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Free Teleconference—Strategies to Improve School Performance of Students with ADHD
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Wednesday, November 9, 2005, 8:30 -9:30 pm
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Research Updates    
Substance Abuse in Adults Treated for ADHD.
A June 2005 article in The ADHD Report summarized an important finding regarding treatment of ADHD in adults and the effect on substance abuse. While research has demonstrated that ADHD (and other co-morbid disorders) contributes to the risk for substance abuse in adults, the course of substance abuse varies in those with ADHD. ADHD substance abusers may more quickly become dependent and may remain so for longer periods of time. This may be due to the ADHD adult's attempt to self-medicate and/or deficits in executive function.

There has been concern expressed in that stimulant treatment may increase the risk for substance abuse. However, these fears appear to be unwarranted. First, methylphenidate taken orally has a low abuse potential due to slow brain uptake. Next, a literature review done by Tim Wilens, MD found a 1.9-fold reduction in risk for substance abuse in ADHD adolescents treated pharmacologically versus those not receiving treatment.

In treating adults with ADHD who have a substance abuse disorder, Wilens emphasizes that treatment of the substance abuse should take first priority. Treatment should include both psychotherapy for the addiction and pharmacotherapy. ADHD medications with a lower likelihood of misuse, such as atomoxetine or bupropion, should be considered first with stimulants as a second tier treatment if necessary.

Wilens, T.E.. (2004) Impact of ADHD and its treatment on substance abuse in adults. Journal of Clinical Psychiatry, 65, 38-45.

Stimulant Abuse Among Substance Abusing Adolescents
A study (Williams, et al, 2004) described in the June 2005 issue of The ADHD Report investigated the prevalence of prescribed stimulant-abusing adolescents with co morbid psychiatric diagnoses. In a retrospective chart review, investigators looked at 450 adolescents seen from (1993-1999) at a center specializing in the assessment and treatment of adolescents with substance abuse and co-morbid psychiatric disorders.

Non-medical use of either methylphenidate or dextroamphetamine were reported by 23% of the adolescents at some point in their lives. This rate jumped to 44% among those prescribed stimulant medications. Of the entire sample, 6% was classified as active, current abusers with the most common methods of abuse being crushing tablets and taking the drug intra-nasally.

The authors indicated that two variables: being out of school and having an eating disorder were the best predictors of abuse.

The authors concluded that for the population studied, "prescription stimulant abuse is neither at crisis proportions nor is it a non-existent problem." They advised that physicians should routinely screen for substance abuse and eating disorders before prescribing medications for ADHD and that they consider non-stimulant options for those who are at-risk for substance abuse. The also recommended greater parental control in administering stimulants to adolescents.

Williams, R.J., Goodale, L.A., Shay-Fiddler, M.A., Gloster, S.P., & Chang, S.Y. (2004). Methylphenidate and dextroamphetamine abuse in substance-abusing adolescents. American Journal on Addictions, 13, 281-389.

November's Featured myADHD.com's Tools
Family communication can often become problematic in households where children and parents may suffer from ADHD. Family therapists often teach communication skills to help family members manage conflict at home. In their book, Negotiating Parent-Adolescent Conflict, authors Arthur Robin and Sharon Foster discuss numerous strategies of this type. You can benefit from November's myADHD.com tools below to help your family, or one that you are working with, learn communication skills.
• 7001 Overcoming Roadblocks to Family Communication
• 7002 Steps to Problem Solving in Family Meetings
• 7003 Problem-Solving Worksheet

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