When ADHD and substance use occur together, mental health professionals can face a dilemma. Treating the ADHD might help treat the substance use, but one of the first-line treatments for ADHD is stimulants – a substance with the potential for abuse.
Considering that substance abuse is an extremely common comorbid condition in ADHD, how mental health professionals approach the potential dilemma has implications for many people with ADHD.
Individual mental health professionals take different perspectives on how to treat ADHD accompanied by problematic drug or alcohol use. Increasingly, though, there seems to be movement toward the recognition that fully treating ADHD, including with stimulant medications, is necessary to help people with both ADHD and substance use.
Last year, for example, 55 experts from 17 countries released a consensus statement on treating co-occurring ADHD and substance use in teenagers. The experts agreed that a combination of therapy and medication was best for these adolescents, with stimulants the go-to medication.
The only area where the experts didn’t reach a consensus was on the question of whether teens with ADHD and substance use should have to reach a point of abstinence from substances before starting ADHD medication.
Now, there’s a study out with new evidence that medication might be an integral part of treating substance use when it occurs alongside ADHD.
The study comes from researchers at Vanderbilt University Medical Center and Massachusetts General Hospital who tracked outpatients in an addiction clinic for six years.
Altogether, nine percent of the substance use patients surveyed received clinical diagnoses of ADHD. These patients tended to be younger, and they were more likely to have problems with cocaine use in particular.
It turned out that whether these people received ADHD medication made a decisive difference in the course of their substance use treatment.
When the participants with ADHD and substance use received medication, they stayed enrolled in their treatment programs for longer, with a median treatment length of 36 months. Unmedicated patients, on the other hand, had a median treatment length of only nine months, and they were about five times as likely to drop out within the first three months of treatment.
According to the authors of the study, that pattern indicates that “ADHD pharmacotherapy is robustly associated with improved short- and longer-term retention in outpatient SUD treatment” – although the study didn’t untangle the cause-and-effect of why that might be the case.
One possible explanation could be that treating ADHD puts people in a better position for managing substance use too while leaving ADHD untreated makes people more vulnerable to continue drug use.
That might happen if substance use is a type of self-medication for people with ADHD, in which case replacing self-medication with actual medication could lesson the need for using illicit or unhealthy substances. It could also happen if ADHD symptoms such as impulsivity put people at higher risk for addiction.
The fact that people with both substance use and ADHD had higher levels of cocaine use is one hint that self-medication could, at least in theory, play a role.
After all, cocaine is a stimulant, and some people with undiagnosed ADHD report “using cocaine to fight the symptoms,” as one article in the Atlantic put it. Research has found that treating ADHD with medication can lead to dramatic reductions in cocaine use and that improvements in ADHD symptoms tend to come before cocaine abstinence among people being treated for ADHD and cocaine dependence.
Whatever the reason, the latest study suggests that treating ADHD symptoms with medication is associated with staying in treatment longer for people who have both ADHD and problematic substance use.
Ultimately, it may be that prescribing medication for people with ADHD and a history of drug use not only isn’t harmful, but is an important step to treating the substance use as well.