Methylphenidate – a treatment option for adult ADHD and substance use disorder?

Abstract

Attention-deficit/hyperactivity disorder (ADHD) in adulthood is frequently associated with comorbid substance use disorders. Treatment algorithms are not yet available. In particular, it remains unclear whether the use of methylphenidate (MPH) is justified in adult patients with ADHD and comorbid substance use disorder. While animal studies indicate an addictive potential with intravenous administration, the abuse potential of MPH in humans appears low when used appropriately by the oral route. Whether MPH treatment of ADHD in childhood protects against the development of substance use disorder in adulthood remains controversial. Although the data are still inconsistent, individual studies and our own longitudinal observations of MPH therapy in substance-dependent patients with ADHD show not only a reduction in ADHD symptoms but also decreases in craving and substance use. Treatment of adult ADHD with comorbid substance use disorder using MPH should be risk-adapted and critically weighed with particular consideration of the substance being abused, motivation for abstinence, and the quality of the physician-patient relationship; it should be monitored regularly and combined with addiction-medicine and disorder-specific psychotherapeutic/psychoeducational interventions.