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How to Treat a Teen Self-Medicating ADHD and Anxiety with Marijuana

Teens, particularly those with undiagnosed ADHD and related conditions, are susceptible to substance abuse. When a child is self-medicating with marijuana, how can professionals and caregivers best adjust his or her treatment plan accordingly? Find out here.

An ADDitude Reader Writes: “My son wasn’t diagnosed with ADHD until 11th grade, at which point he’d already been smoking marijuana for some time. Stimulants seem to make his anxiety worse, so how can we treat his ADHD?”


Treating marijuana abuse alongside attention deficit disorder (ADHD or ADD) can be complicated because oftentimes, such as in this case, another condition is involved. Treatment options include both therapy and prescription medication. Many patients will also require intense cognitive behavioral therapy directed at the substance use, and also at anxiety management. In addition, there are several pharmacologic agents that can help both conditions.

  1. Strattera in an FDA-approved drug that has been shown to combat anxiety in children who have both anxiety and ADHD.
  2. Tricyclic-class antidepressants may also treat co-morbid anxiety and ADHD.
  3. Intense anxiety can be treated with a Prozac-like drug or with Zoloft.
  4. N-Acetylcysteine (NAC) is a supplement that has helped young people with cannabis addiction, according to a study by Dr. Kevin Gray published in the American Journal of Psychiatry. It can be bought in nutrition centers or stores like Whole Foods.

[Free Resource: How Do We Know the Medication Is Working?]

Some primary care physicians may be hesitant to prescribe stimulants for ADHD to a patient with known substance abuse. There is no evidence that stimulant use triggers or exacerbates existing substance abuse among patients with ADHD, however other treatment options do exist, including non-stimulants or extended-release stimulants. Extended-release stimulants appear to be misused less frequently by the individuals to whom they are prescribed. Immediate-release stimulants have a higher abuse rate due to their ability to deliver a faster and more potent high.

[Your Expert Overview: Choosing the Right Professional to Treat ADHD]

This content came from the ADDitude webinar by Timothy Wilens, M.D., titled “ADHD and Substance Use Disorders: How to Recognize and Manage Addiction in Adults and Adolescents”. That webinar is available for free replay here.

Updated on February 1, 2019

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  1. Tim Wilens, MD is no doubt the guru on SUD/ADHD in adolescents.
    On patients 18 – late 20s, it depends on what substance they are abusing. MJ alone is not easy, especially with many new State laws.
    I try to let the patient know that I’m their advocate; not the Dr that’s going to penalize them. Understand WHY they are using MJ. Anxiety, sleep, etc. Work with alternatives.
    I agree with Dr Wilens on
    1. Long acting stimulants for combined type ADHD.
    2. TCAs, prefer Nortriptyline (less side effects vs amitriptyline)
    3. I prefer the SSRI, lexapro vs zoloft, prozac, paxil. Seems to have least side effects, and I start soooooo slow: 2-3wks at 1/2 the 5mg, 2-4wks whole 5mg, then 10mg.
    4. Gabapentin still is great for ADHD anxiety and sleep, in low doses the first 3 months until the Lexapro is titrated up.
    I learned that from Wilens in 2008.
    5. The TCA is also great for sleep.
    Future?
    CBD, once FDA approved is what really helps with anxiety, and allows less stimulant (pending some studies). It has NOT been proven to treat ADHD, however.

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