Stimulants

Treating a Child with ADHD Medication Diminishes His Future Risk of Substance Abuse

To reduce the risk of substance-use disorders, treatment with stimulant medication should begin prior to 9 years of age, according to research on the life-long health factors that affect children with ADHD.

An illustration of a brain with a plus sign in it symbolizes treating ADHD to prevent substance abuse disorders.

Most parents, very understandably, agonize over the decision to treat their child’s ADHD symptoms with stimulant medication. What if the meds change my child’s personality? Will we face major side effects? Do ADHD meds lead to stimulant abuse – or even addiction?

On the last question, the answer is clear: No. What’s more, treatment with ADHD stimulant medication prior to age 9 may actually decrease your child’s likelihood of abusing drugs and alcohol later in life, according to research.

People with childhood attention deficit disorder (ADHD or ADD) are nearly twice as likely to develop a substance use disorder as are individuals who don’t have childhood ADHD.1 However, the risk of substance abuse decreases substantially when patients are treated with stimulant medication – even though it is considered a controlled substance by the FDA because of its risk for dependence.

Research shows that ADHD patients treated with stimulant medications experience a 60% reduction in substance abuse disorders compared to those who were not treated with stimulant medication.2 Considerable evidence also suggests that children taking ADHD medication commonly experience improvements to academic and social functioning, which translates to improved self-esteem, lower rates of self-medication with drugs or alcohol, and decreased risk of substance abuse.

Additionally, research suggests a 10% reduction in substance use disorders for every year of ADHD treatment, especially for patients who start at an earlier age.3

[Free Handout: A Parent’s Guide to ADHD Medications]

The American Academy of Pediatrics (AAP) offers these age-specific treatment recommendations for children with ADHD:

  • For children ages 4 to 5, behavior therapy should be the first line treatment for ADHD.
  • For children ages 6 to 11, stimulant medication and behavior therapy are recommended, along with accommodations at school to address special needs.
  • For adolescents ages 12 to 18, the key is to prescribe medication with the teen’s consent, and to administer it alongside behavior therapy.

But should ADHD treatment with medication begin promptly at age 6? Or is it better to try alternative treatments and delay stimulants for as long as possible? Parents and physicians often struggle to pinpoint the exact right time to add stimulant medication to the treatment mix.

To resolve the timing question, researchers3 at the University of Michigan and Mass General studied 40,000 high school seniors, more than 4,000 of whom had ADHD. The research team compared the risk for marijuana abuse – the most common drug misused by this age group – among teens with ADHD to the overall population. They found that the students with the lowest incidence of substance abuse started treatment with stimulants before 9 years of age. When treatment began between ages 10 and 14, it was helpful, but the students still had a significantly higher likelihood of smoking marijuana. The highest risk of marijuana abuse was found among students medicated after age 15.

As a psychopharmacologist who’s worked with ADHD patients for years, it’s always somewhat unclear when a child should start medications for ADHD. This data is a very clear indicator that the people who did the best started taking stimulants prior to age 9.

[A Patient’s Primer on the Stimulant Medications Used to Treat ADHD]

This content came from the ADDitude webinar by Timothy Wilens, M.D., titled “ADHD and Substance Use Disorders: How to Recognize and Manage Addiction in Adults and Adolescents”. That webinar is available for free replay here.


1Charach et al. “Childhood Attention-Deficit/Hyperactivity Disorder and Future Substance Use Disroders: Comparative Meta-Analyses.” Journal of the American Academy of Child & Adolescent Psychiatry. 2011; 50(1): 9-21. doi: 10.1016/j.jaac.2010.09.019
2Chang Z et al. “Stimulant ADHD medication and risk for substance abuse.” J Child Psychol Psychiatry. 2014; 55(8):878-85. doi: 10.1111/jcpp.12164
3McCabe SE, et al. “Age of Onset, Duration, and Type of Medication Therapy for Attention-Deficit/Hyperactivity Disorder (ADHD) and Substance Use During Adolescence: A Multi-Cohort National Study.” J Am Acad Child Adolesc Psychiatry. 2016; 55(6):479-486: doi: 10.1016/j.jaac.2016.03.011

Updated on May 29, 2019

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