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Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) and substance use disorders
Summary of the evidence
The current literature on pharmacological interventions of SUD in ADHD patients involves norepinephrine, dopamine, and nicotinic acetylcholine receptors as prime neurotransmitters. The same neurotransmitters are addressed purposefully at stabilizing ADHD symptoms. The mindset is that medications that manage ADHD symptoms should also help to decrease the risk of developing SUD.
Pharmacological treatment of attention deficit hyperactivity disorder (ADHD) was found in a systematic review with meta-analysis (Fluyau et al., 2020, 17 studies, N = 2155) to have small but positive pooled effect compared to placebo in:
- reducing in substance use (SMD = 0.405, 95% confidence interval [CI]: [0.252, 0.557], P < .001),
- progression toward abstinence (SMD = 0.328, 95% CI: [0.149, 0.507], P < .001),
- reducing craving (SMD = 0.274, 95% CI: [0.103, 0.446], P = .002),
- decrease in the severity of ADHD symptoms (SMD = 0.533, 95% CI: [0.393, 0.672], P < .001),
- reduction in the frequency of ADHD symptoms (SMD = 0.420, 95% CI: [0.259, 0.582], P < .001).
The pooled effect was moderate for the management of withdrawal symptoms (SMD = 0.577, 95% CI: [0.389, 0.764], P = .001]) and the decrease in the severity of ADHD symptoms (SMD = 0.533, 95% CI: [0.393, 0.672], P < .001).
There were differences among different substances (tobacco, cocaine, amphetamine or cannabis) in the different outcomes when considered individually and not pooled together.
