A new study reveals a concerning gap in care for young people struggling with both attention-deficit/hyperactivity disorder (ADHD) and substance use disorders. Researchers found that adolescents and young adults diagnosed with both conditions are significantly less likely to receive the standard first-line treatment for ADHD – central nervous system (CNS) stimulants – despite evidence suggesting these medications can improve outcomes and even reduce mortality risk.
The findings, published in the Journal of the American Academy of Child & Adolescent Psychiatry, highlight a potential disconnect between clinical guidelines and real-world practice. Up to 50% of individuals with ADHD may also develop a substance use disorder, facing worse outcomes than those with either condition alone, according to the research team from Penn State College of Medicine. This underscores the urgent need to address both conditions concurrently, and effectively.
Researchers analyzed de-identified health records of over 1.2 million individuals aged 15 to 25, identifying approximately 288,000 with both ADHD and a substance use disorder – ranging from nicotine to opioids. The analysis revealed that ADHD treatment, whether with stimulants or non-stimulants, was associated with fewer hospitalizations, emergency room visits, accidental overdoses, and suicidal thoughts. Importantly, overall mortality risk was reduced by roughly 30% over a five-year period for those receiving ADHD treatment.
“For young adults with ADHD and substance use disorder, appropriate treatment for ADHD could potentially save lives,” said Raman Baweja, professor of psychiatry and behavioral health and of public health sciences at Penn State College of Medicine, and the study’s first author. “Clinicians shouldn’t hesitate to provide evidence-based ADHD treatment when it is indicated.”
The Hesitancy Around Stimulant Medication
Whereas CNS stimulants are generally considered the most effective treatment for ADHD, clinicians often express concerns about prescribing them to individuals with a history of substance use. These concerns stem from the potential for misuse and the fear that stimulants could exacerbate substance use symptoms. The medications are also classified as controlled substances, adding another layer of caution. However, the study challenges this hesitancy, demonstrating that, when used appropriately, stimulants are linked to improved health outcomes.
The research showed that patients receiving stimulant medications experienced even greater reductions in risk compared to those on non-stimulant alternatives. Specifically, thoughts of suicide and suicide attempts were 4% lower among those treated with stimulants. Despite this, prescriptions for ongoing stimulant treatment decreased by approximately 15%, and new stimulant prescriptions dropped by over 17% after a young person with ADHD received a substance use disorder diagnosis.
“Although CNS stimulants are first-line, evidence-based treatments for ADHD, some clinicians appear hesitant to prescribe them in patients with substance use disorder based on these findings,” Baweja explained. “We theorize that it is because of concerns about misuse, which we agree are a real risk. Our findings suggest that, when used appropriately, treating ADHD – including with stimulants – can be associated with significantly better outcomes.”
Expanding the Research and Future Directions
The Penn State team is now expanding their research to include a broader age range, from 16 to 65, to further investigate the interplay between ADHD and substance use disorders. This expanded analysis will consider demographic factors like age, sex, and race/ethnicity, as well as clinical factors such as the specific type of substance use disorder and any co-occurring mental health conditions. Understanding these nuances could help clinicians tailor treatment plans more effectively.
The study’s authors included James Waxmonsky, Daniel Waschbusch, Felix Padilla, and Ritika Baweja from Penn State College of Medicine, along with collaborators from Mayo Clinic, the University of California, San Diego, the University of Pittsburgh, and Massachusetts General Hospital. The research was funded by the National Center for Advancing Translational Sciences of the National Institutes of Health.
This research underscores the importance of a comprehensive and integrated approach to treating young people with co-occurring ADHD and substance use disorders. Addressing both conditions simultaneously, rather than focusing solely on substance use, may be crucial for improving long-term health and reducing the risk of tragic outcomes.
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Disclaimer: This article provides informational content and should not be considered medical advice. Please consult with a qualified healthcare professional for diagnosis and treatment of any medical condition.
