ADHD and substance misuse in young people: from cutting edge research to the coal face reality of clinical practice

Author/s
K.A.H Mirza, R. Sudesh, S. Mirza
Citation
Issue 2 Spring 2012
CEPiP.2012.1.132-137
Abstract

Children with ADHD are at high risk of developing substance misuse in adolescence and adulthood. The abuse potential of stimulant medication and the impact of medication treatment on long-term risk of substance misuse are areas of ongoing controversy. Existing literature indicates that treatment of ADHD with medication does not increase the risk of development of substance misuse in the treated individual. Stimulant medications can, however, be diverted or misused, either for subjective euphoric effects or for effects on performance. Integrated treatment of both substance misuse and ADHD should be provided. Strategies to minimize the risk for misuse or diversion of medications include use of extended-release formulations of currently used stimulant medications, new non-stimulant medications and novel pro-drugs. This article provides a brief overview of the extant literature and offers practical guidelines for the management of young people with ADHD and co¬morbid substance misuse.

Keywords: substance misuse, substance dependence, substance abuse, co-morbidity, children, young people, abuse potential

Cite as: Cutting Edge Psychiatry in Practice 2012, 2(1):132-137; https://doi.org/10.65031/tnqh2400

References

  1. NICE (2006) Methylphenidate, Atomoxetine and dexamphetamine for the treatment of Attention deficit hyperactivity disorder in children and adolescents. Technology Appraisal 98. London: NICE. Available at: www.nice.org.uk/TA98.             
  2. Robbins T.W (2002) ADHD and Addiction, Nature Medicine, 8(1) 24-25.         
  3. Breggin P.R and Baughman P.A (2001): Questioning the treatment for ADHD, Science, 291, 595.      
  4. Barrett, S.P.,Darredeau, C., Lana E Bordy, C. E., Robert, O.,(2005). Characteristics of Methylphenidate Misuse in a University Student Sample, Canadian Journal of Psychiatry 50: 457–461. https://doi.org/10.1177/070674370505000805
  5. Woolfall K (2006) Substance use among young people in Wirral, Merseyside. Liverpool, Liverpool John Moores University.
  6. Geraghty, O (2008) An Exploration of the Black Market Availability and Costs of Licensed Medicines in the North West. Liverpool, Liverpool John Moores University School of Pharmacy and Chemistry ( MPharm dissertation).            
  7. Levin, F.R. Evans, S.M. McDowell D.M. and. Kleber, H.D (1998), Methylphenidate treatment for cocaine abusers with adult attention-deficit/hyperactivity disorder: a pilot study, J. Clin. Psychiatry 59, 300–305. https://doi.org/10.4088/jcp.v59n0605
  8. Elkins, I.J., McGue. M, Iacono, W.G ( 2007) Prospective Effects of Attention-Deficit/Hyperactivity Disorder, Conduct Disorder, and Sex on Adolescent Substance Use and Abuse Arch Gen Psychiatry. 64(10):1145-1152. https://doi.org/10.1001/archpsyc.64.10.1145
  9. Kollins SH, MacDonald EK, and Rush CR (2001): Assessing the abuse potential of methyl phenidate in nonhuman and human subjects: a review, Pharmacology, Biochemistry, and Behaviour, 68, pp 611-627. https://doi.org/10.1016/s0091-3057(01)00464-6
  10. Robbins T.W, Everitt B.J. Drug addiction: bad habits add up. Nature. 1999;398:567–570. https://doi.org/10.1038/19208
  11. Volkow, N.D., Ding, Y.S., Fowler, J.S., Wang, G.J., Logan, J., Gatley, J.S., Dewey, S., Ashby, C., Liebermann, J., Hitzemann, R., et al., (1995), Is methylphenidate like cocaine? Studies on their pharmacokinetics and distribution in the human brain, Arch Gen Psychiatry Jun; 52(6): 456-63. https://doi.org/10.1001/archpsyc.1995.03950180042006
  12. 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. Paediatrics, 111(1): 179-185. https://doi.org/10.1542/peds.111.1.179
  13. Mannuzza. S., Klein, R.G., Truong, N.L., Moultan, J.L., 3rd, Roizen, E.R., Howell, E.R., Castellanos, F.X., 2008. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: prospective follow-up into adulthood. American journal of psychiatry, 165(5): 604-609. https://doi.org/10.1176/appi.ajp.2008.07091465
  14. Biederman, J., Monuteaux, M.C., Spencer, T., Wilens, T.E., Macpherson, H.A., Faraone, S.V., 2008. Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: a naturalistic controlled 10-year follow-up study. American journal of psychiatry, 165(5): 597-603. https://doi.org/10.1176/appi.ajp.2007.07091486
  15. Wilens TE, 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
  16. Molina, B. S. G., Flory, K., Hinshaw, S. P., et al. (2007) Delinquent behaviour and emerging substance use in MTA at 36 months: prevalence, course, and treatment effects. Journal of the American Academy of Child and Adolescent Psychiatry,46, 1–11. https://doi.org/10.1097/chi.0b013e3180686d96
  17. Wilens TE, Gignac M, Swezey A, Monuteaux MC, Biederman J (2006);. Characteristics of adolescents and young adults with ADHD who divert or misuse their prescribed medications. Journal of American Academy of Child and Adolescent Psychiatry. 45: 408–414. https://doi.org/10.1097/01.chi.0000199027.68828.b3
  18. Wilens, T. E., Adler, L. A., Adams, J., et al. (2008) Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. Journal of the American Academy of Child and Adolescent Psychiatry, 47, 21–31. https://doi.org/10.1097/chi.0b013e31815a56f1
  19. Mirza KAH and Mirza S. (2008) Adolescent substance misuse. In: Bruce H and Skuse. D (eds), Psychiatry. London: Elsevier, for the Medicine Publishing Group, pp. 357–62. https://doi.org/10.1016/j.mppsy.2008.05.011
  20. Mirza KAH and Buckstein O. (2010): Assessment and treatment of young people with ADHD, disruptive behaviour disorder and co-morbid substance use disorder. In: Kaminer Y and Winters K (eds), Clinical Manual of Adolescent Substance Abuse Treatment. Washington, DC: American Psychiatric Publishing,; pp. 283–305. https://doi.org/10.1176/appi.books.9781615370030.mg42
  21. Riggs P.D, Winhusen, T, Davies R. D et al (2011) Randomized Controlled Trial of Osmotic-Release Methylphenidate (OROS- MPH) for Attention Deficit Hyperactivity Disorder in Adolescents with Substance Use Disorders. Journal of American academy of child and adolescent psychiatry, Vol.50, 9 903-914. 136 https://doi.org/10.1016/j.jaac.2011.06.010
  22. Thurstone,C, Riggs, P.D, Salomonsen-Sautel, S., and Mikulich-Gilbertson,S.K (2010) Randomized, controlled trial of Atomoxetine for ADHD in adolescents with substance use disorder, Journal of American Academy of Child and Adolescent Psychiatry, 2010 June; 49(6): 573–582. https://doi.org/10.1097/00004583-201006000-00006
  23. Wilens, T. E., (2007). The nature of the relationship between attention-deficit/hyperactivity disorder and substance use, Journal of clinical psychiatry, 68 supplement, 11: 4-8.     
  24. Heil SH, Holmes HW, Bickel WK, et al: ( 2002) Comparison of the subjective, physiological, and psychomotor effects of atomoxetine and methylphenidate in light drug users. Drug and alcohol dependence 67, 149-156. https://doi.org/10.1016/s0376-8716(02)00053-4
  25. Findling RL, Bukstein OG, Melmed RD, et al. (2008) A randomized, double-blind, placebo-controlled, parallel-group study of methylphenidate transdermal system in pediatric patients with attention-deficit/hyperactivity disorder. J Clin Psychiatry.;69(1):149–159. https://doi.org/10.4088/jcp.v69n0120