Exploring the relationship among ADHD, stimulants, and substance abuse

There is an ongoing debate among prescribers concerning the risk of inadvertently contributing to the initiation of substance abuse (SA) in children and adolescents through the use of stimulants in the treatment of attention-deficit/hyperactivity disorder (ADHD). Psychiatric nurses at all levels of practice must be informed about this important discourse in order to provide accurate and timely interventions to clients and their families.

This literature review explores the current state of prescriptive stimulant use for ADHD and the possible links to SA. Developmental, genetic, and neuro-chemical theories of the disorder that may contribute to SA as well as the burden of comorbidity are considered. The impact of gender, cultural, legal, and ethical influences on diagnostic and treatment recommendations is also included.

U.S. and other English language articles were identified through PubMed and the Cumulated Index of Nursing and Allied Health Literature. These sources were used to determine the current practice of stimulant prescription and the prevalence of SA as a comorbidity to other child psychiatric disorders including ADHD. Textbooks were consulted for information regarding relevant neurochemistry, genetics, and psychopharmacology.

The authors conclude that the use of stimulants is appropriate for children and adolescents with ADHD when opportunities for screening, family and child education, and counseling concerning SA are consistently integrated into the ongoing treatment regimen.