Treatment Gaps and Outcomes for Adolescents with ADHD and SUD

A retrospective analysis of de-identified health records in people ages 15–25 with ADHD and substance use disorder (SUD) is described as showing differences in ADHD pharmacotherapy patterns when both diagnoses are present.

The report emphasizes two themes: lower stimulant treatment among individuals with co-occurring SUD and reported associations between ADHD medication exposure and several clinical and service-use outcomes. It frames these patterns as arising from routine care data in a large clinical network dataset rather than from a prospective interventional study.

Investigators examined TriNetX US Collaborative Network records and identified about 1.23 million individuals with ADHD, including approximately 288,000 with both ADHD and SUD. Compared with patients with ADHD alone, those with co-occurring SUD were less likely to receive central nervous system stimulant prescriptions (RR = 0.63, 95% CI = 0.62–0.63). The report also notes that new bupropion prescriptions were slightly more frequent in the ADHD-with-SUD cohort (RR = 1.05). These findings are presented as evidence of different prescribing patterns when substance use disorder is documented alongside ADHD.

Beyond prescribing patterns, the report states that receipt of ADHD medication (including stimulant and non-stimulant therapies) was associated with differences in multiple outcomes among those with co-occurring ADHD and SUD. These included fewer hospitalizations and emergency care visits, lower risk of suicidal ideation or suicide attempts (RR range = 0.74–0.82), and more consistent use of psychiatric services (RR = 1.23). Overall ADHD treatment was also associated with about a 30% lower risk of mortality (adjusted HR = 0.70, 95% CI = 0.65–0.75).

When stimulant treatment was compared with non-stimulant treatment within the ADHD-and-SUD group, stimulant therapy was associated with fewer hospitalizations, fewer accidental overdoses, and lower rates of suicidal ideation or suicide attempts (RR range = 0.63–0.79). The report presents these findings as observed associations rather than causal effects of medication.

The study authors describe these prescribing patterns as consistent with clinician hesitancy to prescribe CNS stimulants in the context of SUD. In its overall framing, the report highlights both the lower likelihood of stimulant prescribing among individuals with ADHD and SUD and the observed associations between ADHD treatment and several clinical and service-use outcomes.

Key Takeaways:

• In a retrospective analysis of TriNetX health records, adolescents and young adults with ADHD and co-occurring SUD were less likely to receive stimulant prescriptions than those with ADHD alone.
• ADHD medication use (stimulant and non-stimulant) in patients with ADHD and SUD was associated with fewer hospitalizations and emergency visits, lower risk of suicidal ideation or attempts, and greater use of psychiatric services.
• Overall ADHD treatment was associated with about a 30% lower risk of mortality, and stimulant treatment showed additional associations with fewer hospitalizations, accidental overdoses, and suicidal ideation or attempts compared with non-stimulant therapy.