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ADHD Medication Treatment

Margaret V. Austin, Ph.D., edited by C. E. Zupanick, Psy.D.

What are the treatment options for adult ADHD?

As with many psychiatric conditions, people with ADHD benefit from a combination of medication, education, skill training, and psychotherapy. The treatment process is the same regardless of the condition or method used to address it:

1) identify the problem(s);
2) establish a treatment plan with specific goals;
3) develop strategies to reach those goals;
4) implement the plan;
5) monitor outcomes; and,
6) adjust the treatment as necessary.

The single most effective treatment for adult ADHD is medication. This is also true for children with ADHD. In this section, we will review these treatments as they directly relate to adult ADHD. For more specific information about children with ADHD, we refer you to our companion article on ADHD and children

Medications for adult ADHD: Stimulants and Non-stimulants

yellow and blue pillsMedication is the single most effective component of treatment for most adults with ADHD. Nearly 70% of adults with ADHD benefit from stimulant medication (Biederman & Spencer (2004). Despite the high rate of symptom improvement, many adults are reluctant to try medication. This may be due to preconceived notions or concerns about drug use in general. Most clinicians emphasize the risk is low, relative to the potential benefits. In fact, one potential benefit is that medication can serve to confirm the diagnosis, alleviating fears about taking an unnecessary medication. This is because if someone does not truly have ADHD, the medication will not provide any relief. Stated differently, if someone does have ADHD, a trial of medication could make a huge improvement in their life. Despite these advantages, finding the right medication regime can be a challenging, and sometimes frustrating process.

There are essentially two types of medications that are used treat ADHD:

1) stimulant medications; and,
2) non-stimulant medication.

Stimulants are most often prescribed for ADHD because they are effective for most people. A study by Biederman and Spencer (2004) at Massachusetts General Hospital found that stimulants worked successfully in reducing symptoms for 70% of people when dosed optimally. However, in the United States, stimulants are Class II Drugs which makes many professionals uneasy because this classification means there is a risk of abuse. Therefore, they must be prescribed cautiously.

Prescribing stimulants to treat adult ADHD is somewhat controversial because many people seeking treatment for adult ADHD come to treatment with an existing substance abuse problem. Professionals and non-professionals alike are concerned that the use of stimulant medication will lead to further drug abuse. There is some merit to this concern: Stimulants are drugs that are frequently abused in the general population. Because these drugs are often sold on the black market and abused, people often (incorrectly) assume that an adult with ADHD gets "high"(1) using these drugs. While this assumption makes an understandable and logical argument, the research does not support it. Instead, research by Biederman and Spencer (2004) suggests that adults with ADHD are unlikely to get high using stimulants as prescribed. However, other people taking the same drug and dose would get high.

Over the past decade, our understanding of the biological impact of drugs has dramatically increased. We have a much better understanding of why some people get high from a certain drug, while others do not. Central to this understanding is that some people's brains may have deficiencies in certain necessary chemicals. According to this deficiency theory, replacing these chemicals with a pharmaceutical drug merely raises the neurotransmitters back to an optimal level. In contrast, when someone with a normal brain chemistry takes the same drug, it would produce an excessive neurotransmitter level and s/he would likely get "high". With respect to people with ADHD, it is believed their brains have insufficient levels of certain chemical neurotransmitters, called dopamine and norepinephrine. Both stimulants and non-stimulants alleviate ADHD symptoms by increasing and normalizing levels of these neurotransmitters.

Currently, there is no way to actually measure the levels of someone's brain chemistry, nor to determine their unique, optimal brain chemistry. Nonetheless, if deficit brain chemistry is to blame, it certainly supports the notion that treating adult ADHD with stimulants can actually reduce substance abuse risk by decreasing the need to self-medicate. Self-medication refers to the use of drugs to control unpleasant symptoms without the knowledge, advice, or supervision of a healthcare professional. People self-medicate with street drugs, prescription drugs, and over-the-counter drugs. Contrary to getting high, people who self-medicate are trying to avoid unpleasant symptoms, rather than achieve euphoria. Most clinicians agree: If an ADHD diagnosis seems probable, a therapeutic trial of stimulants warrants strong consideration because the benefits can be assessed almost immediately. This rapid assessment result is due to the medication's quick onset. Nonetheless, there are occasions where stimulants might be contraindicated so be sure to discuss all health care issues when being evaluated for ADHD.

1) The term, "high" is a commonly used slang word in the United States. It refers to the improper use of a drug, or other substance, with the intent of producing a sense of euphoria. It is used as both a noun and verb. As there is no correct, corresponding term with the same meaning, we will adopt its use for consistency and brevity.