Beyond the tip of the iceberg: A narrative review to identify research gaps on comorbid psychiatric disorders in adolescents with methamphetamine use disorder or chronic methamphetamine use

Abstract

Background

Methamphetamine use disorder (MUD) frequently begins in adolescence, often accompanied by other psychiatric or mental disorders. Up to now, no comprehensive review about MUD and comorbid disorders in adolescents is available. We thus aimed to review the literature on comorbid mental disorders and MUD in adolescents in order to identify future research topics. Method: A PubMed search was conducted in July 2019. Relevant comorbidities were defined as attention-deficit disorder with/without hyperactivity, anxiety disorders, depression, eating disorders, post-traumatic stress disorder, psychosis, borderline personality disorder, conduct disorder and antisocial personality disorder, as well as other substance use disorders. For each comorbidity, we summarized prevalence rates, findings on comorbidity mechanisms, and recommended treatment options, if applicable. Results: Few articles focused on MUD in adolescents. Prevalence rates differed largely between comorbid disorders, with tobacco use disorder, conduct disorder, post-traumatic stress disorder, anxiety disorders, and attention-deficit disorders being the most prevalent comorbidities while eating disorders were rare. Examined onset patterns and comorbidity mechanisms indicated three groups of comorbidities: preexisting disorders self-medicated with methamphetamine, disorders induced by chronic methamphetamine use, and disorders arising due to risk factors shared with MUD. Reviewed comorbidities were frequently associated with worse treatment outcomes. Conclusions: The limited evidence is in stark contrast to the presumably high prevalence and relevance of comorbid mental disorders in adolescents with MUD. Suggestions for future research topics, informed by adult findings, include genetic vulnerabilities, biological changes, and consequences of different use patterns. Surprisingly few MUD treatment programs explicitly integrate comorbid mental disorder modules.

Keywords:

• Addiction
• crystal meth
• drug abuse
• mental health
• substance use
• therapy

Acknowledgments

The authors would like to thank Melina Wiedmann (Technische Universität Dresden) and Käthe Kuppka (Technische Universität Dresden) for their help in searching and preparing relevant literature for analysis, and Eveliina Glogan (Maastricht University) for language editing services.

Disclosure statement

SKP declares: In accordance with Taylor & Francis policy and my ethical obligation as a researcher, I am reporting that during the past 12 months I received <100 EUR overall in author fees from a publisher of medical books (Mabuse Verlag) as well as 500 EUR honoraria for one speech from a group of companies (AbbVie Deutschland, Almirall Hermal, Belano medical, Celgene, Janssen-Cilag, LEO Pharma, Lilly Deutschland, Novartis Pharma, Pfizer Pharma, UCB Pharma) that may be affected by the research reported in the enclosed paper.

The other authors have no conflict of interest to declare.

Notes

1 See the online study protocol at https://clinicaltrials.gov/ct2/show/NCT03444974

Additional information

Funding

No funding relates to the manuscript. SKP and LAB were funded through the Sächsische Aufbaubank -Förderbank- [grant 100362999 to YG].