top of page

Destigmatizing ADHD Stimulant Medication and Substance Use Disorder

Clarifying the essentials of ADHD stimulant medication and destigmatizing the potential link of substance use disorder.


Written by Sarah Talarico and reviewed by Shawn Horn, PsyD, PS


A bottle of medication knocked over on a wood surface. Medication picture used as example of substance abuse or ADHD medicine.

Regarding your mental and physical health, you want to ensure that your treatments won't cause problems later on, especially when the solution is medication. For attention-deficit/hyperactivity disorder (ADHD), there are many options for treatment, but stimulant medications stand out among the rest and are considered the first-line treatment for ADHD. Still, there is a commonly held concern among parents of kids with ADHD and adults pursuing ADHD treatments whether the use of stimulant medication could contribute to a higher risk of substance use disorder (SUD).


In this blog, we will explore what stimulant medication is, why it's a first-line treatment for ADHD, whether or not it's linked to substance use disorder, and what you should do for treatment.


 

What Is A Stimulant?


Stimulants are drugs that speed up the body’s systems, such as heightening alertness, concentration, and performance. They can also improve mood and motivation. While terms like cocaine, speed, and methamphetamine are often associated with these drugs, it's crucial to recognize that not all stimulants are equal and aren't universally harmful. For example, coffee, a widely cherished beverage, is a beneficial stimulant that enhances brain function, keeping us awake, alert, and refreshed.

Coffee in a mug, coffee beans, and coffee grounds are on a table. This image is used to show that coffee is an example of a stimulant.

However, we all know that too much of a good thing can be bad, like excessive coffee consumption can lead to anxiety, headaches, and irritability. It's important to acknowledge that stimulants, when misused, have the potential to be addictive and detrimental to our well-being.


How Stimulant Medications Differ From Illicit Stimulant Drugs


While both stimulant medication and illicit stimulant drugs activate the central nervous system (CNS) and increase the body's functions, there are important differences.


ADHD stimulant medications are classified into two main categories: methylphenidate-based and amphetamine-based medications. Within those two types, various dosages, delivery methods, and formulations impact the medication's duration and effectiveness. These medications are controlled, regulated, and prescribed by qualified providers intending to treat a specific condition.


An illicit stimulant drug is illegal to manufacture, possess, or use because of its high potential for abuse, addiction, and adverse health effects. These drugs often have intentional or accidental impurities that increase the toxicity of the substance.


Some ways they differ:

  • Chemical composition and formulation

  • Usage and purpose

  • Legality

  • Potential for abuse and addiction

  • Safety and health effects

  • Monitoring and medical supervision


Here are some articles related to this topic:


Why Are Stimulants A First-Line Treatment For ADHD?


First, we need to understand ADHD a little more. At its core, ADHD is a deficit of executive function, skills that regulate and manage our behaviors and cognitive abilities. These skills include time management, planning and problem-solving, working memory, inhibition (impulse control), emotion regulation, self-awareness, cognitive flexibility, and adaptability. These challenges are associated with an imbalance of neurotransmitters, or chemicals, in the brain. This imbalance can make people with ADHD more susceptible to various coexisting conditions and disorders, such as substance use disorders (SUD).


Research suggests that individuals with ADHD have a heightened risk of developing SUDs, with the likelihood being twice as high for those with ADHD alone and four times higher for those with ADHD and comorbid conduct disorder (Wilens et al., 2011; Ercan et al., 2003; Zulauf et al., 2014). This susceptibility is associated with ADHD symptoms such as impulsivity, engagement in riskier behaviors, self-medication practices, and underlying genetic vulnerabilities (American Psychological Association, n.d.)." This predisposition is why many people are concerned about the use of stimulant medication since stimulants are known to be potentially addictive and harmful. 


So why would doctors and psychiatrists be prescribing stimulants to people who have ADHD if they're especially vulnerable to an SUD?


"Stimulants, a first-line treatment for this condition, are among the most effective and most studied psychotropic medications." - Using Stimulants for Attention-Deficit/Hyperactivity Disorder: Clinical Approaches and Challenges (Stevens et al., 2013)

The decision to prescribe stimulants is grounded in addressing the underlying neurological imbalance of neurotransmitters such as dopamine, serotonin, and norepinephrine, which play a vital role in regulating our cognitive and behavioral abilities. Stimulant medications act to rebalance these neurotransmitters, alleviating executive function challenges and reducing unwanted symptoms.


"[Stimulant medication improves] ADHD symptoms in about 70% of adults and 70–80% of children." - Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers (Advokat & Scheithauer, 2013)

The purpose of using stimulant medication for ADHD treatment is not solely to alleviate symptoms but to restore a neurochemical equilibrium. Stimulants reduce the likelihood of developing an SUD by actively balancing the ADHD brain and treating executive function challenges. The impact of stimulant medications extends beyond symptom management, enhancing academic and occupational performance, interpersonal relationships, and overall quality of life for individuals with ADHD (Banaschewski et al., 2014; Coghill, 2010; Mechler et al., 2022).


"Moreover, there are studies suggesting that psychostimulants also reduce the risk of emergency admission to hospital for trauma (Man et al., 2017), suicidal events (Chen et al., 2014), substance abuse (Chang et al., 2013), criminality (Lichtenstein et al., 2012), and unintentional injuries (Ghirardi et al., 2020; Ruiz-Goikoetxea et al., 2018)." - Evidence-based pharmacological treatment options for ADHD in children and adolescents (Mechler et al., 2021)

Should I Be Worried About Substance Use Disorder?


Multiple studies show that ADHD stimulant medication is not associated with an increase in SUDs. Even though stimulant medication has the potential for abuse, when they are used as prescribed under medical supervision, they are generally safe and effective. In fact, research shows that ADHD stimulant medication significantly reduces the risk of developing an SUD and has a positive long-term protective effect on SUDs (Chang et al., 2013).


“We found that stimulant treatment for ADHD significantly reduced later substance problems – particularly in adolescents.”- The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders (Zulauf et al., 2014)

While individual responses to medication may vary, the overwhelming body of research supports the safety and efficacy of stimulant medications when used as prescribed for the treatment of ADHD. Individuals must engage in open and ongoing communication with their healthcare providers to monitor and optimize treatment plans, addressing potential concerns promptly and comprehensively.


What Should I Do For Treatment?


Everyone is different, so it's best to consult a healthcare professional and create an individualized treatment plan. Healthcare professionals carefully consider genetics, medical history, and individual responses to different medications. They collaborate with patients to tailor treatments that align with their unique needs and preferences. This personalized approach enhances treatment efficacy and minimizes potential side effects, fostering a collaborative, patient-centered healthcare experience.


While stimulant medication for ADHD is considered a first-line treatment, there's still a chance it may not work with you. Fortunately, there are plenty of alternatives for ADHD treatment. Non-stimulant medications act in a similar way to stimulants, although not as strongly, and without methylphenidate and amphetamines. When stimulant medication proves ineffective or leads to adverse reactions, providers typically recommend non-stimulant medications. Reasons for choosing non-stimulant options may include the presence of another coexisting disorder that may not align well with stimulant use, a history of substance use disorder, or individual patient preferences. 


It's essential to recognize that ADHD treatment extends beyond medication alone. While stimulant and non-stimulant medications play a pivotal role, healthcare professionals often recommend a multimodal treatment approach. This approach integrates various therapeutic modalities to address the diverse aspects of ADHD, such as psychoeducation and psychotherapeutic and psychosocial interventions. Psychoeducation equips individuals and their families with a deeper understanding of ADHD, empowering them to navigate challenges effectively. Psychotherapeutic interventions, such as cognitive-behavioral therapy, can complement medication by addressing specific behavioral patterns. Psychosocial interventions, including organizational and time management strategies, contribute to comprehensive ADHD management, ensuring a holistic and personalized treatment plan.


Doctor writing something on a clipboard while smiling and laughing with a patient. Picture is to show a positive relationship with between patients and doctors.

 

We hope you found this information on ADHD stimulant medication helpful. If so, we would be grateful if you shared this blog with a few friends, colleagues, or family members. By sharing our blogs, you play a crucial role in helping us spread mental health awareness and craft more meaningful content for readers like you.


Join our email list to read our current blog articles and to get further resources and information.


Disclaimer for Inspired Living Blog


The information on the Inspired Living Blog is intended for educational and informational purposes only. It is not meant to replace professional psychological advice, diagnosis, or treatment. While the content on this blog is provided with the utmost care and accuracy regarding mental health and psychological topics, it is not a substitute for professional consultation with a qualified psychologist or healthcare provider.


Readers are advised that the understanding and interpretation of mental health issues are complex and highly individualized. Therefore, the insights and guidance provided on this blog should not be used to diagnose or treat any mental health condition independently. If you are struggling with mental health issues, it is crucial to seek the advice of a licensed professional who can provide you with personalized care and support.


 

References


Advokat, C., & Scheithauer, M. (2013). Attention-deficit hyperactivity disorder (ADHD) stimulant medications as cognitive enhancers. Frontiers in Neuroscience, 7, 82. https://doi.org/10.3389/fnins.2013.00082


American Psychological Association. (n.d.). ADHD and substance abuse: The link parents need to know. Retrieved May 29, 2024, from https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/ADHD-and-Substance-Abuse-The-Link-Parents-Need-to-Know.aspx


Banaschewski, T., Johnson, M., Lecendreux, M., Zuddas, A., Adeyi, B., Hodgkins, P., Squires, L. A., & Coghill, D. R. (2014). Health-related quality of life and functional outcomes from a randomized-withdrawal study of long-term lisdexamfetamine dimesylate treatment in children and adolescents with attention-deficit/hyperactivity disorder. CNS Drugs, 28(12), 1191–1203. https://doi.org/10.1007/s40263-014-0193-z


Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). (2019, January 4). ADHD and co-occurring conditions. Retrieved May 29, 2024, from https://chadd.org/about-adhd/co-occuring-conditions/


Chang, Z., Lichtenstein, P., Halldner, L., D’Onofrio, B., Serlachius, E., Fazel, S., ... & Larsson, H. (2013). Stimulant ADHD medication and risk for substance abuse. Journal of Child Psychology and Psychiatry, 55(8), 878–885. https://doi.org/10.1111/jcpp.12164


Chen, Q., Sjölander, A., Runeson, B., D’Onofrio, B. M., Lichtenstein, P., & Larsson, H. (2014). Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: Register based study. BMJ, 348, g3769. https://doi.org/10.1136/bmj.g3769


Coghill, D. (2010). The impact of medications on quality of life in attention-deficit hyperactivity disorder: A systematic review. CNS Drugs, 24(10), 843–866. https://doi.org/10.2165/11537450-000000000-00000


Ercan, E. S., Coşkunol, H., Varan, A., & Toksöz, K. (2003). Childhood attention deficit/hyperactivity disorder and alcohol dependence: A 1-year follow-up. Alcohol and Alcoholism (Oxford, Oxfordshire), 38(4), 352–356. https://doi.org/10.1093/alcalc/agg084


Ghirardi, L., Larsson, H., Chang, Z., Chen, Q., Quinn, P. D., Hur, K., Gibbons, R. D., & D’Onofrio, B. M. (2020). Attention-deficit/hyperactivity disorder medication and unintentional injuries in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 59(8), 944–951. https://doi.org/10.1016/j.jaac.2019.06.010


Kolar, D., Keller, A., Golfinopoulos, M., Cumyn, L., Syer, C., & Hechtman, L. (2008). Treatment of adults with attention-deficit/hyperactivity disorder. Neuropsychiatric Disease and Treatment, 4(2), 389–403. https://doi.org/10.2147/ndt.s6985


Lichtenstein, P., Halldner, L., Zetterqvist, J., Sjölander, A., Serlachius, E., Fazel, S., Långström, N., & Larsson, H. (2012). Medication for attention deficit-hyperactivity disorder and criminality. The New England Journal of Medicine, 367(21), 2006–2014. https://doi.org/10.1056/NEJMoa1203241


Man, K. K. C., Coghill, D., Chan, E. W., Lau, W. C. Y., Hollis, C., Liddle, E., ... & Wong, I. C. K. (2017). Association of risk of suicide attempts with methylphenidate treatment. JAMA Psychiatry, 74(10), 1048–1055. https://doi.org/10.1001/jamapsychiatry.2017.2183


Mechler, K., Banaschewski, T., Hohmann, S., & Häge, A. (2021, June 23). Evidence-based pharmacological treatment options for ADHD in children and adolescents. Pharmacology & Therapeutics. https://www.sciencedirect.com/science/article/pii/S016372582100142X


Miller, C. (2023, January 26). What are nonstimulant medications for ADHD? Child Mind Institute. https://childmind.org/article/what-are-nonstimulant-medications-for-adhd/


Rodden, J. (2023, September 5). Non-Stimulant ADHD medication overview. ADDitude. https://www.additudemag.com/non-stimulant-adhd-medication/


Ruiz-Goikoetxea, M., Cortese, S., Aznarez-Sanado, M., Magallón, S., Alvarez Zallo, N., Luis, E. O., de Castro-Manglano, P., Soutullo, C., & Arrondo, G. (2018). Risk of unintentional injuries in children and adolescents with ADHD and the impact of ADHD medications: A systematic review and meta-analysis. Neuroscience & Biobehavioral Reviews, 84, 63-71. https://doi.org/10.1016/j.neubiorev.2017.11.007


Sofuoglu, M., & Sewell, R. A. (2009). Norepinephrine and stimulant addiction. Addiction Biology, 14(2), 119–129. https://doi.org/10.1111/j.1369-1600.2008.00138.x


Spencer, T., Biederman, J., Wilens, T., Doyle, R., Surman, C., Prince, J., Mick, E., Aleardi, M., Herzig, K., & Faraone, S. (2005). A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. Biological Psychiatry, 57(5), 456–463. https://doi.org/10.1016/j.biopsych.2004.11.043


Stevens, J. R., Wilens, T. E., & Stern, T. A. (2013). Using stimulants for attention-deficit/hyperactivity disorder: Clinical approaches and challenges. The Primary Care Companion for CNS Disorders, 15(2), PCC.12f01472. https://doi.org/10.4088/PCC.12f01472


Wilens, T. E., Faraone, S. V., Biederman, J., & Gunawardene, S. (2003). Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Pediatrics, 111(1), 179–185. https://doi.org/10.1542/peds.111.1.179


Wilens, T. E., Martelon, M., Joshi, G., Bateman, C., Fried, R., Petty, C., & Biederman, J. (2011). Does ADHD predict substance-use disorders? A 10-year follow-up study of young adults with ADHD. Journal of the American Academy of Child and Adolescent Psychiatry, 50(6), 543–553. https://doi.org/10.1016/j.jaac.2011.01.021


Zulauf, C. A., Sprich, S. E., Safren, S. A., & Wilens, T. E. (2014). The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders. Current Psychiatry Reports, 16(3), 436. https://doi.org/10.1007/s11920-013-0436-6

41 views0 comments

コメント


bottom of page