Impact of Treatment with Central Nervous System Stimulant and Risk of Substance Use Disorder in Adults with Attention-Deficit/Hyperactivity Disorder

Diagnoses of adult ADHD and substance use disorder (SUD) have been increased recently, but no treatment guideline is available in the U.S. This study aims to (a) assess the association between central nervous system (CNS) stimulant users and their first SUD diagnosis and (b) examine the impact of CNS stimulant use on health resource utilization (HRU). We conducted a retrospective study using electronic health records. Cox and negative binomial regression models were utilized to examine the association between CNS stimulant use and incidence of SUD and HRU, respectively. A total of 28,540 ADHD patients were mostly White (96.3%) and between 18 and 44 years old (79.7%). The CNS stimulant users were less likely to develop a SUD (HR = 0.86 [0.81–0.91], p < 0.05) and took longer days to develop a SUD (1462 days vs 1077 days) and utilized fewer inpatient and emergency room services. (IRR = 0.90 [0.86–0.95], 0.82 [0.78–0.85], respectively, p < 0.05). Our findings emphasize the need for assessment and treatment of adults with ADHD to mitigate the risk of developing SUD.