Comorbid ADHD with Substance Abuse
Anthony L. Rostain, MD, MA, University of Pennsylvania
Dr. Rostain explored the strong connection/predictability between ADHD and lifetime nicotine, marijuana, cocaine, and other substance use, although this connection can’t be shown definitively for alcohol use because alcohol is so widely used across all demographic groups. ADHD can be seen as a reward deficiency syndrome, which is the breakdown of the reward “cascade”—the patient is not getting rewarded by typically rewarding activities, which leads to impulsivity, other clinical correlates, and addictive behaviors. Neurobiology of ADHD and substance use disorder (SUD) (sustaining attention, motivation) is similar; genetic influences in common have been identified in studies. Dr. Rostain described the significant problem of illicit—ie, nonmedical, no Rx—stimulant use in school settings, and how such illicit stimulant use also correlates with abuse of alcohol and use of Cannabis and other substances. As for treatment, he emphasized that options for the combined disorders are limited and not fully effective. Methylphenidate plus cognitive-behavioral therapy combo is not very effective for treating comorbid ADHD and SUD, although some improvement in ADHD symptoms has been shown.
