Thursday, July 6, 2023

Stimulant Treatment in Youth Not Associated With Substance Use Later in Life

Children and adolescents with attention-deficit/hyperactivity disorder (ADHD) who are treated with stimulants do not have an increased risk of frequent alcohol, marijuana, cigarette, or other substance use later in life, according to a study published yesterday in JAMA Psychiatry.

“Childhood [ADHD] carries risk for elevated substance use and substance use disorder (SUD) by adulthood,” wrote Brook S.G. Molina, Ph.D., of the University of Pittsburgh and colleagues. Because stimulant medications decrease impulsivity in patients with ADHD, some researchers believe the medications decrease substance use in these patients, they continued. “However, early exposure to stimulants may cause neurobiological and behavioral sensitization to other drugs and thus increase the risk for harmful substance use.”

Molina and colleagues used data from the Multimodal Treatment Study of ADHD, a 14-month randomized clinical trial of medication and behavior therapy. Participants aged 7 to 9 years who were diagnosed with ADHD were randomly assigned to one of four treatment groups: medication management, multicomponent behavior therapy, a combination of the two, or referral to usual community care. Participants were assessed prior to randomization, at months three and nine, and at the end of treatment. They were then followed for 16 years and were assessed at years 2, 3, 6, 8, 10, 12, 14, and 16.

During the 12-, 14-, and 16-year follow-ups, the participants completed a questionnaire on their use of alcohol, marijuana, cigarettes, and several illicit and prescription drugs. Information on the participants’ stimulant treatment was collected via the Services for Children and Adolescents Parent Interview until the participants reached the age of 18 years; after age 18, the participants reported on their stimulant treatment.

A total of 579 participants were included in the analysis. Substance use increased steadily through adolescence and remained stable through early adulthood. After accounting for developmental trends in substance use through adolescence into early adulthood, there was no association between current or prior stimulant treatment and substance use. Further, there was no evidence that a longer duration of stimulant treatment was associated with less substance use in adulthood. However, while cumulative stimulant treatment was associated with increased heavy drinking, the authors noted that the effect size of this association was small.

The authors concluded that their study “failed to support any hypotheses of substance use protection or harm from stimulant treatment for ADHD.”

They continued: “Although these results contrast with recent conclusions of protection found in other data sets, across all studies the findings lend a measure of comfort in the consistent lack of evidence that stimulant treatment predisposes children with ADHD to later substance use.”

For related news, see the Psychiatric News article “Symptoms, Impaired Function of ADHD Often Persist Beyond Childhood.”

(Image: Stock/Caiaimage/Chris Ryan)

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