Addressing stimulant use and co-occurring ADHD through medication-assisted treatment: expanding harm reduction options
Research shows a strong connection between attention deficit hyperactivity disorder (ADHD) and problematic drug use. Among adults being treated for alcohol and substance use disorders, the rate of ADHD is about 25%, while between 33% and 44% of young people with ADHD experience alcohol misuse or dependence. For many people with ADHD, stimulant medications boost concentration and focus while reducing hyperactive and impulsive behaviors, thus leading to a trend of misusing prescribed stimulants as a way of self-medicating undiagnosed ADHD.
In recent years, relevant interested parties (from researchers to the community of people who use drugs and medical professionals) around the world are looking for effective treatment options for stimulant use disorders, including medication-assisted treatment. One of the medications that is used for these interventions is methylphenidate - a medication that is officially approved in Ukraine for treating ADHD.
Taking all the above into account and based on voiced concerns and requests from the community of people who use drugs in the country, as well as very limited existing options of harm reduction services available to stimulant DUs, we had combined other countries' experience and global recommendations and launched an intervention that combines medically assisted treatment of ADHD with brief psychosocial interventions and is aimed at people with stimulant use dependencies.
The pilot was launched in 4 cities of Ukraine and aims to cover up to 6 sites and 100 people until the end of 2024. By means of this pilot, we will be able to see how ADHD treatment impacts illicit drug use and overall quality of life in the stimulant users population, as well as assess how this program is generally perceived by the community and what improvements in its design and implementation need to be made to make it more attractive and efficient.
In order to assess the above mentioned aspects, we will be using a number of internationally approved questionnaires and scales, including the Alcohol and Drug Consequences Questionnaire (ADCQ), the WHO Screening Questionnaire for Alcohol, Tobacco and Drug Problems (ASSIST) and the WHO Quality of Life Brief Questionnaire, as well as the Brief Substance Craving Scale (BSCS), etc.
Paying attention to the varied individual issues of each patient/client by using a comprehensive screening and diagnosis approach and developing models that will best suit people with one or more comorbidities is at the core of the people oriented approach that we aim to follow. The need to treat more than just the initial issue that the person comes to us with is a common situation among different groups of people who use drugs and mental health is oftentimes at the core of these issues, especially in Ukraine today. Expansion of the spectrum of services available to PUDs and attention to related mental health and other existing issues, allows us to better respond to the needs of this underserved community.
