CADDRA Expert Series 2, Session 5: Treatment of ADHD and Substance Use Disorder

By the end of this session, participants will be able to:

1. Recognize the rates of ADHD among substance-using populations.
2. Describe research findings regarding the efficacy of ADHD medications in patients with active substance use disorders.
3. List strategies to mitigate the risk of stimulant nonmedical use.

Attention-deficit / hyperactivity disorder (ADHD) is a disorder characterized by inattention, hyperactivity, and impulsivity. Adults with substance use disorders (SUD) are more likely to have ADHD than those who do not. Both pharmacologic and nonpharmacologic treatment strategies targeting ADHD symptoms may improve outcome for those seeking treatment for their SUD. Various therapeutic mechanisms may come into play depending on the substances being used. While there are at least 15 randomized, controlled trials evaluating the efficacy of various pharmacologic interventions, there are numerous methodologic differences making it difficult to reach definitive conclusions regarding the efficacy of any one intervention. Further, there are very little data to guide what nonpharmacologic interventions are best utilized as stand-alone treatment or in combination with pharmacologic interventions. Despite this, there are promising, albeit limited data suggesting that robust dosing long-acting formulations of stimulant medication may be effective for those with stimulant use disorders. Based on the mixed findings in the literature and concerns of potential nonmedical use of prescription stimulants, there are several assumptions regarding the benefit of using ADHD medications for those with SUD often resulting in therapeutic nihilism. These assumptions will be discussed along with strategies to address the concerns of nonmedical use and safety in those actively using alcohol and other substances. At the conclusion of the seminar, ongoing treatment research targeting this comorbid population will be presented.

Dr. Frances Levin:

Frances Rudnick Levin, MD is the Kennedy-Leavy Professor of Psychiatry at Columbia University and the Chief of the Division on Substance Use Disorders at NYSPI/CUIMC. Dr. Levin, working with Columbia University faculty, inaugurated the university-wide Center for Healing of Opioid and Other Substance Use Disorders: Enhancing Intervention Development and Implementation (CHOSEN) in 2020 and serves as one of the senior Directors. She is the Principal Investigator several NIH grants including a long-standing T32 Substance Abuse Research Fellowship. Her current research interests include pharmacologic interventions for opioid, cocaine and marijuana use disorders, and treatments targeting adults with substance use disorders and attention-deficit hyperactivity disorder (ADHD). She is a past President of the American Academy of Addiction Psychiatry and past Chair of the APA Council on Addiction Psychiatry.

CADDRA – Canadian ADHD Resource Alliance has been approved by the College of Family Physicians, the Royal College of Physicians and Surgeons of Canada and the Canadian Psychological Association to offer 1.25 continuing education credits for this session.  CADDRA maintains responsibility for the program.

Participation in a discussion forum is required to claim full credits.