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05/05/2008 - Debate Continues Over Relationship Between Substance Abuse Disorders and Use of Stimulants to Treat ADHD
A new study released in March found that the use of stimulant drugs to treat children with attention deficit-hyperactivity disorder (ADHD) had no effect on their future risk of substance abuse. The report assessed more than 100 young men 10 years after they had been diagnosed with ADHD.
Because stimulants are controlled drugs, there has long been concern that using them to treat children might promote future drug-seeking behavior. The use of stimulant medication for the treatment of ADHD has been one of the most controversial areas in all of child psychiatry.
Despite the new report, the ongoing debate of whether pharmacological interventions alter the risk for patients with ADHD to develop substance use disorders (SUDs) continues.
In the past, longitudinal studies suggested that a diagnosis of ADHD in childhood or adolescence predicts the risk for SUD later in life. A 2006 study published in Psychological Medicine showed that diagnosed with ADHD during childhood were twice as likely as non-ADHD controls to have an SUD at a 10-year follow-up as measured by hazard ratios, an estimate of overall relative risk.
Likewise, additional published studies also indicated adolescents and adults with ADHD are more likely than those without ADHD to be diagnosed with a SUD. In a 2005 study of adolescents, those with ADHD were 6.2 times more likely to have SUD (21.9%) than were the matched controls.
According to a report in a 2005 issue of the American Journal of Psychiatry, in adults with persistent ADHD, the 47 percent rate of a comorbid SUD is remarkably, and significantly, higher than the 28 percent rate in the matched controls.
In one recent report, 34 percent of adolescents who were being treated for SUD had a lifetime diagnosis of ADHD. This finding is similar to that of an earlier study of adults presenting for treatment of cocaine addiction, in which 35 percent met the criteria for a diagnosis of ADHD. These ADHD rates are substantially higher than the 4.4 percent incidence rate reported in the adult US population.
The common comorbidity of ADHD and SUD has led some to hypothesize that this risk is mediated, in part, by exposure to the stimulant medication (methylphenidate and amphetamine) that is used as front-line treatment for ADHD.
Two studies from this year provide more evidence on the association between stimulant treatment and the development of SUD. Together, these two most recent studies cast doubt on the previously supported notion that early stimulant treatment mitigated risk for the development of SUD in individuals with ADHD. Still, much work is needed to draw more firm conclusions.
Stimulant medication continues to be a leading treatment for children, adolescents, and adults with ADHD. The bulk of evidence suggests that this treatment does not increase the risk for the development of SUD. However, the most recent studies suggest that stimulant treatment does not mitigate risk either.
Clearly, additional research is needed to better understand any relationship that may exist between ADHD and substance abuse disorders, as well as to improve the treatment of patients.