ADHD More Closely Linked To Substance Abuse Than Previously Thought

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The association between attention-deficit/hyperactivity disorder (ADHD) and substance abuse has long been noted, not a new report from the American Academy of Pediatrics (AAP) goes a large step further by warning parents and patients that ADHD and substance use disorders (SUDs) are “inextricably intertwined.”

The report was published online June 30 in Pediatrics, and it offers practical strategies for clinicians to reduce the risk of SUDs in patients with ADHD and suggestions for safely prescribing stimulant medication.

slide02An “important part of ADHD treatment and stimulant medication management includes screening for SUDs and providing anticipatory guidance around the appropriate and safe use of stimulant medications,” write Sheryl A. Ryan, MD, of Yale University in New Haven, Connecticut, and the AAP Committee on Substance Abuse.

Previous studies have already illustrated that children with ADHD, the most common neurobehavioral disorder of childhood, are significantly more likely to misuse alcohol, tobacco, and illicit substances compared to peers without ADHD.

Stimulant medications typically used to help treat ADHD could potentially reduce the risk for trying drugs or alcohol and developing an SUD, and the report notes there is no evidence that stimulants increase the likelihood of developing an SUD. However, this is complicated because stimulant medications also have the potential for misuse, diversion, and addiction. As the report explains, “misuse and diversion of stimulant medications are more widespread problems than abuse or addiction.”

The biggest problem is preventing the illicit trade of these medications. Research shows that between 16% and 23% of school-aged children are approached to buy or trade their medication.

“Individuals with co-occurring ADHD and active SUDs require a careful, individual risk/benefit assessment regarding the safety of prescribing a stimulant medication. Longer acting preparations of stimulant medication, the prodrug formulation of dextroamphetamine, and nonstimulant medications for ADHD all have lower abuse potential than short-acting preparations of stimulant medication and, thus, their use should be strongly considered if there is a high risk of misuse, diversion, or abuse of stimulant medications,” the report says.

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