Psychiatr News December 5, 2008
Volume 43, Number 23, page 14
© 2008 American Psychiatric Association
Substance-Abuse Risk Appears Less in Stimulant-Treated ADHD Patients
Jun Yan
Girls with ADHD treated with stimulants are less likely to develop
substance use disorders in adolescence than are girls with ADHD who have never
taken stimulants.
Despite their potential for being abused, stimulants prescribed to treat
children with attention-deficit/hyperactivity disorder (ADHD) do not increase
the risks they will develop substance use disorder (SUD), alcohol use
disorder, or begin smoking in adolescence, according to a study published in
the October Archives of Pediatric and Adolescent Medicine.
In this observational study, the authors collected long-term health data
and medical treatment histories on 114 young female patients with ADHD. The
participants were aged 6 to 18 at the start of the study and followed for five
years.
Twenty participants who had never taken stimulant medications were compared
with the other 94 participants who had been treated with stimulants for ADHD
in terms of each subject's use of cigarettes, alcohol, marijuana, and other
substances.
The study data were derived from a longitudinal case-control study of
adolescents with and without the disorder. The study was naturalistic and was
not randomized. Nevertheless, the authors stated that the patients with and
without stimulant exposure did not differ significantly in age, family status
and SUD history, ADHD severity, and rate of conduct disorder.
The girls in the cohort who had a diagnosis of ADHD and no stimulant
exposure generally did not receive other types of treatment, according to the
study's lead author, Timothy Wilens, M.D., an associate professor of
psychiatry at Harvard Medical School and director of substance abuse services
in the Clinical and Research Program in Pediatric Psychopharmacology at
Massachusetts General Hospital.
The ADHD patients who had taken stimulants had a 73 percent risk reduction
for developing a subsequent SUD and a 72 percent risk reduction in taking up
cigarette smoking compared with those who had never taken stimulants. Both
reductions were statistically significant.
Stimulant-treated patients who did take up smoking did so at an older age
on average than those not treated with stimulants. All the SUD diagnoses were
made by blinded evaluators using DSM-IV criteria.
In addition, exposure to stimulant treatment was not associated with
increased risk of substance dependence and alcohol abuse or dependence.
"The results of this study should calm the fears of both parents and
clinicians that early stimulant treatment will lead to cigarette smoking or
substance use in adolescence," said Wilens.
On the contrary, he continued, "the data showed a reduction in
cigarette smoking and substance use risks [associated with stimulant use] at
least in adolescence, which adds to a growing literature on the long-term
positive effects of ADHD treatment on the development of these
sequelae."
The study was funded by the National Institute of Health and the Lilly
Foundation, the charitable arm of the pharmaceutical company.
Youngsters with untreated ADHD, especially adolescents, are at a
significantly increased risk of developing substance use problems. Past
research has shown that stimulant treatment does not increase the risk of
smoking and substance use in boys with ADHD, the authors noted.
An abstract of "Effect of Prior Stimulant Treatment for
Attention-Deficit/Hyperactivity Disorder on Subsequent Risk for Cigarette
Smoking and Alcohol and Drug Use Disorders in Adolescents" is posted at
<archpedi.ama-assn.org/cgi/content/abstract/162/10/916>.
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