ADHD medication and the risk for substance use disorder, where do they meet?

Background The use of psychostimulant medications in individuals with attention deficit hyperactivity disorder (ADHD) has sparked debate due to concerns over their addictive potential, particularly in this specific population that is already at an increased risk for developing substance use disorders (SUDs).Aims This Think Piece critically examines the relationship between ADHD, psychostimulant treatment, and SUD risk using a selection of the existing empirical literature.Methods Epidemiological, neurobiological and genetic evidence is summarized to investigate the overlap in the etiology and pathophysiology of ADHD and SUD. In addition, the role of psychostimulants in treating ADHD and the risk to develop SUD is reviewed.Results While psychostimulants such as methylphenidate and d(dextro)-amphetamine exhibit addictive properties in neurotypical individuals, a growing body of research demonstrates that their therapeutic use in children and adolescents with ADHD, particularly when initiated early and maintained at appropriate doses, is associated with a reduced risk of later SUD development. Furthermore, both clinical trials and neuroimaging studies suggest that psychostimulant treatment can normalize the reward circuitry in ADHD patients and may be effective—at higher doses—in reducing substance use in individuals with co-occurring ADHD and SUD. However, there is some concern about the diversion of prescribed psychostimulants and long-term adverse events, including cardiovascular problems and psychosis.Conclusion Overall, current scientific data do not support the notion that psychostimulant treatment of ADHD increases the risk of developing SUD and instead suggests that psychostimulants can be protective and therapeutic, especially with started early, adequately dosed, and measures are implemented to prevent misuse and diversion.