Studies Highlight Decreased Risks for Subsequent Substance Abuse Among Children, Adolescents Using Stimulant Medication for AD/HD

1/6/2003

From: Peg Nichols or Winnie Imperio, 301-306-7070, both of Children and Adults with Attention-Deficit/ Hyperactivity Disorder (CHADD)

LANDOVER, Md., Jan. 6 -- Stimulant therapy for Attention-Deficit/Hyperactivity Disorder (AD/HD) may actually reduce risks for subsequent drug and alcohol use disorders according to two key studies featured in the January 2003 issue of Pediatrics, the medical journal of the American Academy of Pediatrics (AAP).

Despite the well-documented efficacy and safety of stimulants for the treatment of AD/HD, questions and confusion about potential risks for subsequent substance abuse persist among the general public. Both studies independently conclude that treatment of AD/HD with stimulants does not lead to substance use disorders; rather it actually produces a "protective effect" from subsequent drug and alcohol abuse.

"These research studies have critically important implications for CHADD and its 20,000 members," said E. Clarke Ross, chief executive officer, Children and Adults with Attention Deficit/ Hyperactivity Disorder (CHADD).

"Families want reassurance that the treatment options they are using are safe and effective. Both studies will arm our members and others with the data, statistics and facts they need to make sound and confident decisions when discussing one aspect of the risks and benefits of medication intervention for AD/HD."

The first study, a prospective led by Russell A. Barkley, Ph.D., formerly of the University of Massachusetts Medical School, and currently a professor at the Medical University of South Carolina in Charleston, followed 147 children with AD/HD for approximately 13 years.

The second study, a meta-analysis led by Timothy E. Wilens, M.D., of Massachusetts General Hospital, examined over the course of from 4-15 years, more than 1,000 youths with AD/HD who had participated in one of six long-term studies designed to determine if stimulant therapy for AD/HD can lead to substance abuse disorders.

Summary and Highlights of Studies

Study One: Does the Treatment of Attention-Deficit/Hyperactivity Disorder with Stimulants Contribute to Drug/Use/Abuse? A 13-Year Prospective Study by Russell A. Barkley, Ph.D., Mariellen Fischer, Ph.D., Lori Smallish, M.A. and Kenneth Fletcher, Ph.D.

"Our goal was to examine the impact of stimulant treatment during childhood and high school and its risk for substance use, dependence and abuse by young adulthood," said Barkley. "Our results are consistent with 11 previous studies that likewise found no association between stimulant treatment and an increased risk of later drug use, including stimulants and cocaine, among children with AD/HD."

Among the highlights:

-- Stimulant-treated children had no greater risk of ever trying drugs by adolescence or any significantly greater frequency of drug use by young adulthood (Barkley et al.).

-- Stimulant treatment in high school also did not influence drug use in high school or adulthood except for greater cocaine use. At first blush, this finding may raise concern; however subsequent analyses demonstrated that this elevated risk was primarily explained by the severity of co-occurring conduct disorder (CD) in both adolescents and adults (Barkley et al.).

-- Children who had received stimulant medication for more than one year were no more likely to use drugs as adolescents or young adults than children who had received stimulant medication for less than a year. Indeed, stimulant treatment for one year or more may contribute to a protective effect concerning the risk of hallucinogen abuse disorders in adults (Barkley et al.).

Study Two: Does Stimulant Therapy of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-Analytic Review of the Literature by Timothy Wilens, M.D., Stephen V. Faraone, Ph.D., Joseph Biedermann, M.D., and Samantha Gunawardene, B.S.

"Concerns exist that stimulant therapy of youths with AD/HD may result in increased risk for subsequent substance use disorders," said Wilens. "We therefore investigated all long-term studies in which pharmacologically treated and untreated youths with AD/HD were examined for later substance abuse disorder outcomes. Our results suggest that stimulant therapy in childhood is actually associated with a reduction in the risk for subsequent drug and alcohol disorders."

Among the highlights:

-- Stimulant treatment in youths reduced the risk for substance abuse in half (Wilens et al.).

-- The protective effect of stimulant medication use in reducing risk of substance abuse was more robust in adolescence (5.8-fold reduction in risk) than in adulthood (1.4-fold reduction in risk) (Wilens et al.).

-- Of similar interest, untreated adults with AD/HD have twice the risk of developing substance abuse disorders, while it appears that treatment reduces the risk to that observed in young adults who do not have AD/HD (Wilens et al.).

To obtain additional information on both studies, please visit the American Academy of Pediatrics website at http://www.aap.org.

Attention-Deficit/Hyperactivity Disorder (AD/HD) is characterized by developmentally inappropriate impulsivity, attention, and in some cases, hyperactivity. AD/HD is a neurobiological disorder that affects three-to-five percent of school-age children and approximately two-to-four percent of adults.

CHADD advocates a multimodal approach to the treatment of AD/HD including parent training in diagnosis, treatment and specific behavior management techniques, an appropriate educational program, individual and family counseling when needed, and medication when required.

------ With 20,000 members and 200 chapters nationwide, CHADD works to improve the lives of people affected by AD/HD through collaborative leadership, advocacy, research, education and support: CHADD CARES.

For additional information about AD/HD or CHADD, contact the National Resource Center on AD/HD at 800-233-4050, or visit the CHADD website at http://www.chadd.org.

------ Note to reporters: To speak directly with Dr. Wilens, Dr. Barkley, or a CHADD spokesperson, contact Peg Nichols or Winnie Imperio (301-306-7070, ext. 102 or 117).