Prevalence of Common Cormorbid Disorders and Impact of Treatment on Adolescents With a Substance Abuse Disorder

Comorbid Disorder	Prevalence Among Adolescents With SUD	Effective Treatment for Adolescents Without SUD	Impact of Treatment on Adolescents With SUD
Conduct Disorder (CD)	60–80%	Multisystemic therapy or other behavioral, family-based intervention	Decreases both CD and substance use, especially when augmented with specific behavioral intervention for SUD
Attention-Deficit/Hyperactivity Disorder (ADHD)	30–50%	Pharmacotherapy (generally, psychostimulants) Medication options with low abuse potential: pemoline, bupropion, atomoxetine	One controlled trial of pemoline suggests: Effective for ADHD Good safety profile No impact on SUD without substance abuse treatment Research is needed on other low-abuse medication
Depression	15–25%	Combined pharmacotherapy and psychotherapy Pharmacotherapy: SSRIs in adolescents without SUD Psychotherapy: cognitive-behavioral therapy (CBT) and interpersonal psychotherapy, combined with medication for severe depression	Preliminary evidence suggests: SSRIs may reduce depression, but are inadequate for SUD in the absence of specific substance abuse treatment Good safety profile for fluoxetine (SSRI) in nonabstinent adolescents in one randomized, controlled trial Bupropion may be effective for depression and ADHD in adolescents; fairly good safety profile with comorbid SUD Tricyclics contraindicated
Anxiety Disorders (often comorbid with depression; includes posttraumatic stress disorder [PTSD])	15–25%	Combined psychotherapy (CBT) and pharmacotherapy (SSRI)	Preliminary evidence suggests: CBT and SSRIs effective for anxiety disorders/PTSD but inadequate for SUD without specific SUD treatment
Bipolar Disorder	10–15%	Pharmacotherapy Mood stabilizers (lithium, valproic acid, carbamazepine)	One randomized controlled trial of lithium for bipolar disorder with SUD suggests: Pharmacotherapy is effective for bipolar disorder but not adequate for SUD without specific SUD treatment