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Four articles in one journal issue reviewed this topic. All had similar conclusions. In one study, virtually no subject on ADHD medications had concurrent substance abuse, unless there was an associated conduct disorder or other psychiatric disorder. Presence of a conduct disorder with ADHD was associated with substance abuse in 20% of these adolescents. Four years later (when all subjects were older than 15), those with ADHD without prescribed stimulant medication had high rates of substance abuse (75%) compared to those on medications who had a 25% rate of substance abuse. The rate of substance abuse among controls (no ADHD) was 20%. Medicating adolescents and adults with ADHD provides protection against a substance abuse disorder – and this protective effect of medications is strongest for adolescents.

Medication for ADHD not only does not increase chances of a substance abuse disorder, it also is not a risk for more experimentation with illicit substances (e.g., tobacco, alcohol, marijuana, etc.). The one exception was increased cocaine use– but this was only true for those with both ADHD and a conduct disorder.

People have postulated that giving stimulants to children and adolescents (ADHD medications) would lead to abuse because cocaine is also a stimulant. However, the pharmacodynamics of methylphenidate (such as Ritalin) give it a significantly lower potential for abuse than cocaine. Unlike cocaine, methylphenidate is cleared more slowly from the brain and is taken orally. Also, methylphenidate may have less potential for abuse among those with ADHD than those without ADHD because ADHD individuals have higher densities of dopamine transporters in their brains.

(Biederman J; J Clin Psychiatry 2003; 64(suppl 11):3-8)
(Faracone SV, Wilens T; J Clin Psychiatry 2003; 64(suppl 11):9-13)
(Kollins SH; J Clin Psychiatry 2003; 64(suppl 11):14-18)
(Fischer M, Barkley RA; J Clin Psychiatry 2003; 64(suppl 11):19-23)

Comment: Despite overwhelming evidence to the contrary, parents are still concerned that putting their child on a stimulant for ADHD will lead to later substance abuse. Prescribing doctors try to make the case for its protective effects – as do school nurses, I am sure. – H.T.






			Does ADHD Medication Lead to Later Substance Abuse? Four articles in one journal issue reviewed this topic. All had similar conclusions. In one study, virtually no subject on ADHD medications had concurrent substance abuse, unless there was an associated conduct disorder or other psychiatric disorder. Presence of a conduct disorder with ADHD was associated with substance abuse in 20% of these adolescents. Four years later (when all subjects were older than 15), those with ADHD without prescribed stimulant medication had high rates of substance abuse (75%) compared to those on medications who had a 25% rate of substance abuse. The rate of substance abuse among controls (no ADHD) was 20%. Medicating adolescents and adults with ADHD provides protection against a substance abuse disorder – and this protective effect of medications is strongest for adolescents. Medication for ADHD not only does not increase chances of a substance abuse disorder, it also is not a risk for more experimentation with illicit substances (e.g., tobacco, alcohol, marijuana, etc.). The one exception was increased cocaine use– but this was only true for those with both ADHD and a conduct disorder. People have postulated that giving stimulants to children and adolescents (ADHD medications) would lead to abuse because cocaine is also a stimulant. However, the pharmacodynamics of methylphenidate (such as Ritalin) give it a significantly lower potential for abuse than cocaine. Unlike cocaine, methylphenidate is cleared more slowly from the brain and is taken orally. Also, methylphenidate may have less potential for abuse among those with ADHD than those without ADHD because ADHD individuals have higher densities of dopamine transporters in their brains. (Biederman J; J Clin Psychiatry 2003; 64(suppl 11):3-8) (Faracone SV, Wilens T; J Clin Psychiatry 2003; 64(suppl 11):9-13) (Kollins SH; J Clin Psychiatry 2003; 64(suppl 11):14-18) (Fischer M, Barkley RA; J Clin Psychiatry 2003; 64(suppl 11):19-23) Comment: Despite overwhelming evidence to the contrary, parents are still concerned that putting their child on a stimulant for ADHD will lead to later substance abuse. Prescribing doctors try to make the case for its protective effects – as do school nurses, I am sure. – H.T.



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