People living with untreated ADHD have a tendency to self-medicate. When ADHDers self-medicate, their drug of choice can range from mostly benign (like coffee) to unhealthy but legal (like cigarettes) to potentially more problematic (like alcohol).

And in some cases, logically enough, ADHDers end up self-medicating with stimulants. It’s not hard to see the rationale here: for the ADHD brain, illicit stimulants can perform some of the same functions as legal ADHD medications like amphetamine and methylphenidate.

AddictionSure, illicit stimulants aren’t as effective as ADHD meds, and there’s a lot that can go wrong – but on some level, any kind of stimulant gives the ADHD brain what it “wants.” The result is that a lot of people with ADHD end up abusing stimulants before they get diagnosed.

And when they do get diagnosed, their doctors have a dilemma: is it really a good idea to prescribe stimulants to someone who has a history of abusing stimulants?

As it turns out, the answer may be yes.

The general idea here is simple even if it’s somewhat paradoxical: if self-medicating for ADHD is part of what leads someone to use illicit stimulants, treating the ADHD removes part of what drives that person to use illicit stimulants. So, by treating the ADHD you’re also treating the stimulant use, and you’re essentially treating the stimulant use by … prescribing stimulants.

For what it’s worth, it’s probably not just a handful of people who abuse stimulants that have ADHD. In fact, a 2013 study of 269 illicit stimulant users found that 45 percent of them had (mostly undiagnosed) ADHD. A 2017 study similarly found that people with ADHD were more likely to use crack and amphetamine.

The science also suggests that treating ADHD can make it easier to treat illegal stimulant use. For example, a recent systematic review of studies looking at stimulant users with ADHD found that treating ADHD with meds, especially at higher doses, is associated with quitting stimulants.

Some scientists even want to take things a step further when it comes to fighting stimulants with stimulants. For instance, one team of researchers at Columbia University has proposed that stimulant medication should be explored as a treatment for cocaine dependence in people both with and without ADHD. In their paper, the researchers reported two examples of people with cocaine dependence who were treated successfully with stimulants, but the idea is still controversial.

What’s less controversial, though, is that untreated ADHD does seem to be pretty clearly associated with higher risk for illicit stimulant use. In practical terms, there are two big takeaways here.

The first is that people who use stimulants are statistically much more likely to have ADHD and should be evaluated for the disorder. And the second is that when stimulant users have ADHD, treating ADHD can make it a lot easier to address the stimulant use.

Image: Flickr/Alan Cleaver