ADHD and Substance Use Disorders
Adult Attention-Deficit/Hyperactivity Disorder (ADHD) is often treated with stimulant medication. The issue with this type of medication has to do with those individuals who have co-occurring substance abuse problems and ADHD. Over one-half of adults with ADHD have a co-occurring substance use disorder; however, 95% of medications to treat ADHD are methylphenidates, or stimulants. Methylphenidate is a safe and effective treatment for ADHD and many find relief from ADHD symptoms through its use. Methylphenidate, however, does have the same properties as amphetamines and cocaine, which is why it is considered a controlled substance.
The issue is that individuals with ADHD can either become addicted to the stimulant medication or can relapse from other substance abuse problems. Antidepressant medications are also prescribed for ADHD; however, some individuals do not respond to antidepressants. As many as 50% of adults with ADHD have co-occurring substance use disorder, primarily alcohol, cocaine, and marijuana. Individuals with ADHD show an earlier onset of substance abuse that is not responsive to treatment and can progress to alcohol and other drugs quickly.
There are four components of ADHD that may account for co-occurring substance use disorders including hyperarousal, inattention, impulsiveness, and a reward system deficit. These neurobehavioral deficits truly define ADHD. Alcohol and drugs can counteract the reward system deficit making it more enjoyable to use substances and drink alcohol.
Considerations should be taken for those individuals with ADHD and substance use disorder and the use of stimulant medication. If a person has not responded well to alternate treatments such as antidepressants, stimulant medication might need to be prescribed. If an individual is severely impaired by their ADHD symptoms, stimulant medication might need to be prescribed. An individual with ADHD can become addicted to stimulant medication; however, this was only found in 8%, as reported in one study. Stimulant abuse might also not develop immediately, and one report found that abuse became apparent after six months of stimulant medication treatment.
Antidepressant medications have shown promise in treating adults with ADHD, as they do not have the potential for abuse; therefore, an individual with co-occurring substance abuse and ADHD should seek medical assistance.
ADHD and substance use disorders are two serious disorders that can affect an individual’s social and occupational functioning. Care should be taken when an adult with ADHD has a co-occurring substance abuse problem especially when needing to take medication for the ADHD.
