Prescribing stimulants to people with ADHD who also have substance use disorders is so counterintuitive that many medical professionals simply refuse to do it. After all, handing over a controlled substance to someone with a drug problem sounds like a bad idea, right?
On the other hand, not prescribing stimulants for people with ADHD and addiction potentially means denying them access to to a treatment that would improve their ADHD symptoms. If the ADHD symptoms are a contributing factor to the drug use, doing so might ultimately exacerbate these people’s drug use.
So how do we know whether prescribing stimulants to people with ADHD and substance use is advisable? Through scientific studies, of course.
A new review published by researchers in Italy suggests that stimulants are a safe treatment for people with drug use, and that these people are likely to benefit from access to ADHD medication. The researchers examined studies of people with ADHD who used drugs including cocaine, marijuana, methamphetamine and opioids.
On the whole, the studies indicated that prescribing stimulants to people with ADHD and addiction is safe. The researchers point out that there are some obvious examples where prescribing stimulants is inappropriate, such as when someone is currently abusing prescription stimulants! They also highlight that treating the substance use before the ADHD is often the best approach but isn’t always necessary:
In general, an active patient with substance use disorders should be treated (usually via referral to a mental health counselor or addiction specialist) before the beginning of a therapy against ADHD. However, for patients with well-documented ADHD that predates the onset of substance use, it may be reasonable to treat both disorders concurrently.
Many, but not all of the studies, found that stimulants improved people’s ADHD symptoms, suggesting that there is real potential for meds to help people with ADHD and substance use. According to the authors, the effectiveness of stimulants in treating ADHD symptoms depended on factors like what substances people used, how long they’d been addicted, and their age.
Interestingly, some of the studies found evidence that ADHD meds also improved people’s substance abuse symptoms, for example by reducing craving and making them less likely to relapse. However, many of the studies also found that meds had little or no effect on substance use.
One way to interpret these mixed findings, according to the authors of the review, is by thinking about which aspects of substance use ADHD meds specifically can help with. According to the authors, ADHD meds may take away people’s need to “self-medicate” their ADHD symptoms with illicit substances, but not help with other aspects of addiction such as withdrawal symptoms.
In the final tally, the researchers conclude that “stimulant and non-stimulant treatments should be used to aid ADHD symptomatology in patients with substance use disorder.”
This recommendation might seem unremarkable, but it’s worth highlighting given that some doctors still refuse to prescribe stimulants to any patients with a history of substance abuse. Considering the recent research that has been done on the topic, such an approach is looking increasingly outdated.
Image: Flickr/Tony Webster