“New evidence regarding ADHD medications and substance use disorders”
December 07, 2017
In a previous article I tried to explain the two main approaches to treating Attention Deficit Hyperactivity Disorder—via behavioral therapy and medication. I stated that medications have been shown in the research to reduce symptoms of ADHD in the majority of people who take them. I wanted to discuss another possible benefit of medication therapy for ADHD, which is the potential for medications to reduce the incidence of substance abuse.
A person with ADHD may find it difficult to control acting on impulses leading to unwanted substance abuse. Symptoms of ADHD include changes in how a person expresses their executive functioning—such as controlling impulses, monitoring one's self-behavior, organization, memory, and managing feelings. When these skills of executive functioning are affected by ADHD, then a child may be predisposed to patterns of substance abuse that continue into adulthood. In an article from the Foundations Recovery Network, recent research from the& nbsp;National Alliance on Mental Illness was used to show that in the United States among a sample of adolescent youth, “while 11 percent of boys and 3 percent of girls without ADHD drink alcohol, 21 percent of boys and 13 percent of girls with ADHD abuse this drug. In many cases, the symptoms of ADHD appear before substance abuse begins, indicating that a lot of kids use drugs and alcohol as a way to cope with the consequences of having this behavioral disorder.” It is important to see the potential for a dual-diagnosis of Substance Use Disorder and ADHD or other behavioral disorders such as depression and SUD or schizophrenia and SUD, which also show higher rates of co-occurring according to the Foundations Recovery Network site dualdiagnosis.org. The symptoms of ADHD that we would expect to correlate with greater substance abuse—lack of impulse control and executive functioning—do in fact have this effect according to the research. Sadly, this suggests that too many ADHD patients are in the population injured or killed by substance abuse.
A September 2017 study in the American Journal of Psychiatry supports this point further by stating that higher rates of substance use disorders contribute to excess mortality of ADHD patients. Using health care insurance claim information of about 3 million people in the US with diagnoses, the researchers looked at when they visited the Emergency Room for SUD-related issues while being prescribed stimulant medication. Allaying the fears of some clinicians who refuse to prescribe for ADHD patients, the researchers were unable to show a link between people who were prescribed stimulants and higher rates of substance abuse. Actually, the reverse was shown—“medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.”
Although I do not have medical training and can only offer my experience as an ADHD patient, I can say stimulant medications helped me establish greater impulse control. Medications improved my attention span and had a calming effect on hyperactivity symptoms which in turn enabled me to develop organization skills and better self-monitoring. If I were to place myself in a situation where I was offered drugs as a kid, I would be less likely to take them if I were already undergoing a medication regimen. However, it’s not hard to understand why some of our peers with ADHD state that their substance use is a coping strategy. Harm reduction is absolutely imperative within this population. And with the proper medication and/or behavioral therapy, unwanted substance use doesn't have to affect so many people.
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