Addiction and ADHD remains one of the most controversial issues surrounding the treatment - and non-treatment - of ADHD.
We will look at a range of facts so that a proper understanding of the links between ADHD and addictions, and the misuse of stimulant medication.
Here are some facts:
One 2006 study in the US showed that 1 in 5 adolescents "misused" their short-acting stimulants. Misuse in this study means that the medication is being used for purposes other intended, such as staying up late to study.
Long-acting stimulants are very difficult to abuse - it is the short-acting ones that are favourites amongst abusers. Bright GM, Delphia B. Survey evaluation of the abuse potential of short-acting versus long-acting stimulants in ADHD. Program and Program and abstracts of the 159th Annual Meeting of the American Psychiatric Association; May 24, 2006; Toronto, Ontario, Canada. Abstract NR757.
Another 2005 study showed similar figures. It also showed that 29% of people diverted their medications to others.
The same 2005 study also showed that that if ADHD is well treated, the rates of misuse are significantly lower than if the ADHD symptoms are poorly controlled. Upadhyaya H, Roase K, Wang W, et al. Attention-deficit/hyperactivity disorder, medication treatment, and substance use patterns among adolescents and young adults. J Child Adolesc Psychopharmacol. 2005;15:799-809
A review of 6 different studies showed that the risk of turning to substance abuse is "greatly reduced." The risk actually falls into the same category as non-ADHD people. Faraone SV, Wilens T. Does stimulant treatment lead to substance use disorders? J Clin Psychiatry. 2003;64(suppl 11):9-13
People with ADHD are at risk of addiction from their early teen years - and the risk never goes away. ADDers who are optimally medicated have a much lower risk than untreated or poorly treated people.
Treating Addicts with ADHD
Dr Rakesh Jain, Assistant Professor of Psychiatry at University of Texas put it very nicely in a Medscape interview:
"..remember a dog can have ticks and fleas. It doesn't have to be ticks or fleas. Both deserve appropriate attention. So, for example, if I have an adult with ADHD who is also substance abusing, I'm very likely to attack both. Because what I've learned -- and data supports it -- is that it's really better to do 1 plus 1 rather than 1 or 1."
It is clear from many different studies, and our own experience, medication is a better choice when optimally prescribed than nothing, and far better than any single therapy.
As the Gold Standard MTA study showed conclusively, medication combined with behavioural therapy is even better.