ADHD and substance use often go together, which raises the tricky question of whether its a good idea to prescribe stimulants for someone with a drug problem.

As Ive written about before, theres research suggesting that yes, it is in fact a good idea. Because peoples ADHD symptoms can contribute to their substance use, treating those ADHD symptoms also seems to help with treating the substance use.

But dont take my word for it ask the experts, as they say.

Theres a new international consensus statement out on the topic of treating co-occurring ADHD and substance use disorder, specifically in teenagers.

To put together the statement, 55 experts in 17 countries were polled to see whether they agreed with a variety of statements on the best practices for treating comorbid ADHD and substance use in teenagers. The experts had a range of scientific and clinical experience with the topic at hand.

As it turned out, the experts were able to reach a consensus on 36 of the statements. Some of the broad recommendations that emerged:

  • Teenagers with substance use should be screened for ADHD and teenagers with ADHD should be screened for substance use (since the two conditions often go together)
  • Stimulants are the go-to treatment for adolescents with both substance use and ADHD
  • Medication should take place in the context of some type of therapy or counseling as well

However, the experts werent able to come to an agreement on one question: should complete abstinence from substances be a prerequisite for medication?

Most experts did not think full abstinence should be a requirement for starting medication, presumably because treating ADHD symptoms might help teenagers achieve abstinence. But some experts did say that stimulants shouldnt be prescribed until full abstinence was reached.

That goes to show how different mental health professionals can take contrasting approaches on preferred practices for treating ADHD and drug use, highlighting the need for more research.

At the same time, a widespread understanding among experts seems to be emerging on the general point that ADHD needs to be treated when it co-occurs with substance use and that stimulants are an effective way of doing so.

Image: Flickr/Anders Sandberg