Impact of ADHD and Its Treatment on Substance Abuse in Adults

Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance abuse in adults. Additionalpsychiatric comorbidity increases this risk. ADHD is associated with different characteristicsof substance abuse: substance abuse transitions more rapidly to dependence, and lasts longer in adultswith ADHD than those without ADHD. Self-medication may be a factor in the high rate of substanceabuse in adults with ADHD. While previous concerns arose whether stimulant therapy would increasethe ultimate risk for substance abuse, recent studies have indicated that pharmacologic treatment appearsto reduce the risk of substance abuse in individuals with ADHD. When treating adults withADHD and substance abuse, clinicians should assess the relative severity of the substance abuse, thesymptoms of ADHD, and any other comorbid disorders. Generally, stabilizing or addressing the substanceabuse should be the first priority when treating an adult with substance abuse and ADHD.Treatment for adults with ADHD and substance abuse should include a combination of addictiontreatment/psychotherapy and pharmacotherapy. The clinician should begin pharmacotherapywith medications that have little likelihood of diversion or low liability, such as bupropion andatomoxetine, and, if necessary, progress to the stimulants. Careful monitoring of patients during treatmentis necessary to ensure compliance with the treatment plan.