RISK OF ADDICTION FOR PEOPLE DIAGNOSED WITH ADHD AND PRESCRIBED AMPHETAMINE MEDICATIONS
There is research evidence that amphetamine medications do not increase risk of addictions and might actually may be protective so that substance use disorders [SUD] are less likely to develop. However, these findings have been questioned more recently. Importantly, a meta analysis [ JAMA Psychiatry. 2013. Humphreys KL. Eng T, Lee SS] showed that the risk of addiction for those with ADHD who are treated with amphetamine medications is near zero. The amphetamine medications are effective in treating ADHD and they do not increase the risk of SUD in adults with ADHD, beyond the 2-3 x the risk of SUD compared to the general population for individuals with ADHD.
The research evidence of the benefit of treating ADHD + SUD with amphetamine medications includes fewer hospitalizations, fewer accidental overdoses and less suicidal ideation and fewer attempts as well as a 30% lower mortality. A prospective MTA analysis [Molina et al. 2023] found no evidence that amphetamine treatment was protective but no evidence of harm [did not contribute to a risk of SUD]. There are recommendations to monitor for evidence of diversion and to preferentially prescribe long-acting medications. The longer acting medications have a slower onset and more even serum levels thus reducing likelihood of euphoric experiences, misuse liability and likelihood of being diverted. The prodrug formulations [lisdexamfetamine[brand name Vyvanse]] are not able to be crushed or snorted or injected. However, one study [Comparative pharmacology and abuse potential of oral dextroamphetamine and lisdexamfetamine-A literature review. Human Psychopharmacology. 2024] showed that lisdexamfetamine can produce subjective drug-liking that is comparable to immediate-release dextroamphetamine. Also, a number of long-acting methylphenidate medications can still be modified for rapid intranasal absorption. So, long-acting medications are preferred for those with ADHD and SUD but they can still be misused.
Misuse of amphetamine medications is a serious problem on college campuses and to a lesser extent in the general population, mostly males from late teens into late 20s. It remains unclear the actual benefit non ADHD people get from the amphetamine medications. There is some evidence for cognitive enhancement but this is also influenced by a placebo effect in that many people who misuse these medications have clear expectations that they will perform better cognitively. There is some research support for cognitive benefits including enhanced memory, response inhibition, working memory, processing speed, and delayed memory.
Importantly, research has repeatedly demonstrated that amphetamine medications when prescribed for individuals with ADHD show improvement in attention, impulsivity, memory and response inhibition. Also, research has demonstrated that individuals with ADHD who are prescribed amphetamines have: improved academic/occupational performance and quality of life; reduced emotional dysregulation and aggression; and lowered risk of injuries, accidents, criminality, substance use, suicide, and premature death. Considering the above, it seems clear, and research also concludes, that the benefits far outstrip the risks when looking at prescribing amphetamines for individuals with ADHD.
