AD/HD, Stimulants, and Substance Abuse
Media stories about stimulant medications for AD/HD are often misleading. Learn what research tells us about AD/HD medications and the risk of substance abuse in children and teens.
By Kristin Stanberry
You've seen the headlines:
Ritalin® Gains Popularity as Party Drug
Students Sell Prescription "Speed" to Classmates
If you're a parent whose child takes prescription stimulant medication for Attention-Deficit/Hyperactivity Disorder (AD/HD) - or you are considering medication for your child - you probably find such news alarming - and confusing. Put your newspaper aside. Turn off the TV news. Let's look at what recent research tells us and get a clear perspective on the benefits and risks of kids taking stimulants to manage AD/HD.
AD/HD and Substance Abuse
In a 1998 report, the National Institutes of Health summarized the results of several studies that showed adults with AD/HD reported higher rates of substance abuse than the general population. The risk of a person developing a substance abuse problem (alcohol and/or drug addiction) during his lifetime is twice as high (52%) for those with AD/HD than for those without the condition (27%).
Why are people with AD/HD at greater risk? To understand this, consider what people with AD/HD must often cope with as they grow up, especially if their condition isn't managed well:
- Poor school performance, due to inattention
- Behavior problems, often related to poor impulse control
- Impaired social skills
Years of struggling with these challenges can severely erode a youngster's self-esteem. Poor self-esteem, coupled with the need for immediate gratification many kids with AD/HD feel, can lead them to seek refuge by "self-medicating" their problems with alcohol or inappropriate use of drugs, including prescription stimulants or illicit drugs.
This challenge is compounded by the fact that an estimated 40% to 60% of kids with AD/HD suffer from at least one other psychiatric disorder. Research suggests, for example, that conditions such as conduct disorder and bipolar disorder increase the risk of substance abuse in teens with AD/HD.1,2
Other factors that increase the odds that a child with AD/HD will develop a substance use disorder (SUD) include:
- a family history of drug abuse
- exposure to active drug abuse in one's household
- cigarette smoking by the teen3
Managing AD/HD: Stimulant Use versus Abuse
One key to preventing substance abuse is for AD/HD to be diagnosed early and managed effectively. Proper management of AD/HD usually includes behavior modification, appropriate accommodations at home and school, and, for the majority of kids with AD/HD, taking medication prescribed by a physician.
Unlike most medications prescribed for AD/HD, stimulants have a long track record and are approved by the Food and Drug Administration (FDA) for treating the disorder. It's critical for parents, teachers, and the doctor to monitor a child's response to medication on a regular basis. The dosage may need adjustment based on the child's reaction, physical growth, hormonal changes, and side effects.
The nagging concern that therapeutic stimulant use may lead to future substance abuse has prompted researchers to study youth with AD/HD over time. So far, the research results are encouraging. Several recent studies have revealed the role of responsible medication management of AD/HD in reducing the risk of developing substance abuse problems.
Here are the findings of two of those studies:
- A study at Massachusetts General Hospital in Boston concluded children who received stimulant medication for AD/HD were at an 84% lower risk of substance abuse compared to kids with AD/HD who went without medication.4 These results mirror previous findings from studies on adults.
- A meta-analysis conducted by Dr. Timothy Wilens, associate professor of psychiatry at Harvard Medical School, and colleagues showed that children who took stimulant medication as part of their treatment for AD/HD were only half as likely to develop a substance abuse disorder in adolescence or adulthood as were peers with AD/HD not treated with psychostimulants.5,6
Results like these should help parents breathe easier. Yet, it's critical that parents continue to ensure appropriate overall management of their children's AD/HD, including monitoring the child's well-being by working with teachers, doctors, and the kids themselves.
At this time, the vast majority of kids who take medication for AD/HD take stimulants. Vyvanse®, one of the newest stimulant medications, has been shown to have a lower abuse potential than other forms of amphetamine. Recent research also suggests long-acting forms of stimulant medication are less likely to be abused than are shorter-acting forms.7,8
Non-stimulant Medications to Manage AD/HD
Several non-stimulant medications appear to be effective for managing AD/HD. Strattera®is one such medication. It acts much like a stimulant but is not a controlled substance. Strattera may be an appropriate first-line medication for children who have AD/HD and also have a family history of substance abuse. Two other groups of medications that are effective in managing AD/HD in some children are antidepressants and antihyptertensives.
Ultimately, it's up to you and your child's doctor to decide if medication - and which type of medication - is the right choice for managing your child's AD/HD. As your child matures, he should be included in medication decisions.