- Many people with ADHD and their loved ones worry about the effects of stimulant medications for ADHD.
- Very often these worries are about the stigma of addiction that is often proposed as a potential side effect.
- Two recent studies found no greater risk for substance use or addiction from stimulant therapy for ADHD.
Despite the effectiveness of stimulant medications approved for the treatment of ADHD across all ages, a concern voiced by skeptics is that the medications are addictive and will lead to substance use disorders. Many adults with ADHD I see in my psychological practice who discuss their ambivalence about seeking a medication consultation or maintaining otherwise effective medication regimens cite the stigma that arises from such assertions—specifically, that they’ll be seem as “addicts”—as well as individual concerns about taking “speed” and being reliant on stimulants.
Although anecdotal clinical evidence of their safety is one source of data, solid empirical data are necessary to allay the concerns of individuals with ADHD, their loved ones, and professional helpers. Such longitudinal research, tracking medication use across time and measuring substance use and/or abuse patterns, is hard to come by, but a recent study, though, has provided these very sorts of data.1
The study used data and follow-up assessments from the Multimodal Treatment Study of ADHD,2 which was a randomized controlled study of 579 children with ADHD combined type established via thorough, rigorous evaluations, which were also used at follow-up assessments. The children received medication treatment, intensive behavioral treatment, or a combination. They were tracked with follow-up assessments 10 times over the next 16 years; follow-up evaluations included assessing ongoing stimulant medication use and substance use. The early assessments relied upon parent-report and shifted to self-report as the children approached young adulthood. The current study was based on 465 participants from the original study, with a 4:1 male:female split, and an average age of 25, which is an impressive retention of participants for a longitudinal study.
The main findings were that whether children with ADHD stayed on continuous, uninterrupted prescribed stimulant treatment for ADHD throughout the intervening years or not, there was no evidence of increased (or decreased) risk for use of alcohol, marijuana, cigarettes, or other substances for teens or young adults with ADHD compared to the risk in the general population. (There were controls for developmental changes, such as the likely normative increased alcohol use in adolescence and young adulthood compared with childhood, but even these changes were no more than general population rates.)
Yes, say the skeptics, but what about prescribed stimulant use for ADHD as gateways for later cocaine and methamphetamine abuse? Another recently published study used a multicohort sample of 5034 U.S. 12th-grade students, which was 52 percent female, who self-reported prescribed stimulant treatment for ADHD at baseline.3 They were reassessed three times until reaching 23 or 24 years old. This group was compared to population controls with no history of stimulant prescription or prescription stimulant misuse at baseline.
The findings showed no difference between adolescents with ADHD treated with approved stimulants and adolescents in the control group in terms of transitioning to cocaine or methamphetamine initiation and use in young adulthood, which is to say that the ADHD group was at no greater risk than those in the population at large who never used or misused stimulants before.
Interestingly, those adolescents who were not receiving medication treatment with stimulants for ADHD at baseline were more than 2.5 times more likely than the general population to initiate and continue misuse of cocaine or methamphetamine later.
For a clinician, these numbers must be recognized as aggregates of group differences. Each client case requires discussing the risks for any sort of problematic substance use, including those that simply reduce quality of life and well-being. Nevertheless, there is a foundation of research that pharmacotherapy does not increase the risk for substance use beyond the existing rates seen in the population. So, no, stimulant treatment for ADHD does not create addicts.
1 Molina et al. (2023). Association between stimulant treatment and substance use through adolescence into early adult hood. JAMA Psychiatry, online ahead of print. doi:10.1001/jamapsychiatry.2023.2157
2 The MTA Cooperative Group. (1999). A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. Multimodal Treatment Study of Children with ADHD. Archives of General Psychiatry , 56(12), 1073-1086. doi:10.1001/archpsyc.56.12.1073
3 McCabe et al. (2023). Cocaine or methamphetamine use during young adulthood following stimulant use for attention-deficit/hyperactivity disorder during adolescence. JAMA Network Open, 6(7):e2322650. doi:10.1001/jamanetworkopen.2023.22650