A study published in the Journal of the American Academy of Child and Adolescent Psychiatry reports that adolescents and young adults diagnosed with both attention-deficit/hyperactivity disorder (ADHD) and substance use disorder are less likely to receive first-line medication treatments for ADHD. The findings were announced by a research team led by Penn State College of Medicine on Mar. 12.
The study highlights a significant treatment gap for young people facing both conditions, which can lead to worse health outcomes. ADHD affects about 12%–13% of adolescents in the United States, and up to half of those diagnosed may develop a substance use disorder. These individuals are at higher risk for hospitalizations, suicidal thoughts, and suicide attempts compared to those with only one condition.
Researchers analyzed national health records from over 1.2 million individuals aged 15 to 25 diagnosed with ADHD, including approximately 288,000 who also had a substance use disorder ranging from nicotine to opioids. They found that after being diagnosed with a substance use disorder, young people were about 15% less likely to continue stimulant prescriptions and new stimulant prescriptions dropped by more than 17%. Despite these reductions, those who received ADHD medications—especially central nervous system stimulants—had better outcomes: fewer emergency visits, hospitalizations, accidental overdoses, suicidal thoughts, and suicide attempts. Over five years, treatment was linked to a roughly 30% lower risk of death.
"Although CNS stimulants are first-line, evidence-based treatments for ADHD, some clinicians appear hesitant to prescribe them in patients with substance use disorder based on these findings. We theorize that it is because of concerns about misuse, which we agree are a real risk," Ritika Baweja said. "Our findings suggest that, when used appropriately, treating ADHD - including with stimulants - can be associated with significantly better outcomes."
The research team plans further analysis across a broader age range (16–65 years) to examine how demographic factors and types of substance use disorders affect treatment patterns.
Other authors include James Waxmonsky (Penn State College of Medicine), Daniel Waschbusch (Penn State College of Medicine), Felix Padilla (Penn State College of Medicine), Balwinder Singh (Mayo Clinic), William Pelham III (University of California San Diego), Brooke Molina (University of Pittsburgh), and Timothy Wilens (Massachusetts General Hospital/Harvard Medical School). Funding was provided by the National Center for Advancing Translational Sciences at the National Institutes of Health.
