Two recent studies present clinical evidence that the use of stimulants to treat boys with attention deficit hyperactivity disorder (ADHD) does not increase their risk of later substance use disorders. This evidence provides clinicians and families with much needed reassurance.

“It is very important for families to know that treatment does not increase the risk of substance abuse in late adolescence and early adulthood; this information should be a key source of comfort to them,” said Joseph Biederman, MD, professor of psychiatry at Harvard Medical School and chief of pediatric psychopharmacology at Massachusetts General Hospital, both in Boston, and lead author of a naturalistic 10-year follow-up study on ADHD.1

ADHD affects between 5% and 10% of children and adolescents. One of the great debates in childhood psychiatry has been whether widespread use of stimulants to treat ADHD might lead to later substance use disorder. The idea is theoretically plausible, according to researchers, because both stimulant medications and drugs of abuse increase concentrations of dopamine in the nucleus accumbens—the neural mechanism considered crucial for their reinforcing effects.2 Also, some studies have suggested a causal link between stimulant treatment in childhood and later substance use disorder.3

That was not the case, however, in a 17-year prospective follow-up study conducted by Salvatore Mannuzza, PhD, and colleagues.4 Coauthor Francisco Castellanos, MD, professor of child and adolescent psychiatry at New York University and director of research for its Child Study Center, said that the study is one of the “most methodologically sound” of those that cumulatively suggest that medication treatment does not increase the long-term risk of substance abuse problems.

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