Childhood attention-deficit/hyperactivity disorder (ADHD) is linked to elevated substance use and substance use disorder (SUD) in adulthood. Stimulant medications are commonly used to treat ADHD and are thought to reduce substance use due to their efficacy in controlling impulsivity. However, early exposure to stimulants may sensitize individuals to other drugs and increase the risk of harmful substance use. Previous studies have yielded mixed results on the effects of stimulant medications on substance use. A recent study aimed to comprehensively assess the association between stimulant treatment and substance use considering age and other confounding factors not previously studied. Data were collected from a randomized multisite clinical trial of ADHD treatments in childhood (mean age 8.5 years) and prospectively for 16 years. Participants with DSM-IV combined type ADHD diagnoses (N=579; 80% male; 61% white; 20% African American; 8% Hispanic) were assessed at 10 time points throughout adolescence and early adulthood (up to a mean age of 25 years). Substance use was measured, including alcohol, marijuana, cigarettes, and other drugs. Part 1 of the analysis, after adjusting for age, found no significant associations between current or recent stimulant medication and substance use. Part 2 used causal inference methods and found no evidence that cumulative stimulant medication use from childhood to early adulthood predicted substance use. Furthermore, there was no evidence that early, continuous stimulant treatment had any effect on substance use in adulthood. In conclusion, this 16-year prospective study did not support the hypotheses that stimulant treatment for ADHD either protects against or predisposes individuals to later substance use.

Reference:

Molina BSG et al. JAMA Psychiatry 2023;e232157. Abstract.