J Am Acad Child Adolesc Psych
Stimulant hesitancy persists despite outcome benefits in ADHD with co-occurring substance use disorder
A retrospective cohort study of 1.23 million adolescents and young adults with ADHD (23% with co-occurring substance use disorder [SUD]) found that clinicians were significantly less likely to prescribe central nervous system (CNS) stimulants to those with SUD (relative risk [RR], 0.63; 95% confidence interval [CI], 0.62–0.63), while bupropion prescribing was slightly higher (RR, 1.05; 95% CI, 1.02–1.08). Yet ADHD treatment—including stimulants and nonstimulants—was consistently associated with improved clinical outcomes in the SUD cohort: fewer hospitalizations and emergency visits, reduced suicidal ideation/attempts (RR range, 0.74–0.82), and a 30% lower mortality risk (adjusted hazard ratio, 0.70; 95% CI, 0.65–0.75). Patients receiving stimulants had even stronger outcome improvements, including reduced hospitalizations, accidental overdoses, and suicidal ideation/attempts (RR range, 0.63–0.79). ADHD treatment was also associated with greater continuity of psychiatric care (RR, 1.23) and fewer methadone prescriptions (RR, 0.74).
Clinical takeaway: For adolescents and young adults with ADHD and co-occurring SUD, carefully monitored ADHD pharmacotherapy—including stimulants when clinically appropriate—may improve outcomes and should not be routinely withheld solely due to substance use concerns.
Source:
Baweja R, et al. (2025, December 18). J Am Acad Child Adolesc Psychiatry. Attention-Deficit/Hyperactivity Disorder Treatment Patterns and Association With Clinical Outcomes in Adolescents and Young Adults with Co-occurring Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder: A Retrospective Analysis. https://pubmed.ncbi.nlm.nih.gov/41421461/