Treatment of Methamphetamine Use Disorder with Comorbid ADHD

Pharmacological Treatment Options

• The American Academy of Child and Adolescent Psychiatry recommends atomoxetine as a primary non-stimulant alternative when stimulants are contraindicated or not tolerated, with a target dose of 60-100 mg daily for adults, and requires 6-12 weeks to achieve full therapeutic effect 1
• Atomoxetine may be particularly useful in patients with active substance use or high diversion risk, as it is an uncontrolled substance, and extended-release guanfacine (1-4 mg daily) or clonidine can be used as monotherapy or adjunctive therapy with effect sizes around 0.7 1
• The FDA recommends monitoring closely for suicidal ideation, clinical worsening, and unusual behavioral changes, especially during initial months or dose changes, when using atomoxetine 2

Essential Treatment Components Beyond Medication

• The National Institute on Drug Abuse recommends combining pharmacotherapy with behavioral support, such as brief psychosocial interventions modeled on motivational principles, to improve treatment outcomes for psychostimulant use disorders 3

Critical Monitoring Parameters

• The American Heart Association recommends monitoring blood pressure and pulse regularly, as stimulants cause statistically significant increases, when prescribing stimulants in this population 4