Answers to your questions about substance abuse in children treated with medication in ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is a behavioural syndrome characterised by hyperactivity and/or inattention leading to impairment in social, academic and occupational functioning. The core group of symptoms of ADHD include persistent impulsivity, hyperactivity and inattention. Although well known to be predominantly a condition of children in preschool and early school years, it is increasingly being recognized to be present in some adults as a remnant of their childhood condition. These adults with ADHD may have difficulty following directions, remembering information, concentrating, organizing tasks or completing work within time limits.

Currently in the media there have been concerns regarding the link between the use of medications in ADHD and the risk of these children becoming substance abusers. There have been two important studies performed that helped to clear up the confusion that exists regarding these concerns.

The first of the two studies was performed in 1999 by Wilens T, Biederman J and colleagues. This study followed children aged 15 years and over for four years and recorded the numbers of those kids that developed substance use disorders (where illicit substances are used inappropriately).

The aim of this study was to test the hypothesis of whether the medications prescribed in ADHD had an effect on the likelihood of developing a substance use disorder. There were three possible outcomes, the first one being that there is no link between medications in ADHD and substance use (called the null hypothesis), the second being that the medications increased the risk, and third that the medications reduced the risk of substance use disorders.

The findings of the study showed that there was a significant reduction in the risk of developing a substance use disorder when patients with ADHD were on medications. It was found that patients on medication were 85% less likely than those not on medication to develop a substance use disorder in the future. Additionally there was a 6 fold increase in the number of substance use disorders in those who were unmedicated.

The study was not perfect, but the results do help to support the use of medication in ADHD.

The second study performed in 2003 by Wilens T, Biederman J and colleagues was a meta-analysis. A meta analysis combines the results of similar studies for a particular hypothesis and by doing so can provide us with more reliable results.

In total the results from six studies were used in the meta-analysis. The findings of this meta-analysis showed that there was a 2 fold reduction in the risk of developing a substance use disorder if medications were used in ADHD. This supported the findings from the previous study performed by the same group as well as 4 other studies that were included in the analysis.

It is important to note that the results of such studies can sometimes be misleading. Many factors contribute to a person developing a substance use disorder, not all of these factors can be measured, therefore the results of the study should be interpreted with caution. However, because there have been many other studies performed that have come to similar conclusions, the current evidence suggests that the use of medications in ADHD is protective against substance use disorders.

Parents of children with ADHD are commonly concerned about the use of medications in ADHD, especially because of their abuse potential. However it is important to note that children with ADHD have a different brain chemistry and that these drugs do not have the same effect on children with ADHD as they do in normal kids. It is therefore important to follow your doctor’s recommendations when your child is prescribed medications for ADHD.

In light of the findings of the two above studies, medications not only help control your child’s ADHD symptoms that can impair their ability to interact with people, it can also have the added benefit of preventing them from becoming substance users and abusers in the future.