Impact of ADHD and Its Treatment on Substance Abuse in Adults
J Clin Psychiatry 2004;65(suppl 3):38-45
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance abuse in adults. Additional
psychiatric comorbidity increases this risk. ADHD is associated with different characteristics
of substance abuse: substance abuse transitions more rapidly to dependence, and lasts longer in adults
with ADHD than those without ADHD. Self-medication may be a factor in the high rate of substance
abuse in adults with ADHD. While previous concerns arose whether stimulant therapy would increase
the ultimate risk for substance abuse, recent studies have indicated that pharmacologic treatment appears
to reduce the risk of substance abuse in individuals with ADHD. When treating adults with
ADHD and substance abuse, clinicians should assess the relative severity of the substance abuse, the
symptoms of ADHD, and any other comorbid disorders. Generally, stabilizing or addressing the substance
abuse should be the first priority when treating an adult with substance abuse and ADHD.
Treatment for adults with ADHD and substance abuse should include a combination of addiction
treatment/psychotherapy and pharmacotherapy. The clinician should begin pharmacotherapy
with medications that have little likelihood of diversion or low liability, such as bupropion and
atomoxetine, and, if necessary, progress to the stimulants. Careful monitoring of patients during treatment
is necessary to ensure compliance with the treatment plan.