# Discuss substance risk with your team

Published by Pawel Jozefiak. [About this project](https://adhd100.jock.pl/about/), [How we check sources](https://adhd100.jock.pl/methodology/)

- Canonical: https://adhd100.jock.pl/discuss-substance-risk-treatment/
- Language: en
- First published: 2026-09-29
- Evidence checked: 2026-09-29, using AI-assisted source verification
- Clinical review: Not clinically reviewed
- Number 38 of 100 in the list: https://adhd100.jock.pl/#discuss-substance-risk-treatment

An honest review can deal with worries about substance use without assuming prescribed ADHD care causes addiction.

**The number:** Registry study: ADHD medication linked with less recorded substance misuse (rate ratio 0.85) ([BMJ, 2025](https://pmc.ncbi.nlm.nih.gov/articles/PMC12344785/))

## The evidence

- How sure: Certainty of evidence: Guideline advice, not formally graded. Measured in people with ADHD.
- Evidence grade: A. Grade A: moderate or high certainty evidence in people with ADHD, or an explicit ADHD guideline recommendation.
- Basis: NICE NG87 1.4.3 and 1.7.4 recommend the discussion and risk assessment; large ADHD-specific observational target-trial emulation, no GRADE rating and no causal prevention claim
- Benefit: 63/100. The benefit score is an editorial prioritization for the general list, weighted by certainty. It is not a prediction of what will happen for you.

## Why it matters

A Swedish registry study of people with ADHD linked medication treatment with a lower rate of recorded substance misuse over two years, an adjusted rate ratio of 0.85. It was an observational target-trial emulation, so it cannot prove the medication prevented misuse, or that misuse is impossible. NICE recommends talking about the raised risk of substance misuse after diagnosis, and assessing the risk of misuse and diversion before medication starts.

## How to do it

1. Tell the prescriber about substance use now and any past problems, including misuse of prescribed medicines.
2. If you need help with both, ask how ADHD care and substance-use care can work together.
3. Raise any worries about dependence, diversion, or being pressured to share your medicine.
4. Agree who keeps an eye on the risks and how to reach the care team if things change.

## Talk to a clinician first

Substance use and prescribing need an assessment of your own situation. This finding does not support taking someone else's medicine, taking extra, or tackling substance problems without clinical help.

## Putting it into practice

### Start now

- 1 minute: Write down the substance-use or medicine-safety worry you want to raise privately with your clinician.
- 5 minutes: List the substances and medicines you use, and any worries about control or safety.
- 15 minutes: Write your questions about joined-up treatment, confidentiality and how the team watches for risk.

### What it looks like

- Mention substance use even if it feels like it has nothing to do with an ADHD appointment.
- If ADHD and substance-use services are separate, ask who coordinates your care.

### Common mistakes

- A link with lower recorded risk is not proof that medicine prevents addiction. Talk about your own risks.
- Fear of being judged can hide what the prescriber needs to know to prescribe safely. Ask how the team can make an honest conversation easier.

### A structured start

**Make substance risk part of care**

1. Share the relevant history with the prescriber.
2. Agree whether coordinated specialist support is needed.
3. Review risks and contact arrangements as circumstances change.

### Trusted how-to guides

- [Tips for Talking With a Health Care Provider About Your Mental Health](https://www.nimh.nih.gov/health/publications/tips-for-talking-with-your-health-care-provider), NIMH
- [Common questions about methylphenidate for adults](https://www.nhs.uk/medicines/methylphenidate-adults/common-questions-about-methylphenidate-for-adults/), NHS

## Sources

- [ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials](https://pmc.ncbi.nlm.nih.gov/articles/PMC12344785/), BMJ, 2025 (Tier 2 study)
- [Attention deficit hyperactivity disorder: diagnosis and management (NG87), recommendations](https://www.nice.org.uk/guidance/ng87/chapter/Recommendations), NICE, 2019 (Tier 1 guideline)
- [Common questions about methylphenidate for adults](https://www.nhs.uk/medicines/methylphenidate-adults/common-questions-about-methylphenidate-for-adults/), NHS, 2025 (Tier 1 guideline)

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General information about ADHD, not a diagnosis or an individual treatment plan. Tailoring changes the order of suggestions; it does not assess you. Medication decisions belong with you and a qualified clinician.

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Reuse: CC BY 4.0, https://creativecommons.org/licenses/by/4.0/