Two studies appearing in this month's issue of Pediatrics appear to debunk
any notion that the use of stimulant medications to treat
attention-deficit/hyperactivity disorder (ADHD) leads to substance abuse
further down the line.
While experts say that the two studies add to 11 previous studies that nix
any link between stimulant medication and substance abuse, they also
caution that randomized, controlled studies are still needed.
The first study, led by Russell A. Barkley, PhD, formerly of the
University of Massachusetts Medical School and currently a professor at
the Medical University of South Carolina, followed 147 children with ADHD
for 13 years.
"Our goal was to examine the impact of stimulant treatment during
childhood and high school and its risk for substance use, dependence, and
abuse by young adulthood," said Barkley. "Our results are consistent with
11 previous studies that likewise found no association between stimulant
treatment and an increased risk of later drug use, including stimulants
and cocaine, among children with ADHD."
The study found that stimulant-treated children had no greater risk of
ever trying drugs by adolescence or any significantly greater frequency of
drug use by young adulthood. Stimulant treatment in high school did not
influence drug use in high school or adulthood, except for greater cocaine
use.
However, the researchers say that increased cocaine use can be explained
by the severity of co-occurring conduct disorder in both adolescents and
adults.
Children who had received stimulant medication for more than one year were
no more likely to use drugs as adolescents or young adults than were
children who had received stimulant medication for less than a year.
Barkley maintains that stimulant treatment for one year or more may
actually contribute to a protective effect concerning the risk of
hallucinogen abuse disorders in adults.
Second Study
The second study, led by Timothy E. Wilens, M.D., of Massachusetts General
Hospital, reviewed six long-term studies involving more than 1,000 youths
with ADHD; the studies were designed to determine if stimulant therapy for
ADHD can lead to substance abuse disorders.
"Concerns exist that stimulant therapy for youths with ADHD may result in
increased risk for subsequent substance use disorders," said Wilens. "We
therefore investigated all long-term studies in which pharmacologically
treated and untreated youths with ADHD were examined for later substance
abuse disorder outcomes. Our results suggest that stimulant therapy in
childhood is actually associated with a reduction in the risk for
subsequent drug and alcohol disorders."
The study found that stimulant treatment in youths reduced the risk for
substance abuse by half.
E. Clarke Ross, chief executive of CHADD (Children and Adults with
Attention-Deficit/Hyperactivity Disorder) said that the two studies have
critically important implications for his organization and its members.
"Families want reassurance that the treatment options they are using are
safe and effective. Both studies will arm our members and others with the
data, statistics and facts they need to make sound and confident decisions
when discussing one aspect of the risks and benefits of medication
intervention for ADHD," said Ross.
Copyright 2003 Alcoholism & Drug Abuse Weekly |