Attention-deficit/hyperactivity disorder (ADHD) is commonly treated with medications that contain amphetamine or some other powerful stimulant. For some time, doctors and researchers have been attempting to find out if children who take these medications have increased risks for abusing drugs or alcohol when they reach adulthood. According to the results of an unusually long-term study on the subject published in January 2014 in the journal Addictive Behaviors, treatment with stimulant ADHD medications in childhood is indeed linked with adult substance abuse and addiction issues.
Stimulant ADHD Treatments
In addition to amphetamine, the stimulant substances used to treat the symptoms of ADHD include amphetamine-related medications called dextroamphetamine, lisdexamfetamine dimesylate and methamphetamine hydrochloride, as well as non-amphetamine-based medications called methylphenidate and dexmethylphenidate. One of the most well known ADHD medications, Adderall, contains a combination of amphetamine and dextroamphetamine. Other dextroamphetamine-containing products include Dexedrine and Dextrostat. Methylphenidate-containing medications include Ritalin, Concerta and Metadate; dexmethylphenidate products include Focalin and Focalin XR. The sole lisdexamfetamine-based ADHD medication on the U.S market is Vyvanse. The sole methamphetamine-based ADHD medication is called Desoxyn. Stimulants produce their basic effects by speeding up activity in the central nervous system. Two of the known consequences of this activity acceleration are an increase in the ability to remain alert and an increase in the ability to focus attention. By delivering controlled doses of stimulants, properly administered ADHD medications take advantage of these effects and trigger an increased sense of calm. Doctors will typically only prescribe most of these medications (including Ritalin) to children age 6 or older; however, some ADHD stimulant medications (including Adderall and Dexedrine) can be prescribed for children as young as 3.
Potential for Harm
Like any other powerful stimulants, stimulant-based ADHD medications can trigger problems with abuse or addiction if taken in excessive amounts and/or used by someone who does not have attention-deficit/hyperactivity disorder. Apart from these issues, the critical question is whether stimulant ADHD medications can cause short- or long-term problems when used correctly under a doctor’s guidance. As of early 2014, there is no firm consensus on this matter. Some researchers believe that even appropriate use of these medications increases the risks for substance abuse and addiction both in the latter stages of childhood and during adulthood. Other researchers believe that people given stimulant ADHD medications during childhood have no greater chance of experiencing abuse- or addiction-related issues than people who never received these medications.
In the study published in Addictive Behaviors, researchers from five Danish and Norwegian institutions used a long-term project to track the connection between ADHD stimulant use in childhood and diagnosable cases of substance use disorder (substance abuse or substance addiction) in adulthood. This project included 183 boys and 25 girls who were tracked from childhood up to an average age of 31. The researchers compared the rate of substance-related problems among the study group to the rate of these problems in adults the same age not affected by ADHD or the use of ADHD stimulant medications. The researchers concluded that, compared to adults in their early 30s from the general population, adults in their early 30s who took stimulant medications for ADHD in childhood developed some form of diagnosable substance abuse or addiction at an overall rate of 7.7 to 1. They also concluded that, compared to their unaffected peers, adults who took stimulant ADHD medications in childhood developed problems with alcohol in particular at an average rate of 5.2 to 1. In addition, the researchers concluded that two specific factors substantially increase the chances that a child treated with stimulant medications will develop substance-related problems and eventually need treatment. These factors are being female and having a childhood mental health condition called conduct disorder. Interestingly, the risks for developing substance issues during adulthood decreased when use of ADHD medications began at a relatively early age.
Significance and Considerations
The authors of the study published in Addictive Behaviors believe that theirs is the most thorough, long-ranging project of its kind ever completed. Their findings echo the conclusions reached by most researchers who have conducted shorter-term examinations of the connections between childhood use of ADHD stimulants and adult substance problems. Based on their conclusions, the authors recommend that public health officials and future researchers start directing a larger portion of their resources toward the substance use issues that occur in girls who take stimulant ADHD medications.