You just knew he had ADHD! Now, he is prescribed a stimulant…is that safe? Parents often raise important questions about the risk of developing a substance abuse disorder when their child is diagnosed with ADHD and prescribed a stimulant such as Focalin, Ritalin, or Concerta. According to the Journal of Child Psychology and Psychiatry, “There are persistent concerns of long-term effects of simulant ADHD mediation on the development of substance abuse,” (Zheng et al., 2014). A study on 26,000 men and 12,500 women from 1960 to 1998 examined the association between stimulant ADHD medication and substance abuse-related death, crime or hospital visits. The results? ADHD medication was NOT associated with an increased rate of substance abuse. Instead, the authors found that the rate of substance abuse was 31% lower in those prescribed ADHD medication. Conclusions? There is not a direct correlation of increased risks of substance abuse among individuals prescribed stimulant medication. The authors postulate that treatment for ADHD with the use of a stimulant may provide a long-term protective effect on substance abuse.
The Society for the Study of Addiction (Howard et al., 2015) examined the association between inattention, hyperactivity-impulsivity and delinquency through childhood and adolescence, and binge drinking and marijuana use in early adulthood. The randomized controlled trial examined 579 children, age 7 to 9 years old, who had been diagnosed with ADHD. Follow-up surveys rated inattention, hyperactivity-impulsivity and delinquency at 8 years and self-reports of binge drinking and marijuana use were collected. The researchers found that worsening inattention symptoms and delinquency were associated with higher rates of early adult binge drinking and marijuana use, compared with those who were stable or improving with symptoms and delinquency. Worsening inattention symptoms and delinquency during adolescence was associated with higher levels of early adult substance use. In other words, if left untreated, ADHD may increase the chances of binge drinking or marijuana use in early adulthood.
In a 2014 CRG newsletter article, CRG psychiatrist Dr. Jason Rowland explained the link between ADHD, anxiety and substance abuse:
“People with ADHD, particularly if this hasn’t been adequately diagnosed or treated, are at a higher risk for developing anxiety, depression, and substance abuse issues. Studies have shown that children with ADHD who take stimulant medications decrease the likelihood of experiencing substance abuse issues in adolescence and adulthood. In situations where anxiety or depression co-occur with ADHD, which set of symptoms to address first has to be taken on a case-by-case basis. The interaction between anxiety and ADHD, can be complicated. Medications that treat anxiety can make the ADHD look worse, and medications that treat ADHD can sometimes make the anxiety look worse. In some people who are both distractible and anxious, sometimes the distractibility can be your friend. Distracting yourself from the thoughts that make you anxious can be a very easy way to feel anxious less of the time. Some anxiety helps you address working memory issues by keeping you focused on something you need to remember, giving a sense of urgency to get something started or completed, and some social anxiety can help keep impulsivity in check in some settings. If your worries aren’t stemming from ADHD, like having a fear of storms, then treating the ADHD won’t help to address these types of anxieties. In people who have significant anxiety or depression in addition to ADHD, treating with psychotherapy, particularly cognitive-behavioral therapy (CBT), to address the anxiety and depressive symptoms while treating the ADHD with medication, ADHD coaching, appropriate accommodations, and other interventions can be an effective combination.”
Dr. Rowland also explained the use of stimulants:
“The reason that stimulants get used most often in people with ADHD is because they work most effectively with the greatest number of people to reduce ADHD symptoms. About 60% of individuals with ADHD will have a very good symptomatic response to the first stimulant they try. There are a lot of brand names but the stimulants that get used to treat ADHD all are one of two chemicals: methylphenidate or amphetamine. If people with ADHD don’t respond well to a preparation in the first chemical group, they are still likely to respond well to one from the second group 60% of the time. The other advantage of the stimulants is, they work quickly. So, if you have the right medication and the right dose, you’ll see improvement on Day 1. You don’t need time for the medication to build up in the person’s blood stream. Stimulants also have some common drawbacks. One of the biggest of which is that they can’t cover the whole day. You have to let them wear off by bed-time so you can get to sleep. Consequently, there’s a period of time at the end of the day and when you first wake up in the morning that you can’t cover with a stimulant medication. They also have the potential to make anxiety worse and they can trick the part of your brain that tells you that you are full to give that message when you are not. This can lead to weight loss or lack of weight gain. People who don’t eat well during the day due to stimulant side effects can also experience low blood sugar levels, which in turn can lead to headaches, irritability and feeling sluggish.”
Parents should be concerned with the risks and benefits of any and all medications. However, with appropriate testing, diagnosis and prescriptive medication, the benefits of treatment and medication can outweigh the risks. Continue to partner with your CRG team and improve your child’s chances for success!
