Do stimulants for ADHD increase the risk of substance use disorders?
For some patients, stimulants might protect against future SUDs
Table 2 offers clinical recommendations to minimize the risk of SUDs when treating ADHD patients with stimulants. Long-acting stimulant formulations are preferred over short-acting medications because they are less likely to be abused. Psychosocial interventions for treating ADHD and co-occurring SUD disorder include cognitive-behavioral therapy with emphasis on structured skills training and cognitive remediation.
Table 2
Minimizing SUD risk when treating ADHD patients with stimulants
| Assess symptom burden and psychosocial impairment |
| Establish a treatment contract and boundaries at the onset of treatment, including your right to terminate treatment if you suspect stimulant misuse |
| Assess for comorbidities that may increase your patient’s SUD risk (see Table 1) |
| Emphasize strict adherence to treatment recommendations |
| Involve the patient’s family as much as possible |
| Obtain collateral information on the patient’s history of ADHD-related symptoms from parents, siblings, significant others, etc. |
| Distinguish between patients with substance use vs an SUD or a history of an SUD |
| Obtain urine toxicology screening as appropriate |
| Carefully document dispensed stimulants– strength of medication, number of capsules, pills, patches, etc. Note date of dispensation and refill dates |
| Select delayed- or extended-release stimulant formulations |
| Consider prescribing nonstimulants if appropriate |
| Use rating scales such as Conners Adult ADHD Rating Scale to monitor ADHD symptom severity and response to treatment |
| Schedule frequent, face-to-face clinical monitoring visits |
| ADHD: attention-deficit/hyperactivity disorder; SUD: substance use disorder |
Related Resource
- Faraone SV, Wilens T. Does stimulant treatment lead to substance use disorders? J Clin Psychiatry. 2003;64(suppl 11):9-13.
- Upadhyaya HP, Rose K, Wang W, et al. Attention deficit hyperactivity disorder medication and substance use patterns among adolescents and young adults. J Child Adolesc Psychopharmacol. 2005;15:799-809.
- Mariani JJ, Levin FR. Treatment strategies for co-occurring ADHD and substance use disorders. Am J Addict. 2007;16(suppl 1):45-56.
Drug Brand Names
- Atomoxetine • Strattera
- Bupropion • Wellbutrin, Zyban
- Guanfacine • Tenex, Intuniv
- Methylphenidate • Ritalin
- Modafinil • Provigil
- Venlafaxine • Effexor
Disclosures
Dr. Shailesh Jain and Dr. Islam report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
Dr. Rakesh Jain has received research support from, is a consultant to, and/or is a speaker for Addrenex Pharmaceuticals, AstraZeneca, Eli Lilly and Company, Forest Pharmaceuticals, Merck, Pamlab, Pfizer Inc., Shionogi Inc., Shire, and Sunovion Pharmaceuticals.
