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Stimulants reduce later risk for developing substance use disorders, smoking in girls with ADHD

Wednesday, October 22 2008 | Comments

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What's This? Prior prescription stimulant therapy appears to protect adolescent girls who have attention-deficit/hyperactivity disorder (ADHD) from the subsequent risk of smoking or having substance use disorders (SUDs), according to a new study.

The prospective, case-control analysis focused on 5-year follow-up interviews with 114 girls with ADHD (average age at follow-up, 16.2 years) who were part of a longitudinal study and had complete medication and SUD data. Structured interviews were used to diagnose substance abuse or dependence and determine the lifetime use of nicotine, alcohol, marijuana, and other drugs.

When compared with the subjects who did not receive treatment, the females who received stimulants (n=94) in a naturalistic setting were significantly more likely to have parents with a lifetime history of ADHD, so additional analyses controlled for this variable.

The age-adjusted rates of SUDs indicated that the adolescents who took stimulants were a significant 73% less likely to develop SUDs relative to the nontreated girls. More specifically, stimulant exposure had no significant effect on alcohol abuse or dependence, but a significant protective effect on the age-adjusted rate of developing drug abuse and a lesser, nonsignificant effect on drug dependence.

Moreover, after adjusting for age, there was a significant 72% lower risk and a later onset of cigarette smoking with stimulant use.

When controlling for conduct disorder, a comorbidity that strongly predicts subsequent risk for SUDs and cigarette smoking, the results did not change. Neither age of onset nor duration of stimulant therapy affected the development of SUDs or smoking; stimulant use also had no effect on the duration or severity of SUDs or the duration of smoking.

"These results should allay lingering concerns among clinicians and families about future substance use problems when prescribing stimulants to a child with ADHD," the study authors concluded. (Wilens TE, et al. Arch Pediatr Adolesc Med 2008;162:916-921.)

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