E290 - ADHD and Substance Use Disorders: Treatment Challenges with Dr. Timothy Wilens

I love the concept here, Tim, of shared decision-making.

That's so important.

And you're right, in my experience, people with a history of substance abuse don't want to jeopardize the recovery generally, and we'll be pretty forthcoming with you about that.

But, you know, I've got to talk about it.

It just seems like it's...

Really hard to prescribe stimulants these days.

They're scheduled to.

There's a lot of, even as I go and talk to other providers as you do around the country, there's still a lot of reluctance to prescribe stimulants independent of this issue we're talking about.

But when you layer this on top, it just adds another layer of reluctance.

But it reminds me of our good friend Roger McIntyre talks about the implementation gap.

And the lack of applying evidence-based medicine, and my gosh, Tim, look at the evidence you're dropping on our audience like a bomb here.

The evidence base says in appropriate patients with shared decision-making, there's no reason you should be reluctant to use a stimulant.

If anything, you may really help the patient.

As you said, even patients who are relatively recently in recovery, as long as they're in treatment programs, that's really important.

It is.

And, you know, your point is well taken.

If you look at the different clinical trials, and again, you've done half of them.

But a lot of the clinical trials done in ADHD had exclusion for people coming with substance use, but six months a year.

But they also included a fair number of people with past histories of substance use.

And we began, this is one of those papers that I never wrote that I wish I had written, a study that looked at, we did an analysis looking at, does past history of substance use you know, up to a year, because that seemed to be the standard metric, increased the likelihood for any breakthrough substance use after treatment with stimulus or non-stimulus.

We didn't find evidence of that.

We found no evidence of that whatsoever.

So, for people in past histories, not a problem if you used a stimulant or non-stimulus.

Now, there's a lot of qualifiers.

These are clinical trials, etc., We're re-examining that now in electronic health records.

I love the concept here, Tim, of shared decision-making.

That's so important.

And you're right, in my experience, people with a history of substance abuse don't want to jeopardize the recovery generally, and we'll be pretty forthcoming with you about that.

But, you know, I've got to talk about it.

It just seems like it's...

Really hard to prescribe stimulants these days.

They're scheduled to.

There's a lot of, even as I go and talk to other providers as you do around the country, there's still a lot of reluctance to prescribe stimulants independent of this issue we're talking about.

But when you layer this on top, it just adds another layer of reluctance.

But it reminds me of our good friend Roger McIntyre talks about the implementation gap.

And the lack of applying evidence-based medicine, and my gosh, Tim, look at the evidence you're dropping on our audience like a bomb here.

The evidence base says in appropriate patients with shared decision-making, there's no reason you should be reluctant to use a stimulant.

If anything, you may really help the patient.

As you said, even patients who are relatively recently in recovery, as long as they're in treatment programs, that's really important.

It is.

And, you know, your point is well taken.

If you look at the different clinical trials, and again, you've done half of them.

But a lot of the clinical trials done in ADHD had exclusion for people coming with substance use, but six months a year.

But they also included a fair number of people with past histories of substance use.

And we began, this is one of those papers that I never wrote that I wish I had written, a study that looked at, we did an analysis looking at, does past history of substance use you know, up to a year, because that seemed to be the standard metric, increased the likelihood for any breakthrough substance use after treatment with stimulus or non-stimulus.

We didn't find evidence of that.

We found no evidence of that whatsoever.

So, for people in past histories, not a problem if you used a stimulant or non-stimulus.

Now, there's a lot of qualifiers.

These are clinical trials, etc., We're re-examining that now in electronic health records.