New West Virginia University research shows adults with attention-deficit/hyperactivity disorder who use an extended-release medication are more likely to continue the treatment and have a lower risk of developing substance use disorder. (WVU Photo/Aira Burkhart)
Adults with attention-deficit/hyperactivity disorder, or ADHD, who use an extended-release medication are more likely to continue the treatment and have a lower risk of developing substance use disorder, according to two West Virginia University studies.
“There is a lot of information about childhood and adolescent ADHD, but very few talk about adult ADHD,” said Abdullah Al-Mamun, a data scientist and assistant professor in the WVU School of Pharmacy Department of Pharmaceutical Systems and Policy. “It’s a behavioral disease which can be always treated. You just have to take your medications regularly. If you don’t, symptoms become more aggravated and other symptoms like depression, substance use, etc. are likely to develop.”
The lack of research into adult ADHD nationally is what led Al-Mamun to conduct these studies — one to understand factors related to medication adherence and another to determine how likely patients were to develop substance use disorder based on whether they took their prescriptions regularly.
Al-Mamun said, while the true prevalence of adult ADHD in the United States is unknown, a new national survey of 1,000 American adults finds 25% of adults now suspect they may have undiagnosed ADHD.
The disease is usually diagnosed in childhood — marked by lack of focus, ignoring social rules and fidgeting — and may last into adulthood. However, it can also initially develop in adults, and symptoms differ from those in children to include impulsiveness, excessive activity or restlessness and low frustration tolerance.
While there is no standard guideline in the United States for treating adult ADHD, patients of all ages are commonly prescribed medications known as central nervous system stimulants that act to invoke calmness and alleviate symptoms. Patients with higher levels of agitation may also attend psychotherapy sessions.
“In other countries, especially Sweden, the U.K. and Germany, there are emerging guidelines to treat adult ADHD,” Al-Mamun said. “We need more guidelines here in the United States, not only for medications but for behavioral treatment. I hope these studies will highlight the needs for further rigorous assessment of adult ADHD and treatments, which will be extremely valuable to the clinicians.”
Al-Mamun’s study indicates about 80% of adults with ADHD fail to comply with the treatment plan within the first year of diagnosis. He said the reasons could be social stigma, simple forgetfulness or disbelief that they still have the disease beyond adolescence.
Using data from the Medical Expenditure Panel Survey, a nationally representative dataset, researchers compared adult patients taking extended-release CNS stimulants to those taking the instant release form to assess factors influencing medication adherence and health care utilization.
Researchers found those taking the extended-release version, especially in the 36-45 and 56-65 age groups, showed a higher rate of adhering to medications. That group also utilized more outpatient visits and prescription refills than ones who weren’t taking the medications regularly.
“That is a good thing because it means people who are taking their medications are concerned about their condition,” Al-Mamun added.
However, patients using the instant release pills didn’t take their medications regularly. They had higher rates of outpatient and emergency room visits, hospital stays and home health services compared to those who took extended-release versions and kept up with their medication schedule.
“This is a huge problem in the United States because medication non-adherence for ADHD is very costly,” Al-Mamun said.
Statistics cited in his study show an estimated cost of up to $100 to $300 billion annually which included direct and indirect health care costs. However, there is no accurate estimation for the adult ADHD population in the U.S.
Beyond the health care cost burden, Al-Mamun said non-adherence to medication results in problems for the patients, their families and work colleagues.
“Patients with adult ADHD often forget things or feel misunderstood which makes them experience agitations and they may be short-tempered,” Al-Mamun explained. “Medications can help, but if they’re not taking them it can become like a spider web. When they get frustrated and people don’t understand why, they become more frustrated.”
He also added those reactions could lead to depression or the use of addicting substances, a trend he found to be on the rise while analyzing West Virginia toxicology data for another project.
“I saw that there are a lot of people in the adult ADHD population dying because of drug overdose,” he said. “That’s what made me think about doing the second study to see what their risks of developing substance use disorder are.”
Other studies estimated about one in four patients who experience substance use disorder have been diagnosed with ADHD.
Al-Mamun’s study compared records of more than 28,500 patients with ADHD who had received care in West Virginia. Subjects were divided into two groups — one that was prescribed CNS stimulants and one that was not. In both groups, researchers assessed the time frame between ADHD diagnosis and when they experienced substance use disorder related to alcohol, cannabis, nicotine or opioids.
“We found that people with adult ADHD who take CNS stimulants were less likely to develop substance use disorder and, if they do, they take a longer time to develop it,” he explained. “For example, they take 1,462 days to develop SUD compared to people who don’t take CNS stimulants and develop it in 1,077 days.”
Adult ADHD patients who continued taking medication also had fewer emergency room visits and hospital admissions, the study shows.
“These studies are very important because we don’t know much about what is happening with the adult ADHD population in the United States,” he said. “I have found that people who have ADHD in childhood and whose symptoms improve tended to discontinue their medications. Then we don’t know how they’re doing as adults. I think we need more case studies that track patients from childhood into adult years.”
Al-Mamun and doctoral student Ki Jin Jeun are currently researching the societal costs involved with adult ADHD. In the future, he would like to continue studies to understand why adults with ADHD discontinue their medication and how that relates to substance use disorder.
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MEDIA CONTACT: Linda Skidmore
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