ADHD can have a negative impact on academic or work performance and may hinder social development. Many people living with ADHD turn to substance abuse as a way to combat these effects. Research has shown that about 21 percent of males with ADHD and 13 percent of females with ADHD abuse drugs or alcohol.
That research is consistent with general drug use among young people in the UK, so like their peers your sample may be using drugs to manage an underlying mental health problem which in this case is labelled ADHD. Ironically the most common ADHD drug is also being used by young people as a relaxant prior to exams, and to help them focus during exam stress. 90% of young offenders have an undiagnosed mental health problem in the UK. It may be chance that some get into the criminal justice system rather than CAMHS services and acquire an anti-social label rather than mental illness diagnosis. Long term use studies of ADHD drugs are showing worrying consequences.
Metaanalyses (Biederman at al., 2006; Wilens at al., 2003; Wilens at al., 2008) have concluded that treatment of ADHD with stimulant medications substantially reduced the risk for later substance use/abuse, although some studies (e.g., Dalsgaard at al., 2014) have found no overall risk or increased risk only under specific conditions (e.g., elevated risk for those who were prescribed stimulants at a later age). If one is inclined toward greater caution, risk may be decreased by prescribing an extended release version of stimulant medications, which are more difficult to abuse.
Sorry about the typos. Spell check on my phone is not always my friend.
"Patients with Attention Deficit/Hyperactivity Disorder (ADHD) and comorbid Substance Use Disorders (SUD) are increasingly being treated with central stimulant medication despite limited evidence for its effectiveness. Lack of longitudinal follow-up studies of dosing and adverse effects has resulted in conflicting treatment guidelines. This study aims to explore whether individuals with ADHD and comorbid SUD are treated with higher stimulant doses than individuals with ADHD only, and whether doses increase over time as a sign of tolerance, a core symptom of addiction...
Patients with Attention Deficit/Hyperactivity Disorder (ADHD) and comorbid Substance Use Disorders (SUD) are increasingly being treated with central stimulant medication despite limited evidence for its effectiveness. Lack of longitudinal follow-up studies of dosing and adverse effects has resulted in conflicting treatment guidelines. This study aims to explore whether individuals with ADHD and comorbid SUD are treated with higher stimulant doses than individuals with ADHD only, and whether doses increase over time as a sign of tolerance, a core symptom of addiction...Patients with SUD were, two years after initiating stimulant treatment, prescribed approximately 40% higher doses compared to individuals with ADHD only. The results may suggest a need for increased doses in this population to achieve optimal ADHD symptom control. A tendency towards increasing doses during the first years of treatment, more pronounced in individuals with comorbid SUD, may reflect a reluctance to prescribe adequate doses due to lack of clinical guidelines..."
Eur Neuropsychopharmacol. 2017 Nov;27(11):1144-1152. doi: 10.1016/j.euroneuro.2017.08.435. Epub 2017 Sep 19.
@Ana Fructuoso That is really interesting. I will look that paper up today and read more!
Methylphenidate is a central nervous system stimulant drug that has become the primary drug of choice in treating attention-deficit/hyperactivity disorder in children. Side effects are usually mild and are generally well tolerated by patients. Along with increases in prescribing frequency, the potential for abuse has increased. Intranasal abuse produces effects rapidly that are similar to the effects of cocaine in both onset and type. The clinical picture of stimulant abuse produces a wide array of psychiatric symptoms.
There is little in the literature to differentiate methylphenidate from other stimulants when they are abused. The need for education of all involved with the use of methylphenidate is discussed to help prevent an increasing pattern of methylphenidate abuse.
Methylphenidate Abuse and Psychiatric Side Effects; November 2000The Primary Care Companion to The Journal of Clinical Psychiatry 2(5):159-164; DOI: 10.4088/PCC.v02n0502
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