View Full Version : NEWS: Substance-Abuse Risk Appears Less in Stimulant-Treated ADHD Patients


XxMichellexX
12-07-08, 05:30 PM
http://pn.psychiatryonline.org/cgi/content/full/43/23/14-a

Substance-Abuse Risk Appears Less in Stimulant-Treated ADHD Patients

Jun Yan

Girls with ADHD treated with stimulants are less likely to develop substance<SUP> </SUP>use disorders in adolescence than are girls with ADHD who have<SUP> </SUP>never taken stimulants.<SUP> </SUP>

Despite their potential for being abused, stimulants prescribed<SUP> </SUP>to treat children with attention-deficit/hyperactivity disorder<SUP> </SUP>(ADHD) do not increase the risks they will develop substance<SUP> </SUP>use disorder (SUD), alcohol use disorder, or begin smoking in<SUP> </SUP>adolescence, according to a study published in the October Archives<SUP> </SUP>of Pediatric and Adolescent Medicine.<SUP> </SUP>
In this observational study, the authors collected long-term<SUP> </SUP>health data and medical treatment histories on 114 young female<SUP> </SUP>patients with ADHD. The participants were aged 6 to 18 at the<SUP> </SUP>start of the study and followed for five years.<SUP> </SUP>
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Twenty participants who had never taken stimulant medications<SUP> </SUP>were compared with the other 94 participants who had been treated<SUP> </SUP>with stimulants for ADHD in terms of each subject's use of cigarettes,<SUP> </SUP>alcohol, marijuana, and other substances.<SUP> </SUP>
The study data were derived from a longitudinal case-control<SUP> </SUP>study of adolescents with and without the disorder. The study<SUP> </SUP>was naturalistic and was not randomized. Nevertheless, the authors<SUP> </SUP>stated that the patients with and without stimulant exposure<SUP> </SUP>did not differ significantly in age, family status and SUD history,<SUP> </SUP>ADHD severity, and rate of conduct disorder.<SUP> </SUP>
The girls in the cohort who had a diagnosis of ADHD and no stimulant exposure<SUP> </SUP>generally did not receive other types of treatment, according<SUP> </SUP>to the study's lead author, Timothy Wilens, M.D., an associate<SUP> </SUP>professor of psychiatry at Harvard Medical School and director<SUP> </SUP>of substance abuse services in the Clinical and Research Program<SUP> </SUP>in Pediatric Psychopharmacology at Massachusetts General Hospital.<SUP> </SUP>
The ADHD patients who had taken stimulants had a 73 percent<SUP> </SUP>risk reduction for developing a subsequent SUD and a 72 percent<SUP> </SUP>risk reduction in taking up cigarette smoking compared with<SUP> </SUP>those who had never taken stimulants. Both reductions were statistically<SUP> </SUP>significant.<SUP> </SUP>
Stimulant-treated patients who did take up smoking did so at<SUP> </SUP>an older age on average than those not treated with stimulants.<SUP> </SUP>All the SUD diagnoses were made by blinded evaluators using<SUP> </SUP>DSM-IV criteria.<SUP> </SUP>
In addition, exposure to stimulant treatment was not associated<SUP> </SUP>with increased risk of substance dependence and alcohol abuse<SUP> </SUP>or dependence.<SUP> </SUP>
"The results of this study should calm the fears of both parents<SUP> </SUP>and clinicians that early stimulant treatment will lead to cigarette<SUP> </SUP>smoking or substance use in adolescence," said Wilens.<SUP> </SUP>
On the contrary, he continued, "the data showed a reduction<SUP> </SUP>in cigarette smoking and substance use risks [associated with<SUP> </SUP>stimulant use] at least in adolescence, which adds to a growing<SUP> </SUP>literature on the long-term positive effects of ADHD treatment<SUP> </SUP>on the development of these sequelae."<SUP> </SUP>
The study was funded by the National Institute of Health and<SUP> </SUP>the Lilly Foundation, the charitable arm of the pharmaceutical<SUP> </SUP>company.<SUP> </SUP>
Youngsters with untreated ADHD, especially adolescents, are<SUP> </SUP>at a significantly increased risk of developing substance use<SUP> </SUP>problems. Past research has shown that stimulant treatment does<SUP> </SUP>not increase the risk of smoking and substance use in boys with<SUP> </SUP>ADHD, the authors noted.<SUP> </SUP>An abstract of "Effect of Prior Stimulant Treatment for Attention-Deficit/Hyperactivity<SUP> </SUP>Disorder on Subsequent Risk for Cigarette Smoking and Alcohol<SUP> </SUP>and Drug Use Disorders in Adolescents" is posted at <archpedi.ama-assn.org/cgi/content/abstract/162/10/916 (http://archpedi.ama-assn.org/cgi/content/abstract/162/10/916)>. http://pn.psychiatryonline.org/math/squf.gif<SUP> </SUP>

djquietude
02-11-09, 05:53 AM
Interesting, and I think it's very accurate. They should expand the study to boys, and adult men and women.

I'd have to attest to one adult male who has discovered this to be very true-- me! Since going on ADD meds, I've been able to quit drinking entirely and have made great strides in avoiding substances I used to abuse. There's a lot to this.

I personally think it's because proper ADD medication treatment eliminates a lot of need for self-medication!

ADHDTigger
02-11-09, 02:21 PM
Thanks for posting this! I agree, it would be good to expand the study. I'd be interested in knowing what the rate of SUD is both pre and post treatment as well.

One of the things that kept me from considering drug use in the 70s was knowing about the ADHD and that my system wasn't normal. It might have been bad information (incomplete, anyway) but it was enough.

jeffpuffer
02-11-09, 02:55 PM
This isn't news... this information has been around for like 10 years now.

djquietude
02-11-09, 05:33 PM
This isn't news... this information has been around for like 10 years now.

Well I haven't seen it during those 10 years, so it's news to me! :D

ecu20
02-12-09, 04:55 AM
http://pn.psychiatryonline.org/cgi/content/full/43/23/14-a

Substance-Abuse Risk Appears Less in Stimulant-Treated ADHD Patients

Jun Yan

Girls with ADHD treated with stimulants are less likely to develop substance<sup> </sup>use disorders in adolescence than are girls with ADHD who have<sup> </sup>never taken stimulants.<sup> </sup>
...
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extract: <archpedi.ama-assn.org/cgi/content/abstract/162/10/916 (http://archpedi.ama-assn.org/cgi/content/abstract/162/10/916)>. <sup> </sup>

This is great for initial study data. However, the counterpoints from the devils advocate:

Severely under-populated therapy groups (only 20 people not on medication? There is a 5% change with 1 person's decision in the outcome of amount of substance abuse for the no stimulant therapy group! This would drive my research methods professor CRAZY with the lack of validity this research contains.


When looking at the graphical data points, one could come to the conclusion that there are 3 points that non stimulant therapy users develop SUD: Age 11, age 15, and age 18. The jump on all 3 points seem to jump almost exactly at a rate of .2 for developing SUD. That's 20%, and 4 people. This indicates a scenario that's highly unlikely to be reproducible on a much larger clinical testing scale.

I really do wish they would produce a much larger and more "secure" study base...

None the less, I feel that stim therapy/medication decreases my desire to use other legal substances (alcohol, etc). It's difficult to describe why though.

ADHDTigger
02-12-09, 11:32 AM
This is great for initial study data. However, the counterpoints from the devils advocate:

Severely under-populated therapy groups (only 20 people not on medication? There is a 5% change with 1 person's decision in the outcome of amount of substance abuse for the no stimulant therapy group! This would drive my research methods professor CRAZY with the lack of validity this research contains.


When looking at the graphical data points, one could come to the conclusion that there are 3 points that non stimulant therapy users develop SUD: Age 11, age 15, and age 18. The jump on all 3 points seem to jump almost exactly at a rate of .2 for developing SUD. That's 20%, and 4 people. This indicates a scenario that's highly unlikely to be reproducible on a much larger clinical testing scale.

I really do wish they would produce a much larger and more "secure" study base...

None the less, I feel that stim therapy/medication decreases my desire to use other legal substances (alcohol, etc). It's difficult to describe why though.

I totally understand your points on the study. The population isn't nearly representative and is entirely too small. I guess I look at it from the perspective of, at least someone is looking at it. Flaws and all.

I also can echo your sentiments about the use of substances. I never bothered with the illegal ones but have been a heavy coffee drinker and smoker all my life. With the meds, I don't drink coffee and am actually thinking that I can be successful quitting smoking. After nearly 30 years, that is truly amazing.

ecu20
02-12-09, 02:31 PM
I totally understand your points on the study. The population isn't nearly representative and is entirely too small. I guess I look at it from the perspective of, at least someone is looking at it. Flaws and all.

I also can echo your sentiments about the use of substances. I never bothered with the illegal ones but have been a heavy coffee drinker and smoker all my life. With the meds, I don't drink coffee and am actually thinking that I can be successful quitting smoking. After nearly 30 years, that is truly amazing.

The age 15 is about the time kids get into high school and network socially with people, including the all so friendly drug dealers in school. You'd of had to add another notch to age 15 if I were included in that study. :o After a quick exit of that, 1g+/day of caffeine total was not unrealistic.

Caffeine withdraw is the worst withdraw i've experienced. It's like having a residual hangover for 2-7 days, and SUCKS! I have almost zero side effects from abruptly ceasing adderall and dextrostat medication (~120mg/day) aside from being a bit tired the next day after using it daily for 2 months. Caffeine use for a week followed by abrupt stop in consumption after only a WEEK of use KILLS me.

And yes, my caffeine consumption plummeted after I started taking medication. I am now down to occasional use weekly, and it's great :)

djquietude
02-12-09, 02:40 PM
I really do wish they would produce a much larger and more "secure" study base...

None the less, I feel that stim therapy/medication decreases my desire to use other legal substances (alcohol, etc). It's difficult to describe why though.

Agreed. And I wanted to comment on the second part of the quote-- I think stimulants provide the chemical "reward" in the brain that alcohol does. It's well known that although a depressant, alcohol has a stimulating effect, at least until one crosses the threshold from buzzed into drunk... this is just my cockeyed non-scientific theory.

For me, I believe my brain is happiest with the effects of stimulants and thus makes alcohol seem sloppy and most undesirable. Also, being focused for once in my life makes me hesitate to give that up to flooding my brain with alcohol.

Pray4Him
02-13-09, 04:40 PM
I would be willing to bet my lifes savings on the fact that if it was not for Concerta my 16 yr old DS would be involved with drugs. Without the meds he has almost no impulse control. With meds he is able to slow down, think, and make proper decisions.

QueensU_girl
02-13-09, 06:28 PM
re: 10
Have you heard of MBT? Mindfulness based therapy?

I think it can help people slow down, as you say.

djquietude
02-13-09, 06:30 PM
re: 10
Have you heard of MBT? Mindfulness based therapy?

I think it can help people slow down, as you say.

I have a friend who moved from Wisconsin to Sweden, and he says MBT is very effective treatment. He's in it for relationship counseling.

Thich Nhat Hanh, the Vietnamese Zen master, has a great book on mindfulness called "Zen Keys." Highly recommended.