Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, affecting 12% to 13% of adolescents in the United States, according to several studies. Patterns of inattention, hyperactivity, and impulsivity can interfere with daily life and cause problems at home, work, and school. At the same time, people diagnosed with ADHD are at increased risk of developing a substance use disorder.
However, treating the combination of these two conditions can be complicated. A team led by researchers at Penn State College of Medicine identified treatment disparities among adolescents and young adults diagnosed with both ADHD and substance use disorders.
In a study published in the Journal of the American Academy of Child and Adolescent Psychiatry, researchers found that young people who were diagnosed with ADHD but also had a substance use disorder were significantly less likely to be prescribed central nervous system (CNS) stimulants, the drug-based first-line treatment for ADHD symptoms. However, people receiving this type of ADHD medication saw improved health outcomes, with fewer serious complications, including fewer emergency visits, hospitalizations, and fewer suicidal thoughts. Over five years, treating ADHD led to an approximately 30% reduction in the risk of death.
For young people with ADHD and substance use disorders, proper treatment of ADHD can save lives. Clinicians should not hesitate to provide evidence-based ADHD treatment when indicated. ”
Raman Baweja, professor of psychiatry and behavioral health and public health at Penn State College of Medicine and lead author of the study
The researchers say that up to 50% of people diagnosed with ADHD go on to develop a substance use disorder, and these people face worse outcomes than if they had either disorder alone. They are more likely to be hospitalized and consider suicide, and have higher rates of suicide attempts.
ADHD symptoms can be treated with both CNS stimulants and non-stimulants. CNS stimulants usually have higher response rates. However, clinicians often have concerns about prescribing drugs, particularly stimulants, because of their controlled substance nature and the Food and Drug Administration’s warnings against misuse, the researchers explained. There are concerns that this drug may be misused or worsen symptoms of substance use, especially among young adults who already suffer from a substance use disorder. As a result, clinicians may steer patients away from stimulants, which are evidence-based treatments for ADHD symptoms.
Understanding how individuals with ADHD and substance use disorders are currently treated and the health outcomes they experience can better guide clinicians in making treatment decisions and help improve patient outcomes, Baweja said.
In this study, the researchers examined a national sample of de-identified health records of adolescents and young adults between the ages of 15 and 25. More than 1.2 million of them were diagnosed with ADHD, and about 288,000 of them were diagnosed with both ADHD and a substance use disorder, ranging from nicotine use disorder to alcohol, cocaine, and opioid use disorder. The team then analyzed ADHD treatment patterns and one-year clinical outcomes, as well as five-year mortality rates.
Researchers found that among youth diagnosed with both ADHD and substance use disorders, receiving ADHD treatment with either stimulants or non-stimulants was associated with fewer hospitalizations, emergency department visits, and accidental overdoses. Suicidal thoughts are reduced. Low risk of suicide attempt. Utilized psychiatric services more consistently compared to those who did not receive treatment for ADHD. Overall, young people had a 30% lower risk of dying over five years.
Notably, patients receiving stimulants experienced an even greater reduction in risk compared to patients receiving non-stimulant alternatives. For example, patients treated with stimulants had 4% lower rates of suicidal thoughts and attempts.
However, researchers found that young people were less likely to be prescribed ADHD medication after a substance use disorder diagnosis. After youth with ADHD were also diagnosed with a substance use disorder, the number of ongoing stimulant treatment prescriptions decreased by approximately 15%, and the number of new stimulant prescriptions decreased by more than 17%.
“CNS stimulants are an evidence-based first-line treatment for ADHD, but some clinicians may be hesitant to prescribe them to patients with substance use disorders based on these findings. We theorize that this is because of concerns about misuse, and we agree that this is a real risk,” Baweja said. “Our findings suggest that, when used appropriately, treatments for ADHD that include stimulants may have significantly better outcomes.”
The research team is advancing this work by examining a broader age group of individuals with ADHD and substance use disorders, from 16 to 65 years old. This analysis examines how demographic factors, such as age, gender, and race/ethnicity, and clinical factors, such as type of substance use disorder and co-occurring mental illness, influence both the likelihood of receiving ADHD treatment and the type of medication prescribed.
Other authors from the Penn State College of Medicine include senior author James Waxmonsky, professor of psychiatry and behavioral health and university professor of child psychiatry; Daniel Waschbusch, professor of psychiatry and behavioral health and vice chair for research; Felix Padilla, assistant professor of psychiatry and behavioral health; and Ritika Baweja, associate professor of psychiatry and behavioral health and obstetrics and gynecology.
Other authors of the paper include Balwinder Singh, assistant professor at the Mayo Clinic. William Pelham III, assistant professor of psychiatry at the University of California, San Diego; Brooke Molina, professor of psychiatry, psychology, pediatrics, and clinical and translational sciences at the University of Pittsburgh; Timothy Willens, director of child and adolescent psychiatry at Massachusetts General Hospital and professor of psychiatry at Harvard Medical School.
This research was supported by funding from the National Center for the Advancement of Translational Sciences at the National Institutes of Health.
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Reference magazines:
Baweja, R. Others. (2025). Associations between attention-deficit/hyperactivity disorder treatment patterns and clinical outcomes in adolescents and young adults with comorbid attention-deficit/hyperactivity disorder and substance use disorders: A retrospective analysis. Journal of the American Academy of Child and Adolescent Psychiatry. DOI: 10.1016/j.jaac.2025.12.003https://www.jaacap.org/article/S0890-8567(25)02232-4/abstract
