. Das Vorliegen von ADHS im Kindes- und Jugendalter ist zudem ein stabiler Prädiktor für den Konsum von Tabak, Alkohol und illegalen Suchtmitteln im Erwachsenenalter. Die Problematik einer integrierten Therapie von erwachsenen Patienten mit der Komorbidität ADHS und SUD zählt zu den zentralen Herausforderungen in der klinischen Versorgung dieser Patientengruppe. Das Ziel dieser Übersichtsarbeit sind die Darstellung und Diskussion der Komorbidität von ADHS und SUD bei erwachsenen Patienten anhand der aktuellen Literatur sowie die Ableitung der Implikationen für eine adäquate Diagnostik und Therapie. Des Weiteren werden die Prävalenzen komorbider Störungen, die Herausforderungen der (Differenzial-)Diagnostik durch Symptomüberschneidungen und Ausblicke für eine integrierte psychiatrisch-psychotherapeutische Behandlung von ADHS und substanzbezogenen Störungen dargestellt.

Abstract

Substance use disorders (SUD) are one of the most frequent mental disorders among adults. Attention-Deficit/Hyperactivity-Disorder (ADHD) is one of the most common mental health issues in childhood and adolescence, often persisting in adulthood. ADHD in childhood and adolescence is a robust predictor of tobacco, alcohol and illicit substance use in adulthood. Prevalence of comorbid ADHD in SUD patients is high. Nearly one quarter of these patients fulfill the DSM IV criteria for ADHD. Integrated concepts for treatment of SUD and ADHD are needed, but rare up to now. The aim of this review is to present and discuss recent scientific literature on the topic SUD and ADHD among adults and show its implications for clinical diagnostics and treatment.

Schlüsselwörter

ADHS bei Erwachsenen - Substanzbezogene Störung - ADHS und Sucht - integrierte Therapie

Key words

Substance Use Disorder - addiction - integrated behavioral therapy - ADHD in adults
 

  • Literatur

  • 1 Jacobi F. Wittchen HU. Hölting C. et al. Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychological medicine 2004; 34 (04) 597-611
    CrossrefPubMedGoogle Scholar
  • 2 Schlack R. Holling H. Kurth BM. et al. The prevalence of attention-deficit/hyperactivity disorder (ADHD) among children and adolescents in Germany. Initial results from the German Health Interview and Examination Survey for Children and Adolescents (KiGGS). Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz 2007; 50 (05) 827-835
    CrossrefPubMedGoogle Scholar
  • 3 Dunne EM. Hearn LE. Rose JJ. et al. ADHD as a risk factor for early onset and heightened adult problem severity of illicit substance use: an accelerated gateway model. Addictive behaviors 2014; 39 (12) 1755-1758
    CrossrefPubMedGoogle Scholar
  • 4 Vitulano ML. Fite PJ. Hopko DR. et al. Evaluation of underlying mechanisms in the link between childhood ADHD symptoms and risk for early initiation of substance use. Psychology of addictive behaviors: journal of the Society of Psychologists in Addictive Behaviors 2014; 28 (03) 816-827
    PubMedGoogle Scholar
  • 5 Molina BS. Pelham Jr WE. Childhood predictors of adolescent substance use in a longitudinal study of children with ADHD. Journal of abnormal psychology 2003; 112 (03) 497-507
    CrossrefPubMedGoogle Scholar
  • 6 Barkley RA. Murphy KR. Fischer M. ADHD in adults: What the science says. Guilford Press; 2010
    PubMedGoogle Scholar
  • 7 Fayyad J. Sampson NA. Hwang I. et al. The descriptive epidemiology of DSM-IV Adult ADHD in the World Health Organization World Mental Health Surveys. Attention deficit and hyperactivity disorders. 2016
    PubMedGoogle Scholar
  • 8 Fayyad J. De Graaf R. Kessler R. et al. Cross-national prevalence and correlates of adult attention-deficit hyperactivity disorder. The British journal of psychiatry: the journal of mental science 2007; 190: 402-409
    CrossrefPubMedGoogle Scholar
  • 9 Huss M. Holling H. Kurth BM. et al. How often are German children and adolescents diagnosed with ADHD? Prevalence based on the judgment of health care professionals: results of the German health and examination survey (KiGGS). European child & adolescent psychiatry 2008; 17 (Suppl. 01) 52-58
    CrossrefPubMedGoogle Scholar
  • 10 de Graaf R. Kessler RC. Fayyad J. et al. The prevalence and effects of adult attention-deficit/hyperactivity disorder (ADHD) on the performance of workers: results from the WHO World Mental Health Survey Initiative. Occupational and environmental medicine 2008; 65 (12) 835-842
    CrossrefPubMedGoogle Scholar
  • 11 Kessler RC. Adler L. Barkley R. et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. The American journal of psychiatry 2006; 163 (04) 716-723
    CrossrefPubMedGoogle Scholar
  • 12 Sobanski E. Bruggemann D. Alm B. et al. Subtype differences in adults with attention-deficit/hyperactivity disorder (ADHD) with regard to ADHD-symptoms, psychiatric comorbidity and psychosocial adjustment. European psychiatry: the journal of the Association of European Psychiatrists 2008; 23 (02) 142-149
    CrossrefPubMedGoogle Scholar
  • 13 Estevez N. Dey M. Eich-Hochli D. et al. Adult attention-deficit/hyperactivity disorder and its association with substance use and substance use disorders in young men.. Epidemiology and psychiatric sciences 2015; 1-12
    PubMedGoogle Scholar
  • 14 Retz W. Retz-Junginger P. Romer K. et al. Standardised psychopathological rating scales for the diagnosis of ADHD in adults. Fortschritte der Neurologie-Psychiatrie 2013; 81 (07) 381-389
    PubMedGoogle Scholar
  • 15 Klassen LJ. Katzman MA. Chokka P. Adult ADHD and its comorbidities, with a focus on bipolar disorder. Journal of affective disorders 2010; 124 (01) 1-8
    CrossrefPubMedGoogle Scholar
  • 16 Young JT. Carruthers S. Kaye S. et al. Comorbid attention deficit hyperactivity disorder and substance use disorder complexity and chronicity in treatment-seeking adults. Drug and alcohol review 2015; 34 (06) 683-693
    CrossrefPubMedGoogle Scholar
  • 17 Levy S. Katusic SK. Colligan RC. et al. Childhood ADHD and risk for substance dependence in adulthood: a longitudinal, population-based study. PloS one 2014; 9 (08) e105640
    CrossrefPubMedGoogle Scholar
  • 18 De Alwis D. Lynskey MT. Reiersen AM. et al. Attention-deficit/hyperactivity disorder subtypes and substance use and use disorders in NESARC. Addictive behaviors 2014; 39 (08) 1278-1285
    CrossrefPubMedGoogle Scholar
  • 19 Nigg JT. Attention-deficit/hyperactivity disorder and adverse health outcomes. Clinical psychology review 2013; 33 (02) 215-228
    CrossrefPubMedGoogle Scholar
  • 20 Wilens TE. Adler LA. Weiss MD. et al. Atomoxetine treatment of adults with ADHD and comorbid alcohol use disorders. Drug and alcohol dependence 2008; 96 (01) 145-154
    CrossrefPubMedGoogle Scholar
  • 21 Wilens TE. The nature of the relationship between attention-deficit/hyperactivity disorder and substance use. The Journal of clinical psychiatry 2007; 68 (Suppl. 11) 4-8
    CrossrefPubMedGoogle Scholar
  • 22 van de Glind G. Konstenius M. Koeter MW. et al. Variability in the prevalence of adult ADHD in treatment seeking substance use disorder patients: results from an international multi-center study exploring DSM-IV and DSM-5 criteria. Drug and alcohol dependence 2014; 134: 158-166
    CrossrefPubMedGoogle Scholar
  • 23 van Emmerik-van Oortmerssen K. van de Glind G. van den Brink W. et al. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug and alcohol dependence 2012; 122 (01) 11-19
    CrossrefPubMedGoogle Scholar
  • 24 Hannesdottir H. Tyrfingsson T. Piha J. Psychosocial functioning and psychiatric comorbidity among substance-abusing Icelandic adolescents. Nordic journal of psychiatry 2001; 55 (01) 43-48
    CrossrefPubMedGoogle Scholar
  • 25 Matsumoto T. Kamijo A. Yamaguchi A. et al. Childhood histories of attention-deficit hyperactivity disorders in Japanese methamphetamine and inhalant abusers: preliminary report. Psychiatry and clinical neurosciences 2005; 59 (01) 102-105
    CrossrefPubMedGoogle Scholar
  • 26 Serra-Pinheiro MA. Coutinho ES. Souza IS. et al. Is ADHD a risk factor independent of conduct disorder for illicit substance use? A meta-analysis and metaregression investigation. Journal of attention disorders 2013; 17 (06) 459-469
    CrossrefPubMedGoogle Scholar
  • 27 Preuss UW. Rujescu D. Giegling I. et al. Psychometric evaluation of the German version of the Barratt Impulsiveness Scale. Der Nervenarzt 2008; 79 (03) 305-319
    CrossrefPubMedGoogle Scholar
  • 28 Verdejo-Garcia A. Lawrence AJ. Clark L. Impulsivity as a vulnerability marker for substance-use disorders: review of findings from high-risk research, problem gamblers and genetic association studies. Neuroscience and biobehavioral reviews 2008; 32 (04) 777-810
    CrossrefPubMedGoogle Scholar
  • 29 Sher KJ. Derefinko KJ. Pelham WE. ADHD and Substance Use. Oxford University Press; 2016
    PubMedGoogle Scholar
  • 30 Roberts W. Peters JR. Adams ZW. et al. Identifying the facets of impulsivity that explain the relation between ADHD symptoms and substance use in a nonclinical sample. Addictive behaviors 2014; 39 (08) 1272-1277
    CrossrefPubMedGoogle Scholar
  • 31 Iacono WG. Malone SM. McGue M. Behavioral disinhibition and the development of early-onset addiction: common and specific influences. Annual review of clinical psychology 2008; 4: 325-348
    CrossrefPubMedGoogle Scholar
  • 32 Kaye S. Gilsenan J. Young JT. et al. Risk behaviours among substance use disorder treatment seekers with and without adult ADHD symptoms. Drug and alcohol dependence 2014; 144: 70-77
    CrossrefPubMedGoogle Scholar
  • 33 Ortal S. van de Glind G. Johan F. et al. The Role of Different Aspects of Impulsivity as Independent Risk Factors for Substance Use Disorders in Patients with ADHD: A Review. Current drug abuse reviews 2015; 8 (02) 119-133
    CrossrefPubMedGoogle Scholar
  • 34 Ellis C. Hoffman W. Jaehnert S. et al. Everyday problems with executive dysfunction and impulsivity in adults recovering from methamphetamine addiction. Addictive disorders & their treatment 2016; 15 (01) 1-5
    CrossrefPubMedGoogle Scholar
  • 35 Meil WM. LaPorte DJ. Mills JA. et al. Sensation seeking and executive deficits in relation to alcohol, tobacco, and marijuana use frequency among university students: Value of ecologically based measures. Addictive behaviors 2016; 62: 135-144
    CrossrefPubMedGoogle Scholar
  • 36 Mostert JC. Onnink AM. Klein M. et al. Cognitive heterogeneity in adult attention deficit/hyperactivity disorder: A systematic analysis of neuropsychological measurements. European neuropsychopharmacology: the journal of the European College of Neuropsychopharmacology 2015; 25 (11) 2062-2074
    CrossrefPubMedGoogle Scholar
  • 37 Rommelse NN. Altink ME. Arias-Vasquez A. et al. A review and analysis of the relationship between neuropsychological measures and DAT1 in ADHD. American journal of medical genetics Part B, Neuropsychiatric genetics: the official publication of the International Society of Psychiatric Genetics 2008; 147b (08) 1536-1546
    CrossrefPubMedGoogle Scholar
  • 38 Fergusson DM. Horwood LJ. Ridder EM. Conduct and attentional problems in childhood and adolescence and later substance use, abuse and dependence: results of a 25-year longitudinal study. Drug and alcohol dependence 2007; 88 (Suppl. 01) S14-S26
    PubMedGoogle Scholar
  • 39 Szobot CM. Rohde LA. Bukstein O. et al. Is attention-deficit/hyperactivity disorder associated with illicit substance use disorders in male adolescents? A community-based case-control study. Addiction (Abingdon, England) 2007; 102 (07) 1122-1130
    CrossrefPubMedGoogle Scholar
  • 40 Flory K. Lynam DR. The relation between attention deficit hyperactivity disorder and substance abuse: what role does conduct disorder play?. Clinical child and family psychology review 2003; 6 (01) 1-16
    CrossrefPubMedGoogle Scholar
  • 41 Brook JS. Balka EB. Zhang C. et al. ADHD, Conduct Disorder, Substance Use Disorder, and Nonprescription Stimulant Use. Journal of attention disorders. 2014
    PubMedGoogle Scholar
  • 42 Matthys F. Möbius D. Stess S. et al. Good Clinical Practice in de herkenning en behandeling van ADHD bij (jong) volwassenen met verslavingsproblemen. Richtlijnen voor de klinische praktijk Brussel. VAD; 2010
    PubMedGoogle Scholar
  • 43 Kessler RC. Adler L. Ames M. et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in the general population. Psychological medicine 2005; 35 (02) 245-256
    CrossrefPubMedGoogle Scholar
  • 44 van de Glind G. van den Brink W. Koeter MW. et al. Validity of the Adult ADHD Self-Report Scale (ASRS) as a screener for adult ADHD in treatment seeking substance use disorder patients. Drug and alcohol dependence 2013; 132 (03) 587-596
    CrossrefPubMedGoogle Scholar
  • 45 Rösler M. Retz-Junginger P. Retz W. et al. HASE – Homburger ADHS-Skalen für Erwachsene. Göttingen: Hogrefe; 2008
    PubMedGoogle Scholar
  • 46 Christiansen H. Kis B. Hirsch O. et al. German validation of the Conners Adult ADHD Rating Scales (CAARS) II: reliability, validity, diagnostic sensitivity and specificity. European Psychiatry 2012; 27 (05) 321-328
    CrossrefPubMedGoogle Scholar
  • 47 Grabemann M. Methoden. Das Essener Interview zur schulzeitbezogenen Biografie bei adulter ADHS. Springer; 2016: 43-48
    Google Scholar
  • 48 Capella Mdel M. Benaiges I. Adan A. Neuropsychological Performance in Polyconsumer Men Under Treatment. Influence of Age of Onset of Substance Use. Scientific reports 2015; 5: 12038
    CrossrefPubMedGoogle Scholar
  • 49 van Emmerik-van Oortmerssen K. Vedel E. Koeter MW. et al. Investigating the efficacy of integrated cognitive behavioral therapy for adult treatment seeking substance use disorder patients with comorbid ADHD: study protocol of a randomized controlled trial. BMC psychiatry 2013; 13: 132
    CrossrefPubMedGoogle Scholar
  • 50 Ercan ES. Coskunol H. Varan A. et al. Childhood attention deficit/hyperactivity disorder and alcohol dependence: a 1-year follow-up. Alcohol and alcoholism (Oxford, Oxfordshire) 2003; 38 (04) 352-356
    CrossrefPubMedGoogle Scholar
  • 51 Carroll KM. Rounsaville BJ. History and significance of childhood attention deficit disorder in treatment-seeking cocaine abusers. Comprehensive psychiatry 1993; 34 (02) 75-82
    CrossrefPubMedGoogle Scholar
  • 52 Arias AJ. Gelernter J. Chan G. et al. Correlates of co-occurring ADHD in drug-dependent subjects: prevalence and features of substance dependence and psychiatric disorders. Addictive behaviors 2008; 33 (09) 1199-1207
    CrossrefPubMedGoogle Scholar
  • 53 Khantzian EJ. The self-medication hypothesis of substance use disorders: a reconsideration and recent applications. Harvard review of psychiatry 1997; 4 (05) 231-244
    CrossrefPubMedGoogle Scholar
  • 54 Gehricke JG. Whalen CK. Jamner LD. et al. The reinforcing effects of nicotine and stimulant medication in the everyday lives of adult smokers with ADHD: A preliminary examination. Nicotine & tobacco research: official journal of the Society for Research on Nicotine and Tobacco 2006; 8 (01) 37-47
    CrossrefPubMedGoogle Scholar
  • 55 Gehricke JG. Loughlin SE. Whalen CK. et al. Smoking to self-medicate attentional and emotional dysfunctions. Nicotine & tobacco research: official journal of the Society for Research on Nicotine and Tobacco 2007; 9 (Suppl. 04) S523-S536
    CrossrefPubMedGoogle Scholar
  • 56 Loflin M. Earleywine M. De Leo J. et al. Subtypes of attention deficit-hyperactivity disorder (ADHD) and cannabis use. Substance use & misuse 2014; 49 (04) 427-434
    CrossrefPubMedGoogle Scholar
  • 57 Pedersen SL. Walther CA. Harty SC. et al. The Indirect Effects of Childhood ADHD on Alcohol Problems in Adulthood through Unique Facets of Impulsivity. Addiction (Abingdon, England) 2016; 111 (09) 1582-1589
    CrossrefPubMedGoogle Scholar
  • 58 Philipsen A. Jans T. Graf E. et al. Effects of Group Psychotherapy, Individual Counseling, Methylphenidate, and Placebo in the Treatment of Adult Attention-Deficit/Hyperactivity Disorder: A Randomized Clinical Trial. JAMA psychiatry 2015; 72 (12) 1199-1210
    CrossrefPubMedGoogle Scholar
  • 59 Perez de los Cobos J. Sinol N. Perez V. et al. Pharmacological and clinical dilemmas of prescribing in co-morbid adult attention-deficit/hyperactivity disorder and addiction. British journal of clinical pharmacology 2014; 77 (02) 337-356
    CrossrefPubMedGoogle Scholar
  • 60 Rosler M. Fischer R. Ammer R. et al. A randomised, placebo-controlled, 24-week, study of low-dose extended-release methylphenidate in adults with attention-deficit/hyperactivity disorder. European archives of psychiatry and clinical neuroscience 2009; 259 (02) 120-129
    CrossrefPubMedGoogle Scholar
  • 61 Casas M. Rosler M. Sandra Kooij JJ. et al. Efficacy and safety of prolonged-release OROS methylphenidate in adults with attention deficit/hyperactivity disorder: a 13-week, randomized, double-blind, placebo-controlled, fixed-dose study. The world journal of biological psychiatry: the official journal of the World Federation of Societies of Biological Psychiatry 2013; 14 (04) 268-281
    PubMedGoogle Scholar
  • 62 Huss M. Ginsberg Y. Tvedten T. et al. Methylphenidate hydrochloride modified-release in adults with attention deficit hyperactivity disorder: a randomized double-blind placebo-controlled trial. Advances in therapy 2014; 31 (01) 44-65
    CrossrefPubMedGoogle Scholar
  • 63 Durell TM. Adler LA. Williams DW. et al. Atomoxetine treatment of attention-deficit/hyperactivity disorder in young adults with assessment of functional outcomes: a randomized, double-blind, placebo-controlled clinical trial. Journal of clinical psychopharmacology 2013; 33 (01) 45-54
    CrossrefPubMedGoogle Scholar
  • 64 Castells X. Ramos-Quiroga JA. Rigau D. et al. Efficacy of methylphenidate for adults with attention-deficit hyperactivity disorder: a meta-regression analysis. CNS drugs 2011; 25 (02) 157-169
    CrossrefPubMedGoogle Scholar
  • 65 Skoglund C. Brandt L. Almqvist C. et al. Factors Associated With Adherence to Methylphenidate Treatment in Adult Patients With Attention-Deficit/Hyperactivity Disorder and Substance Use Disorders. Journal of clinical psychopharmacology 2016; 36 (03) 222-228
    CrossrefPubMedGoogle Scholar
  • 66 Bihlar Muld B. Jokinen J. Bolte S. et al. Long-term outcomes of pharmacologically treated versus non-treated adults with ADHD and substance use disorder: a naturalistic study. Journal of substance abuse treatment 2015; 51: 82-90
    CrossrefPubMedGoogle Scholar
  • 67 Thurstone C. Riggs PD. Salomonsen-Sautel S. et al. Randomized, controlled trial of atomoxetine for attention-deficit/hyperactivity disorder in adolescents with substance use disorder. Journal of the American Academy of Child and Adolescent Psychiatry 2010; 49 (06) 573-582
    PubMedGoogle Scholar
  • 68 Kollins SH. MacDonald EK. Rush CR. Assessing the abuse potential of methylphenidate in nonhuman and human subjects: a review. Pharmacology, biochemistry, and behavior 2001; 68 (03) 611-627
    CrossrefPubMedGoogle Scholar
  • 69 Dursteler KM. Berger EM. Strasser J. et al. Clinical potential of methylphenidate in the treatment of cocaine addiction: a review of the current evidence. Substance abuse and rehabilitation 2015; 6: 61-74
    PubMedGoogle Scholar
  • 70 Janssen L. Kan CC. Carpentier PJ. et al. Mindfulness based cognitive therapy versus treatment as usual in adults with attention deficit hyperactivity disorder (ADHD). BMC psychiatry 2015; 15: 216
    CrossrefPubMedGoogle Scholar
  • 71 Green AI. Drake RE. Brunette MF. et al. Schizophrenia and co-occurring substance use disorder. The American journal of psychiatry 2007; 164 (03) 402-408
    CrossrefPubMedGoogle Scholar
  • 72 Green AI. Noordsy DL. Brunette MF. et al. Substance abuse and schizophrenia: pharmacotherapeutic intervention. Journal of substance abuse treatment 2008; 34 (01) 61-71
    CrossrefPubMedGoogle Scholar
  • 73 Schnell T. Integrierte Behandlung bei der Komorbidität Psychose und Sucht. Positionen der Psychiatrie. Springer; 2012: 121-125
    PubMedGoogle Scholar
  • 74 Najavits LM. Hien D. Helping vulnerable populations: a comprehensive review of the treatment outcome literature on substance use disorder and PTSD. Journal of clinical psychology 2013; 69 (05) 433-479
    CrossrefPubMedGoogle Scholar
  • 75 Lee NK. Cameron J. Jenner L. A systematic review of interventions for co-occurring substance use and borderline personality disorders. Drug and alcohol review 2015; 34 (06) 663-672
    CrossrefPubMedGoogle Scholar
  • 76 Kienast T. Stoffers J. Bermpohl F. et al. Borderline personality disorder and comorbid addiction: epidemiology and treatment. Deutsches Ärzteblatt international 2014; 111 (16) 280-286
    PubMedGoogle Scholar
  • 77 Miller WR. Motivational enhancement therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. DIANE Publishing; 1995
    PubMedGoogle Scholar
  • 78 Kadden R. Cognitive-behavioral coping skills therapy manual: A clinical research guide for therapists treating individuals with alcohol abuse and dependence. DIANE Publishing; 1995
    PubMedGoogle Scholar
  • 79 Safren S. Perlman C. Sprich S. et al. Mastering your adult ADHD: A cognitive-behavioral therapy approach. New York: Oxford University Press; 2005
    PubMedGoogle Scholar
  • 80 van Emmerik-van Oortmerssen K. Vedel E. van den Brink W. et al. Integrated cognitive behavioral therapy for patients with substance use disorder and comorbid ADHD: two case presentations. Addictive behaviors 2015; 45: 214-217
    CrossrefPubMedGoogle Scholar