Friday, October 31, 2008

ADHD medications protect against drug abuse

There is often a heated debate amongst professionals, families and individuals surrounding the safety of ADHD stimulant medications and their potential for abuse. One camp claims that exposing the brain to amphetamines or amphetamine-like substances (drug categories in which almost every ADHD stimulant medication falls) fosters a long-term dependance and subsequent drug addiction later in life. The other side claims that these medications are safe and that by not taking them, most individuals with ADHD will attempt to "self-medicate" with illegal drugs, nicotine or alcohol. So which side is correct?

While arguments and information support both sides of the issue, it appears that, as of now, the overall safety and efficacy of stimulant medications for ADHD is relatively high. In an earlier post, we discussed the overall safety and addiction potential of Ritalin for treating ADHD. It appears that amidst the hype, the overall potential for addiction with this drug is relatively low. This is not to say that there is no risk at all, the discussion suggested that individuals with ADHD are able to handle the stimulant drug with less of a risk for abuse than those without the disorder.

Nevertheless, this was but one study on ADHD drugs and abuse potential, so I have decided to review additional articles on the topic. Based on an evaluation done by Joseph Biederman, and published in the Journal of Clinical Psychiatry, on the topic of ADHD medications and substance abuse, it appears that taking proper medications for ADHD at the correct dose results in a reduced risk of having a drug addiction later in life.

Some key findings of this study include:

  • A high percentage of previous studies on ADHD and drug abuse fail to take into account the factor of conduct disorders, which often occur alongside (but are not directly connected to) ADHD. Individuals with conduct disorders are more prone to abuse of stimulants and other drugs. Because of this, a number of these studies incorrectly label ADHD individuals on medication for having higher rates of substance abuse, when in fact, it is often the co-occuring conduct disorder.

  • Along the same lines, instead of viewing ADHD as one disorder, it is more accurate to see it as a mosaic, occuring in multiple different forms and with multiple different side effects and overlapping related disorders. For example, issues such as depression, bipolar disorders, behavioral issues and learning disabilities, one or more of which often occur alongside ADHD all become influencing factors in areas such as substance abuse. Failure to allocate a "correction factor" for these co-existing and overlapping disorders unfairly puts the blame on ADHD and results in an inaccurately high level of negative effects being placed on the disorder.

  • For studies which did factor out these co-existing conditions, it was determined that childhood ADHD by itself does increase both the potential for and earlier onset of substance abuse, by two-fold. The duration of abuse was also longer, and typically followed individuals into adulthood. Therefore, both ADHD, as well as symptoms which commonly occur alongside it can each, independently as well as in conjunction, increase the risk of future persistent substance abuse.

  • The article referred to a large study done previously (by the same author, which included a 4-year follow-up for test subjects), which observed that siblings of ADHD children were much more likely to have substance abuse issues than the ADHD children themselves (around 4 times greater). Adults with ADHD were higher than either the ADHD children or their siblings.

  • While unmedicated children with ADHD made up only 25% of the test subjects in the 4-year study listed above, they made up 75% of the substance abuse disorder cases. This was true not just for amphetamines (which are chemically similar to most ADHD stimulant medications), but also other drugs such as marijuana, cocaine, hallucinogens and alcohol.

  • The article concluded that proper medication for ADHD in individuals (with a focus on males in their mid to late teens and early 20's) resulted in a significant reduction in later substance-abuse risk.

Based on these findings, we should strongly challenge the assumption that ADHD medications promote stimulant (or other types of chemical) abuse in individuals. Nevertheless, we should still be aware of some potential safety risks for ADHD medications.

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