Sensitization-based risk for substance abuse in vulnerable individuals with ADHD: Review and re-examination of evidence.

Evidence of sensitization following stimulants administration in humans is just emerging, which prevents reaching more definitive conclusions in favor or against a purported protective role of stimulant treatments for ADHD for the development of substance use disorders. Existing evidence from both animal and human research suggest that stimulants produce neurophysiological changes in the brain reward system, some of which could be persistent. This could be relevant in choosing optimal treatments for young patients with ADHD who have additional clinical risk factors for substance abuse (e.g. conduct disorder (CD) and/or familial addictions). Here we stipulate that, while the majority of youth with ADHD greatly benefit from treatments with stimulants, there might be a subpopulation of individuals whose neurobiological profiles may confer risk for heightened vulnerability to the effects of stimulants on the responsiveness of the brain reward system. We propose that focused human research is needed to elucidate the unknown effects of prolonged stimulant exposure on the neurophysiology of the brain reward system in young patients with ADHD. • Evidence showing sensitization effects of stimulants in animals is substantial while there is minimal evidence for sensitization in humans. • ADHD and SUD share common features of the brain reward system responsiveness to stimulant. • Some ADHD individuals may have unique neurobiological profiles possibly linked to susceptibility to sensitization and risk for substance use. • There no studies to inform the clinically relevant question if sensitization should be considered when youth are exposed to stimulants. • Proposed new lines of research that may provide more definitive answers are discussed. [ABSTRACT FROM AUTHOR]