Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder.
Level 3 - non-randomized controlled study
Non-randomized longitudinal cohort study with control groups.
PubMed 10429138 · doi:10.1542/peds.104.2.e20
What was done
A longitudinal study evaluated the cumulative incidence of substance use disorders (SUD) across adolescence in three groups of boys: 56 medicated subjects with ADHD, 19 nonmedicated subjects with ADHD, and 137 non-ADHD control subjects.
What was found
Unmedicated boys with ADHD had a significantly increased risk for any SUD at follow-up compared with non-ADHD controls (adjusted OR 6.3 [95% CI: 1.8–21.6]). In contrast, boys with ADHD who were medicated at baseline showed a significantly lower risk for SUD compared to untreated boys with ADHD (adjusted OR 0.15 [95% CI: 0.04–0.6]), reflecting an 85% risk reduction. A consistent direction of effect was observed across each individual SUD subtype.
Why it matters
This study provides longitudinal evidence that pharmacological treatment of ADHD during childhood does not sensitize patients to substance abuse, but rather significantly decreases adolescent SUD risk relative to untreated ADHD.
Limits
The study included only male participants, limiting generalizability to females. Treatment was observational rather than randomized, creating potential confounding by indication. The unmedicated ADHD comparison group was small (n = 19), resulting in wide confidence intervals. Specific medications, dosages, and adherence were not reported in the abstract.
Cited by
- supports A Harvard study found that 52% of individuals with untreated ADHD have substance abuse issues.