Stimulants May Protect Against Drug Abuse in Kids With ADHD

Caroline Cassels

July 10, 2013

Stimulant medications appear to lower the risk for substance abuse disorders in adolescents with attention-deficit/hyperactivity disorder (ADHD), new research shows.

In a large, prospective, longitudinal study investigating the effect of stimulant medication on the development of substance use disorder (SUD) in ADHD, investigators from the State University of New York Upstate Medical University in Syracuse found that adolescents with ADHD who were not treated with a stimulant medication for their disorder had a 2-fold increased risk of developing an SUD compared with their counterparts who were treated.

Untreated adolescents with ADHD also had a 2.6-fold increased risk of developing an SUD compared with a healthy, age-matched control group.

"We found that stimulant medication has a protective effect on the development of substance use disorders in adolescence, and that children who start stimulant medication at a younger age are better protected. We didn't find any impact on the development of nicotine dependence," lead researcher Stephen V. Faraone, PhD, said in a statement.

The study was published online July 11 in the British Journal of Psychiatry.

Previous research has shown a strong link between ADHD and an increased risk for both SUDs and nicotine dependence. At the same time, concerns have been raised over the fact that because stimulant medications — the first-choice medication treatment for ADHD — have addictive potential, they may increase this risk for subsequent SUDs.

To assess the effect of stimulant treatment on subsequent risk for SUD and nicotine dependence, the investigators conducted a prospective, longitudinal ADHD case-control study that included 505 teens with ADHD recruited from the German International Multicentre ADHD Genetics study, and 223 healthy control participants recruited from high schools in the same geographic region.

At baseline, ADHD, conduct disorder, and oppositional defiant disorder were assessed. A total of 327 individuals with ADHD were treated with stimulant medications, and 61 were not.

At a mean follow-up of 4.4 years after study entry, all participants underwent a retrospective assessment of their alcohol, drug, and nicotine use.

The investigators found that among those with ADHD, stimulant treatment was linked to a reduced risk for SUDs compared with no stimulant treatment, even after they controlled for conduct disorder and oppositional defiant disorder (hazard ratio [HR], 1.91; 95% confidence interval [CI], 1.10 - 3.36). However, it was not linked to a reduced risk for nicotine dependence (HR, 1.12; 95% CI, 0.45 - 2.96).

There were no differences in substance use between those with ADHD who took stimulant medications and healthy control participants. The researchers also found that those participants who started stimulant medication at an earlier age were less likely to develop an SUD.

Exactly how stimulant medications guard against substance abuse is not entirely clear, but Dr. Faraone said it is possible that these medications work by "decreasing the core symptoms of ADHD, including impulsivity, and associated problems such as poor self-esteem and school failure, which can lead to drug and alcohol use."

"Stimulant treatment has a protective effect on the development of drug- and alcohol-related substance use disorders," the investigators conclude.

Dr. Faraone reports that in the past year, he received consulting income and/or research support from Shire, Otsuka, and Alcobra and research support from the National Institutes of Health. He reports that in previous years, he received consulting fees or was on advisory boards or participated in continuing medical education programs sponsored by Shire, McNeil, Janssen, Novartis, Pfizer, and Eli Lilly. Disclosure information of the other authors can be found in the original study.

Br J Psych. Published online July 11, 2013. Abstract

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