Kristopher Kast, MD, assistant professor in the Department of Psychiatry and Behavioral Sciences and clinical director of Vanderbilt’s Addiction Consult Service, has discovered a strong association between attention-deficit/hyperactivity disorder (ADHD) pharmacotherapy and retention rates for substance use disorder (SUD) treatment.
The findings were reported in the Journal of Clinical Psychiatry.
By analyzing electronic health record data, Kast, along with researchers from the Department of Psychiatry at Massachusetts General Hospital, identified patients who were diagnosed with both ADHD and SUD. They found that treating patients with medication for ADHD resulted in greater short and long-term retention for SUD treatment.
“No one has really studied the effect on long-term retention of treating these patients with the best available medications for ADHD,” Kast said. “Historically, we have been reluctant to prescribe ADHD medications to patients actively struggling with substance use disorders because the most effective medications are controlled substances classified as stimulants, which could potentially lead to misuse.”
Despite reluctance, the need for integrated treatment options is made clear by the number of patients with both ADHD and SUD. “Individuals with ADHD make up about a quarter of patients who come to us for substance use disorder treatment,” Kast said. “We wanted to answer the question: what happens if we treat their ADHD symptoms in our substance use disorder clinic?”
To find the answer, Kast and colleagues compared SUD patients who did and did not receive medication to treat their ADHD. The patients who received ADHD medication had significantly improved retention rates, specifically past 90 days — an important marker in SUD treatment.
“Retention is arguably the most important factor in SUD treatment,” said Kast. “Early dropout can lead to relapse and other social and medical complications, while a stay beyond 90 days is associated with improved results in the long term. This supports the idea that we should be diagnosing and treating ADHD early on in the course of substance use treatment.”
Kast says these findings were not particularly surprising, as they supported the hypothesis that treating ADHD symptoms with medication would improve patients’ attention and executive function — increasing their ability to make it to appointments, engage in therapy and take their medication as prescribed.
The research team was surprised, however, that ADHD medication was the only factor strongly associated with improved retention rates. They expected to find that substance use disorder medications such as Suboxone would also have an effect on retention, but regression analysis proved only ADHD pharmacotherapy had a significant impact.
Kast hopes that clinicians use these findings to safely prescribe ADHD medication to affected SUD patients. He recommends having a specialized treatment frame in place, meeting with patients weekly, prescribing medications in short supplies and doing regular toxicology screenings to ensure effective and safe patient outcomes.
“I want the research to increase awareness and encourage clinicians to look for and diagnose ADHD in this population early on in treatment,” Kast said. “The early period is a crucial time to stabilize ADHD symptoms in order to retain patients in treatment and avoid the worst-case scenario of a relapse, overdose or death.”
