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Aug 17

Two studies have shown that medications used to treat ADHD do not increase the risk of future drug and alcohol abuse as the patients who take them grow into early adulthood.

Attention-Deficit/Hyperactivity Disorder (ADHD) is often treated with stimulant medications such as methylphenidate. Ritalin is the best known brand name of methylphenidate. Because these medications belong to a class of drugs often abused on the streets, the fear was that those who took them medicinally as children or adolescents might be more susceptible to drug abuse as young adults.

“These studies say [ADHD medications] don’t have an impact,” says Dr. Alice Charach, head of the neuropsychiatry team in the Department of Psychiatry at Toronto’s SickKids Hospital (SickKids), refering to a child’s future risk of drug abuse. At the same time, parents whose children are taking any medication on a daily basis are right to be concerned and should become informed about the potential long-term impact that medication will have, she says. The first study, published in the American Journal of Psychiatry, shows these fears to be unfounded. Researchers followed up on 112 males ten years after they had first been diagnosed with ADHD and prescribed medications, including Ritalin. At this ten-year mark, the study found no significant increased risk of abuse of drugs, alcohol, or nicotine.

The second study, also published in the American Journal of Psychiatry, also found no link with substance abuse and further concluded that it did not matter when a child was first prescribed stimulants for ADHD, nor how long the child remained on the medication: no association with future drug abuse existed.

“This information is reassuring because it is the first study of its kind to follow young people right through their age of risk,” namely, the late adolescent and early adult years when people are most likely to abuse drugs or alcohol, says Dr. Charach. Previous studies had not tracked patients for such an extended period of time.

“That these medications are linked to drug abuse is a common belief,” Dr. Charach says, adding these beliefs persist due to inaccurate information disseminated through alternative media. At the same time, “[Ritalin] does have some street value for teens and college students,” she admits, which no doubt contributes the negative public perception of these stimulant medications.

Newer, longer- and slower-acting forms of methylphenidates, which are now more commonly prescribed and were included in these studies, make the drug less attractive for those taking it for non-medicinal purposes.

Conduct disorder and future drug abuse
Dr. Charach says while there is no connection between ADHD medication and future drug abuse, the same cannot be said for conduct disorder, the psychological term for chronic bad behaviour. “Many studies have noted that if the child with ADHD has a history of breaking rules, getting into trouble, and hanging out with others who do these things as a group, there is a higher risk for future drug abuse,” she says. “Thankfully, most children with ADHD are not like this. They try very hard and are very motivated to do as they are told. They may be impulsive and have trouble paying attention, but these are now considered separate and distinct difficulties from rule-breaking and other bad behavior.”

Biederman J, Monuteaux MC, Spencer T, Wilens TE, MacPherson HA, Faraone SV. Stimulant therapy and risk for subsequent substance use disorders in male adults with ADHD: A naturalistic controlled 10-year follow-up study. American Journal of Psychiatry. 2008; 165: 597-603

Mannuzza S, Klein RG, Truong NL, Moulton JL 3rd, Roizen ER, Howell KH, Castellanos FX. Age of methylphenidate treatment initiation in children with ADHD and later substance abuse: Prospective follow-up into adulthood. American Journal of Psychiatry. 2008; 165: 604-609

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