How Does Stimulant Medication for ADHD in Children Affect Later Substance Use?

Kathryn L. Humphreys, M.A., Ed.M.  Clinical Psychology Doctoral Student UCLA Department of Psychology 1285 Franz Hall, Box 951563 Los Angeles, CA 90095MedicalResearch.com eInterview with Kathryn L. Humphreys, M.A., Ed.M.

Clinical Psychology Doctoral Student
UCLA Department of Psychology
1285 Franz Hall, Box 951563
Los Angeles, CA 90095

MedicalResearch.com: What are the main findings of the study?

Response: Our primary question was to answer whether the use of stimulant medication in the treatment of ADHD was associated with increased or decreased risk for a variety of substance use (ever tried) and substance use disorder (abuse or dependence) outcomes (alcohol, cocaine, marijuana, nicotine, and non-specific drug use).

Prior research from individual studies of children have provided mixed evidence (i.e., some found medication increased later risk, some found medication decreased risk, and still others found no difference in risk). We examined available longitudinal studies (i.e., medication treatment preceded measurement of substance outcome) together using meta-analysis, a technique that aggregates findings from a number of studies, in order to examine this question in a much larger sample of individuals.

Our main finding was that children with ADHD who received medication treatment did not differ in risk for lifetime substance use or abuse or dependence compared to those children with ADHD who did not receive medication treatment.

MedicalResearch.com: Were any of the findings unexpected?

Response: One thing this study helped to convey was that scientists should keep asking questions. There was a study that came out 10 years ago on this question, which found that stimulant medication was associated with decreased risk for later alcohol and drug abuse and dependence. That our finding would replicate this was a reasonable expectation, but it did not. In fact, when we examined a larger pool of research studies, including both published and unpublished data, there was no difference in later risk for a variety of substance outcomes based on stimulant medication history.

MedicalResearch.com: What should clinicians and patients take away from your report?

Response: Many parents face difficult decisions regarding the best course of treatment for their child’s ADHD. Pediatricians and child psychiatrists also must weigh the potential costs and benefits of various treatment options. The only prior meta-analysis of this question, which included fewer studies and examined fewer outcomes, found stimulant medication reduced risk for alcohol and drug use disorders. Our study provides an important update to clinicians in the field of child mental health. This update can play a part in helping parents and physicians make informed choices about treatment. Particularly for those who are concerned that stimulant medication is a “gateway” drug or “sensitizes” risk for later substance use, our study suggests that, at a group level, there is not support for this hypothesis.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: One important note was that children were not randomly assigned to received medication treatment or not, meaning that there may be factors that predict the likelihood of choosing this treatment type. Ideally, a study could examine the effect of stimulant treatment in groups of children randomly assigned to treatment, and measure the type, dosage, adherence, and length of treatment. Also, following these individuals over time to examine later life outcomes is an important step in understanding the pattern of development for children with ADHD as they age, and the potential role of medication or other types of treatment in impacting those outcomes in middle and older ages.

Citation:

Humphreys KL, Eng T, Lee SS. Stimulant Medication and Substance Use Outcomes: A Meta-analysis. JAMA Psychiatry. 2013;():1-9. doi:10.1001/jamapsychiatry.2013.1273.