A qualitative review of issues arising in the use of psychostimulant medications in patients with ADHD and co‑morbid substance use disorders

  title={A qualitative review of issues arising in the use of psychostimulant medications in patients with ADHD and co‑morbid substance use disorders},
  author={Scott H. Kollins},
  journal={Current Medical Research and Opinion},
  pages={1345 - 1357}
  • S. Kollins
  • Published 1 April 2008
  • Psychology, Medicine
  • Current Medical Research and Opinion
ABSTRACT Objective: This review addresses the relationship between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs), with an emphasis on factors that determine the potential for psychostimulant abuse. Strategies for identification and treatment of patients with ADHD who are at risk for, or have, co-morbid SUD are also addressed. Research design and methods: The article was based on a qualitative review of current literature addressing co-morbid ADHD and SUD… 
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Several factors, including ADHD symptom severity, psychiatric comorbidity, persistent drug use, choice of medication, and concomitant psychosocial intervention, influence study results, and taking these factors into account may improve the likelihood of detecting significant effects in future research.
When ADHD and substance use disorders coexist : etiology and pharmacological treatment
Investigating the etiological relationship between ADHD and substance use problems and exploring doses of, and adherence to, pharmacological treatment for ADHD in the presence of SUD suggest that ADHD and SUD share common genetic underpinnings, that individuals with comorbid SUD receive higher stimulant doses than individuals with ADHD only, without signs of tolerance, and that Stimulant doses predict adherence to pharmacology treatment in individuals withComorbidSUD.
The Patient’s Perspective on the Link Between ADHD and Substance Use
Children with ADHD may have strong rational and emotional reasons for the use of alcohol and drugs, and investigation of personal reasons for alcohol/drug use deserves a place when planning for the treatment of adult ADHD.
Methylphenidate for Attention-Deficit and Hyperactivity Disorder in Adult Patients With Substance Use Disorders: Good Clinical Practice
Carefully applied guideline-based diagnostics to clarify the potential presence of ADHD as well as a responsible prescription practice in a well-defined therapeutic setting with reliable monitoring of medication intake and regular consultations are essential conditions for a safe and proficient MPH treatment of ADHD in patients with SUD.
The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders
It appears that ADHD pharmacotherapy does not increase the risk for SUD, and medication treatment alone does not appear to be particularly effective in treating SUD in currently active substance abusing individuals with ADHD.
Moodiness in Patients with ADHD and Substance Use Disorders
The extent of ADHD and SUDs, especially in clinical populations, and the etiological relationships between ADHD andSUDs are discussed, as well as their clinical management, from screening, assessment, and diagnosis, to treatment planning and specific interventions.
Treatment of Adult ADHD without Stimulants: Effectiveness in A Dually Diagnosed Correctional Population
It does appear that nonstimulants are effective in this population of patients with substance use disorders, residing in a correctional community center for treatment and reintegration purposes, and it is speculated that the response and remission rate could be improved by adding ADHD specific psychosocial interventions.
Prospective relationships of ADHD symptoms with developing substance use in a population-derived sample
Inattentiveness and hyperactivity may be more predictive of alcohol use disorders and maladaptive patterns of alcohol and illicit drug use among girls than boys.
A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders
Overall, the literature indicates that the ED and SUD should be addressed simultaneously using a multi-disciplinary approach and the need for medical stabilization, hospitalization or inpatient treatment needs to be assessed based on general medical and psychiatric considerations.
ADHD and Substance Abuse in Children and Adolescents
  • J. Sadek
  • Psychology, Biology
    Clinician’s Guide to ADHD Comorbidities in Children and Adolescents
  • 2018
Clinicians are encouraged to review the management considerations when using ADHD medications in adolescents with ADHD and addictions and some of the important principals of treatment for substance abusing adolescence with ADHD are discussed in this chapter.


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The results are consistent across substances and ADHD diagnoses, and support the hypothesis that pharmacotherapy does not cause subsequent SUDs.
Substance Abuse in Patients with Attention-Deficit Hyperactivity Disorder
This review article highlights the research in this area with a focus on the treatment of individuals who present with concomitant ADHD and SUD and indicates that methylphenidate in a population of adults with active cocaine dependence and ADHD indicates that this is the case.
Prevalence and Characteristics of Adolescent Patients with Co-Occurring ADHD and Substance Dependence
Results indicate 31% of patients have current ADHD diagnosis and 20% reported illicit diversion of Schedule II medication, which may be risky for an SUD population since individuals with SUD may have a higher likelihood of abusing or diverting the medications.
Impact of ADHD and its treatment on substance abuse in adults.
  • T. Wilens
  • Psychology, Medicine
    The Journal of clinical psychiatry
  • 2004
Treatment for adults with ADHD and substance abuse should include a combination of addiction treatment/psychotherapy and pharmacotherapy, and clinicians should assess the relative severity of the substance abuse, the symptoms of ADHD, and any other comorbid disorders.
Psychostimulant treatment and risk for substance abuse among young adults with a history of attention-deficit/hyperactivity disorder: a population-based, birth cohort study.
Findings indicate that psychostimulant treatment of childhood ADHD is associated with reduced risk for later substance abuse among boys with ADHD.
Pharmacotherapy of Attention-deficit/Hyperactivity Disorder Reduces Risk for Substance Use Disorder
Untreated ADHD was a significant risk factor for SUD in adolescence in boys with attention-deficit/hyperactivity disorder and pharmacotherapy was associated with an 85% reduction in risk for Sud in ADHD youth.
Is ADHD a risk factor for psychoactive substance use disorders : Findings from a four-year prospective follow-up study
Adolescents with and without ADHD had a similar risk for PSUD that was mediated by conduct and bipolar disorder, and a sharp increase in PSUD is to be expected in grown-up ADHD children during the transition from adolescence to adulthood.
Does stimulant therapy of attention‐deficit/hyperactivity disorder beget later substance abuse?
It is suggested that stimulant therapy in childhood is associated with a reduction in the risk for subsequent drug and alcohol use disorders.
A controlled trial of methylphenidate in adults with attention deficit/hyperactivity disorder and substance use disorders.
The effect of low-dose methylphenidate in adult ADHD patients with concomitant substance use disorders is limited, and ADHD symptoms in adults were susceptible to a distinct short-term placebo response.