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This page is an AI-assisted Turkish summary of the study presented at the 26th World Congress of Psychiatry. The study belongs to the presenting authors; please refer to the original source when citing it.

EV0005

Methylphenidate in addictions: emerging evidence on substance use and addictive behaviors in adults with and without ADHD

METHYLPHENIDATE IN ADDICTIONS: EMERGING EVIDENCE ACROSS SUBSTANCE USE AND ADDICTIVE BEHAVIOURS IN ADULTS WITH AND WITHOUT ADHD

Methylphenidate is not yet a general treatment for addiction; the strongest clinical signal is seen in amphetamine-type stimulant use disorder, but effects are modest and heterogeneous.

The aim of this study is to critically review the evidence on “novel” uses of methylphenidate (MPH) in addictions, distinguishing between substance use disorders and addictive behaviors, and between groups with and without ADHD. The methodology is a narrative review. The mechanistic rationale rests on the high comorbidity and more severe clinical course of ADHD and addictions; a shared phenotype characterized by impulsivity, impaired inhibition, and difficulty delaying gratification; overlapping dopamine and noradrenaline mechanisms in frontostriatal and thalamostriatal circuits; and methylphenidate’s enhancement of executive control. The poster emphasizes that this represents biological plausibility rather than established causality. Across the evidence gradient, the strongest clinical signal is in amphetamine-type stimulant use disorder: a meta-analysis of 10 randomized controlled trials involving 561 participants found reduced craving and modest reductions in stimulant use, but the effects were small and heterogeneous. Higher doses and longer treatment duration were associated with better outcomes, while no robust benefit was demonstrated for sustained abstinence. The 2024 ASAM/AAAP guideline makes a conditional recommendation, based on low-certainty evidence, that long-acting methylphenidate may be considered, particularly in enriched subgroups of individuals who use stimulants on 10 or more days per month and those with comorbid ADHD. For cocaine, although real-world cohort data are favorable, clinical trials and Cochrane evidence do not demonstrate robust superiority over placebo in achieving sustained abstinence. For cannabis, only neurobiological data are available (thalamic modulation and changes in connectivity between the thalamus and nucleus accumbens), while for tobacco, alcohol, and opioids, there is no consistent evidence of a direct anti-addiction effect. For addictive behaviors (problematic internet use, compulsive buying, food addiction–like symptoms, and compulsive sexual behavior), prospective data in adults with ADHD suggest reductions in symptoms, impulsivity, and mood symptoms, but controlled studies are still lacking. For safety in off-label use, long-acting formulations, cardiovascular screening and monitoring, monitoring for misuse and diversion, and careful patient selection and follow-up are recommended.

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