Does Stimulant Medication Cause Drug Dependence?
An expert addresses the misconception that kids (or adults) with ADHD will become drug addicts if they’re treated with stimulant medications.
Parents — and many adults — are understandably concerned about the addictive properties of stimulants. These concerns are fueled by media hype, some animal studies, and lay books erroneously supporting the notion that treating ADHD with stimulants can lead to substance abuse.
There is considerable evidence to the contrary. Stimulant treatment is well known to improve a child’s academic and social functioning. These improvements translate into enhanced self esteem, less self-medication, and hence, studies show, less substance abuse.
There is little debate that stimulant medications can be addictive to humans and animals. Widespread abuse of amphetamines in the 1970s, cocaine in the 1990s, and current cases of prescription stimulant abuse give credence to this concern.
In addition, studies in rats indicate that young pups exposed to methyphenidate (Ritalin) develop as adult animals a response termed sensitization” which predisposes them to drug-seeking like behavior.
What is often missing from descriptions of animal studies, however, is critical information on dosing. These animals received from 50-200 times the dose of medication prescribed for ADHD. Therefore, it is unlikely that these animal studies are particularly relevant to your child.
What is relevant is what we know about adults and teens who were give medications as children. Ten studies that have addressed this important issue.
- Six of the studies demonstrate clearly that earlier treatment results in reduced substance abuse.
- Three studies show no difference.
- One study shows higher risk for substance abuse connected to earlier treatment.
- No study shows any increased risk of substance abuse when the severity of ADHD is factored in.
To examine this issue further, our group at Harvard Medical School followed a group of adolescents for four years. We divided them into three: boys with ADHD taking medication, boys with ADHD not taking medication, and boys without ADHD.
In mid-adolescence we checked for alcohol, cocaine, stimulant, and other illicit substance use. The ADHD group taking medication had far lower rates of substance abuse than the ADHD group not taking medication.
There are similar findings in a study of adults with ADHD who were treated previously with stimulants. Those treated with stimulants as youths had lower rates of substance abuse than ADHD adults who were never treated with medication.
Treatment isn’t all that matters. So does treatment response. Studies show that adolescents with ADHD who respond well to their medications are at lower risk for substance abuse compared than those who respond poorly to their medication.
- Stimulant treatment of ADHD appears to result in reduced alcohol and drug problems, not increased substance abuse.
- Some ADHD youth and adults self medicate with substances to treat their ADHD and self esteem problems. Treating ADHD with medication may reduce this phenomenon.
Ongoing studies funded by the National Institute on Drug Abuse are furthering research in this important area. Since teens with ADHD are at higher risk of substance abuse than teens without it, my advice to parents is to aggressively treat your child’s ADHD and carefully monitor for their response to medication.
Also, watch closely for self esteem problems, friendships with at-risk peers, and cigarette use; these are well-documented and powerful gateways to substance abuse.