Talk to the Veterans Crisis Line now
An official website of the United States government
|
Recommended citation: |
Download PDF: Complete Report, Executive Summary, Report, Appendices, Visual Summary
Prescribing stimulants to people with ADHD may have no effect on the risk of subsequent SUD. Available studies did not identify broad evidence of harm associated with the prescription of stimulants for people with ADHD. There are limited data about misuse and diversion of stimulant medications in people with ADHD. Prescribers should consider stimulant medications or other treatments for ADHD after a thorough, individualized risk benefit discussion with people.
Over the past decade there has been an increase in the documented prevalence and incidence of ADHD among adults. Prescription psychostimulants are first-line pharmacologic treatments for ADHD in adults. However, there is concern for misuse and diversion of psychostimulants, and concern that these medications may lead to a new SUD diagnosis or precipitate substance-related problems in people with co-occurring SUD and ADHD. This review synthesizes the literature of the effect of prescription stimulants on the incidence of SUD in adulthood in people with ADHD, as well as the effect of these medications on people with co-occurring ADHD and SUD.
Seven studies reported the incidence of SUD in people with ADHD without SUD at baseline and prescribed stimulant. Among people prescribed stimulants for ADHD, approximately 1 in 7 (14%, 95% CI [2%, 35%]) is newly diagnosed with SUD, though estimates varied drastically across studies (no evidence grading). Only 1 study assessed diversion or misuse among people prescribed stimulants for ADHD, where diversion was reported in 11% of people and misuse in 10% to 31% depending on definition (no evidence grading). Among people prescribed stimulants for ADHD compared to people with ADHD not prescribed stimulants, there is no evidence of a difference in the risk of a new SUD (low confidence). Seven studies compared stimulant treatment to other ADHD treatments in people with both ADHD and SUD. Among people with co-occurring ADHD and SUD who are prescribed versus not prescribed stimulants, there is no evidence of a difference in ADHD treatment adherence, substance use, SUD symptom change, and abstinence (all conclusions with low confidence). Among people with co-occurring ADHD and SUD who are prescribed versus not prescribed stimulants, there is insufficient evidence (no conclusion) to assess differences in ADHD symptom change, SUD treatment adherence, misuse or diversion, and depression/anxiety.
ADHD and Substance Use Disorders in Adults: A Systematic Review (Management Brief)
