Impact of ADHD Treatment on Substance Use Disorders

It's no secret that individuals with ADHD have the potential to develop other behavioral disorders such as oppositional defiant disorder (ODD) and conduct disorder (CD). Unfortunately, the risk of developing substance use disorder (SUD) increases by as much as four times for individuals with any of these behavioral disorders - a fact that complicates treatment of ADHD.

The most pressing concern about ADHD treatment among both parents and physicians is whether treatment with stimulant medications that have potential for abuse, such as Ritalin, increases the potential for SUD during adolescence or adulthood. And for children who have both ADHD and SUD, how do you treat both conditions without worsening either?

Recent research has suggested that for several reasons, it is important to treat ADHD, even if it means using stimulant medications, regardless of the existence or potential for SUD. For one, those with ADHD, particularly in the presence of CD, are more likely to use substances earlier in adolescence, use them more heavily, and have more trouble recovering. If ADHD is treated, there is less risk for the development of SUD. And if the child already has SUD as well as ADHD, medication used to treat ADHD may assure a better outcome from substance abuse treatment.

Experts agree that it is important to combine behavioral treatment with medication for those adolescents with ADHD who also have SUD so as to reduce the amount of medication needed. Doctors should consider prescribing newer long-acting medications or a non-stimulant medication called Strattera, which is very effective for the symptoms of ADHD but has little abuse potential.