2026-03-12 ペンシルベニア州立大学（Penn State）
＜関連情報＞
- https://www.psu.edu/news/research/story/teens-and-young-adults-adhd-and-substance-use-disorder-face-treatment-gap
- https://www.sciencedirect.com/science/article/abs/pii/S0890856725022324
注意欠陥・多動性障害と物質使用障害を併発する青年および若年成人における注意欠陥・多動性障害の治療パターンと臨床転帰との関連性：後向き分析 Attention-Deficit/Hyperactivity Disorder Treatment Patterns and Association With Clinical Outcomes in Adolescents and Young Adults with Co-occurring Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder: A Retrospective Analysis
Raman Baweja MD, MS, Daniel A. Waschbusch PhD, Felix M. Padilla MD, Ritika Baweja MD, Balwinder Singh MD, MS, William E. Pelham III PhD, Brooke S.G. Molina PhD, Timothy E. Wilens MD, James G. Waxmonsky MD
Journal of the American Academy of Child & Adolescent Psychiatry Available online: 18 December 2025
DOI:https://doi.org/10.1016/j.jaac.2025.12.003
Objective
This study evaluated the impact of co-occurring SUD on ADHD treatment patterns and examined clinical outcomes associated with ADHD treatment in adolescents and young adults with both ADHD and SUD.
Method
This retrospective cohort study used TriNetX US Collaborative Network data on 1.23 million individuals 15 to 25 years of age who were diagnosed with ADHD from 2007 to 2024. About 23% (n = 288,159) had co-occurring SUD. Prescription patterns for ADHD medications and associated clinical outcomes were analyzed over 1 year. Relative risks (RRs), hazard ratios (HRs), and 95% CIs were calculated using propensity score matching and Cox proportional hazards models to adjust for confounders.
Results
Central nervous system (CNS) stimulant prescriptions were less frequent in the ADHD with SUD cohort (RR = 0.63, 95% CI = 0.62-0.63), whereas new bupropion prescriptions were slightly more frequent (RR = 1.05, 95% CI = 1.02-1.08) compared with ADHD without SUD. In ADHD with SUD, ADHD treatment (including prescriptions for CNS stimulants and nonstimulants) was associated with fewer hospitalizations, reduced emergency care, lower risk of suicidal ideation/attempts (range of RRs = 0.74-0.82), and continuous use of psychiatric services (RR = 1.23), but fewer methadone prescriptions (RR = 0.74). Compared with nonstimulants, stimulant treatment was associated with fewer hospitalizations, accidental overdoses, and suicidal ideation/attempts (range of RRs = 0.63-0.79). Overall, ADHD treatment was associated with a 30% lower risk of mortality (aHR = 0.70, 95% CI = 0.65-0.75).
Conclusion
Clinicians appear to be hesitant to prescribe CNS stimulants in the context of SUD; however, these findings align with clinical trials suggesting potential benefits of ADHD medication for individuals with co-occurring SUD. Bridging the gap between clinical practice and the evidence base will require ongoing research, clinician education, and policy change.
