ADHD Medication and Risk for Later Alcohol and Drug Use

Many parents have to make difficult choices about how to help their children with an ADHD (attention deficit hyperactivity disorder) diagnosis. Two treatments have been proven in well-designed and carefully controlled research studies to be effective: behavioral management (also known as parent training) and medication (typically Ritatin or Adderall). Medication treatment has raised concerns about whether the use of medication to treat ADHD may be either a “gateway” for future substance use (e.g., ever trying alcohol, cigarettes, or drugs), or even a precursor to substance use disorders like drug abuse and dependence. On the other hand, research published in 2003 indicated that medication for ADHD may actually reduce the risk for later substance use disorders. Our research group recently conducted an updated study, in which all available data from various research labs around the world were examined who assessed whether children with ADHD received medication treatment at one time point, and asked questions about substance use (ever used, yes/no) and whether the individual met criteria for a substance use disorder (abuse or dependence) at a later date.
The research was published online recently in JAMA Psychiatry. Together, over 2,000 individuals were examined over time, and across all outcomes: alcohol, nicotine, marijuana, cocaine, and other drugs, there was no association between medication treatment in childhood and ever trying these substances and becoming abusive or dependent on these substances. The results have been covered widely, in part because it helps to provide an update to pediatricians, child psychiatrists, child psychologists, and parents. It should be noted that children with ADHD are already at increased risk for substance use and substance use disorders. Thus, while medication treatment does not appear to increase risk for later substance problems, children with ADHD merit increased monitoring in regards to potentially problematic substance use.

In addition, while 15 independent studies were included in the meta-analysis, the question is not set to rest. Several of the individual studies showed either increased risk or decreased risk, and varied in terms of the gender ratio of the sample, age in which the children were assessed and contacted for follow-up, and many other methodological and demographic factors. Thus, as with most questions in psychological science, we need to continue to ask questions that have been asked before, as new answers may emerge. I hope in another 10 years we will be able to obtain even more data to help people make the best decisions for their child’s health and future in regards to treatment for ADHD.

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