AAP Issues Statement on ADHD and Substance Abuse

Substance abuse with ADHD is not uncommon but risk can be reduced

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Even though ADHD (attention deficit hyperactivity disorder) can be treated with stimulant medications, those who have ADHD are at higher risk for substance abuse.

For this reason, the American Academy of Pediatrics (AAP) recently released a statement discussing ways to reduce that risk.

One of the most important ways to reduce the risk, they reported, is to treat the ADHD, including with stimulant medications.

At the same time, these same medications can be a source of problems in those who develop a substance use problem.

The authors of the statement therefore recommend that health care providers regularly screen those who have ADHD and take stimulants for possible signs of a substance use problem.

"Follow instructions on taking ADHD medications."

This statement, authored by Elizabeth Harstad, MD, MPH, of the AAP Committee on Substance Abuse, reviewed strategies for reducing the risk that those with ADHD will develop substance abuse problems.

First, the authors reviewed what the risks are for those with ADHD, including the fact that those with ADHD are twice as likely to develop alcoholism than those without ADHD.

In addition, those with ADHD are three times more likely to become dependent on nicotine as a teen or adult and twice as likely to use it over a lifetime, compared to those without ADHD.

In addition to showing increased risks for using marijuana or cocaine, past research reveals that those with ADHD are about 2.5 times more likely to develop any substance use problem than those without the disability.

Yet, treating ADHD with stimulant medications decreases the risk of developing a substance use disorder by 85 percent, the authors reported.

The younger individuals are treated, the less likely they are to develop substance use problems, and behavioral therapy may reduce that risk as well.

"However, the recommended first-line medication therapy for ADHD is stimulant medications, which themselves pose a risk of misuse, diversion and abuse," the statement noted.

Therefore, one essential element to successful treatment of ADHD includes screening patients for substance use disorders and providing them with appropriate guidance on safely taking the medications.

"Individuals with co-occurring ADHD and active SUDs require a careful, individual risk/benefit assessment regarding the safety of prescribing a stimulant medication," the authors noted.

"Longer acting preparations of stimulant medication, the pro-drug formulation of dextroamphetamine and non-stimulant medications for ADHD all have lower abuse potential than short-acting preparations of stimulant medication," they wrote.

"Thus, [these medications'] use should be strongly considered if there is a high risk of misuse, diversion, or abuse of stimulant medications," they concluded.

The statement was published June 30 in the journal Pediatrics. The statement did not require outside funding. Information on conflicts of interest were not provided.

Review Date: 
June 30, 2014
Last Updated:
June 30, 2014