Can we prevent the misuse of prescription stimulants? : a case report

Background: The diagnosis of attention-deficit/hyperactivity disorder and the use of
prescription stimulants have rapidly increased in children and adults in the past decade. The most
reported motivations for misuse were the help with alertness and concentration. Commonly, abusers use
prescription stimulants from friends who received a prescription from a healthcare provider.

Methods: Here we present a 23-year-old patient who was diagnosed with ADHD. She came to our outpatient
clinic looking for a second opinion. The patient reported symptoms of hyperactivity and attention disorder. Her
main concern was problem with forming social relationships during her childhood and adolescence.
She often felt misunderstood and had difficulties expressing her emotions. Her psychiatrist prescribed her 80 mg of atomoxetine which she gradually stopped taking. She asked if methylphenidate could be prescribed to her because a lot of her colleagues are taking it, and they feel great while using it. She found self-report scales of autism on the internet and claimed that she should be
diagnosed with autism and treated with methylphenidate.

Results: We took a detailed medical history and supported a patient. Psychological testing was
performed and showed no elements of autism. Psychoeducation about autism, ADHD, and misuse of
psychostimulants was provided for the patient so she could better understand her condition. According
to her mental status and psychological testing, we found no arguments for excluding atomoxetine and
adding methylphenidate to her therapy. We advised her to continue her monthly checkups and to go to
individual psychotherapy. The patient refused to take the recommended pharmacotherapy, but 
agreed to go to psychotherapy and continue her monthly checkups at our outpatient clinic.

Conclusions:  After loosening the diagnostic criteria for ADHD we should make an effort to reconsider the pattern of prescribing stimulants. Psychoeducational and psychotherapeutic interventions could play a major role in the prevention of misuse of prescription
stimulants.