2 August 1999

ADHD Sufferers At Less Risk Of Substance Abuse

by Kate Melville

Boys with attention-deficit hyperactivity disorder (AHDH) who are treated with medications - usually stimulant drugs like Ritalin - are one-third as likely to develop substance abuse or dependence as are boys with ADHD who receive no treatment, according to a study from the Massachusetts General Hospital (MGH). The report in the August issue of Pediatrics contradicts a common fear that stimulant treatment could open the door to future drug abuse.

"Because the mainstay of ADHD treatment has been potentially addictive, stimulant drugs, there has been a mythology that the use of these medications could 'prime' children to become addicts in future or could develop a 'culture of drug taking'," says Joseph Biederman, MD, director of the MGH Pediatric Psychopharmacology Unit and lead author of the study. "We have found that the opposite is the case - children who are medically treated for ADHD have a smaller risk of drug abuse than do those who are not treated."

The current report is based on analysis of data from an earlier study that followed a group of more than 500 children for four years. The children and their mothers were inter-viewed on three occasions - when they first entered the study, one year later, and four years after enrollment - regarding symptoms of a variety of psychological and behavior problems. The children were categorized into three groups: those who met criteria for ADHD and reported having been treated with medication for the disorder, those meeting ADHD criteria who had received no treatment, and children not meeting criteria for ADHD.

In order that the three groups be as similar as possible, data was analyzed only from males who were 15 or older when entering the study, resulting in a study group of 56 medicated participants with ADHD, 19 non-medicated participants with ADHD, and 137 participants without ADHD. Results of the interviews were analyzed to determine whether participants met criteria for abuse of or dependence on a variety of substances - including alcohol, marijuana, hallucinogens, stimulants and cocaine.

Analysis of the results showed that boys with ADHD who had not been treated with medication were three times more likely to meet criteria for substance abuse than were those whose ADHD was treated. The risk of substance abuse among those taking medications for ADHD was virtually identical to the risk seen among those without ADHD.

"These results have extraordinary public health implications and should reassure the families of children receiving these therapies," Biederman says. "We believe that children with ADHD who are medically treated will have fewer problems resulting from their disorder and more successful lives, probably giving them fewer reasons to experiment with substance abuse."

Timothy Wilens, MD, a co-author of the report, notes: "This study supports the vast majority of information in the current literature showing that treatment with medication - particularly treatment with stimulant drugs - is protective against substance abuse and other long-term negative outcomes associated with ADHD."

The researchers add that, while there is no reason to believe that these results would not apply to all children with ADHD, studies are needed in larger, more diverse groups of children - including more girls and a broader ranges of ages and ethnic backgrounds.