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Methylphenidate for Attention-Deficit and Hyperactivity Disorder in Adult Patients With Substance Use Disorders: Good Clinical Practice Publisher



Chamakalayil S1 ; Strasser J1 ; Vogel M1, 2 ; Brand S3, 4, 5, 6, 7 ; Walter M1 ; Dursteler KM1, 8
Authors
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Authors Affiliations
  1. 1. Department of Addictive Disorders, Psychiatric University Clinic Basel, Basel, Switzerland
  2. 2. Department of Addictive Disorders, Psychiatric Services Thurgau, Munsterlingen, Switzerland
  3. 3. Center for Affective, Stress and Sleep Disorders (ZASS), Psychiatric University Hospital Basel, Basel, Switzerland
  4. 4. Department of Clinical Research, University of Basel, Basel, Switzerland
  5. 5. Division of Sport and Psychosocial Health, Department of Sport, Exercise, and Health, University of Basel, Basel, Switzerland
  6. 6. Substance Abuse Prevention Research Center and Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
  7. 7. School of Medicine, Tehran University of Medical Sciences (TUMS), Tehrren, Iran
  8. 8. Department for Psychiatry, Psychotherapy and Psychosomatic, Psychiatric Hospital, University of Zurich, Zurich, Switzerland

Source: Frontiers in Psychiatry Published:2021


Abstract

Attention-deficit and hyperactivity disorder (ADHD) is a widespread neurodevelopmental disorder in children and adolescents, persisting into adulthood in a majority of them. ADHD and substance use disorders (SUDs) commonly co-occur in the clinical adult population. The higher-than-normal prevalence rates of SUDs in people with ADHD indicate increased risk for developing SUD. This narrative review deals with the question of whether or not adults with both disorders should be treated with methylphenidate (MPH), addressing specific issues surrounding this form of treatment. MPH is considered as first-line pharmacotherapy for ADHD. However, because of its stimulant-like reinforcing properties, MPH has a significant addictive potential to which persons with SUDs are especially susceptible. Appropriate treatment is therefore complex. Because of concerns about misuse and diversion of MPH medication, clinicians may be reluctant to use MPH to manage ADHD symptoms in these patients. However, it is essential to diagnose and treat ADHD adequately as appropriate therapy reduces the impairments, as well as the risk of developing comorbid disorders and poor treatment response. MPH should not be deprived of these patients because of the risk for misuse, especially as several strategies can be applied to minimize this risk. To conclude, carefully applied guideline-based diagnostics to clarify the potential presence of ADHD as well as a responsible prescription practice in a well-defined therapeutic setting with reliable monitoring of medication intake and regular consultations are essential conditions for a safe and proficient MPH treatment of ADHD in patients with SUD. © Copyright © 2021 Chamakalayil, Strasser, Vogel, Brand, Walter and Dursteler.
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