1/26/2003 - Two New Studies Conclude that Stimulant Medications do not Contribute to Risk for Later Substance Use, Dependence or Abuse
Two New Studies Conclude that Stimulant Medications do not Contribute to Risk for Later Substance Use, Dependence or Abuse
Date: Mon, 6 Jan 2003 08:37:16 -0500
News From CHADD
Volume Three, Issue One
For Immediate Release
January 6, 2003
TWO KEY STUDIES HIGHLIGHT DECREASED RISKS FOR SUBSEQUENT SUBSTANCE ABUSE
AMONG CHILDREN AND ADOLESCENTS USING STIMULANT MEDICATION FOR TREATMENT
Results Conclude that Stimulants do not Contribute to Risk for Later
Substance Use, Dependence or Abuse
Landover, MD-Stimulant therapy for Attention-Deficit/Hyperactivity
Disorder (AD/HD) may actually reduce risks for subsequent drug and
alcohol use disorders according to two key studies featured in the
January 2003 issue of Pediatrics, the medical journal of the American
Academy of Pediatrics (AAP).
Despite the well-documented efficacy and safety of stimulants for the
treatment of AD/HD, questions and confusion about potential risks for
subsequent substance abuse persist among the general public. Both
studies independently conclude that treatment of AD/HD with stimulants
does not lead to substance use disorders; rather it actually produces a
"protective effect" from subsequent drug and alcohol abuse.
"These research studies have critically important implications for CHADD
and its 20,000 members," said E. Clarke Ross, CHADD Chief Executive
Officer. "Families want reassurance that the treatment options they are
using are safe and effective. Both studies will arm our members and
others with the data, statistics and facts they need to make sound and
confident decisions when discussing one aspect of the risks and benefits
of medication intervention for AD/HD."
The first study, a prospective led by Russell A. Barkley, Ph.D.,
formerly of the University of Massachusetts Medical School, and
currently a professor at the Medical University of South Carolina in
Charleston, followed 147 children with AD/HD for approximately 13 years.
The second study, a meta-analysis led by Timothy E. Wilens, M.D., of
Massachusetts General Hospital, examined over the course of from 4-15
years, more than 1,000 youths with AD/HD who had participated in one of
six long-term studies designed to determine if stimulant therapy for
AD/HD can lead to substance abuse disorders.
Summary and Highlights of Studies
Study One: Does the Treatment of Attention-Deficit/Hyperactivity
Disorder with Stimulants Contribute to Drug/Use/Abuse? A 13-Year
Prospective Study by Russell A. Barkley, Ph.D., Mariellen Fischer,
Ph.D., Lori Smallish, M.A. and Kenneth Fletcher, Ph.D.
"Our goal was to examine the impact of stimulant treatment during
childhood and high school and its risk for substance use, dependence and
abuse by young adulthood," said Barkley. "Our results are consistent
with 11 previous studies that likewise found no association between
stimulant treatment and an increased risk of later drug use, including
stimulants and cocaine, among children with AD/HD."
Among the highlights:
* Stimulant-treated children had no greater risk of ever trying
drugs by adolescence or any significantly greater frequency of drug use
by young adulthood (Barkley et al.).
* Stimulant treatment in high school also did not influence drug
use in high school or adulthood except for greater cocaine use. At
first blush, this finding may raise concern; however subsequent analyses
demonstrated that this e! levated risk was primarily explained by the
severity of co-occurring conduct disorder (CD) in both adolescents and
adults (Barkley et al.).
* Children who had received stimulant medication for more than one
year were no more likely to use drugs as adolescents or young adults
than children who had received stimulant medication for less than a
year. Indeed, stimulant treatment for one year or more may contribute
to a protective effect concerning the risk of hallucinogen abuse
disorders in adults (Barkley et al.).
Study Two: Does Stimulant Therapy of Attention-Deficit/Hyperactivity
Disorder Beget Later Substance Abuse? A Meta-Analytic Review of the
Literature by Timothy Wilens, M.D., Stephen V. Faraone, Ph.D., Joseph
Biedermann, M.D., and Samantha Gunawardene, B.S.
"Concerns exist that stimulant therapy of youths with AD/HD may result
in increased risk for subsequent substance use disorders," said Wilens.
"We therefore investigated all long-term studies in which
pharmacologically treated and untreated youths with AD/HD were examined
for later substance abuse disorder outcomes. Our results suggest that
stimulant therapy in childhood is actually associated with a reduction
in the risk for subsequent drug and alcohol disorders."
Among the highlights:
* Stimulant treatment in youths reduced the risk for substance
abuse in half (Wilens et al.).
* The protective effect of stimulant medication use in reducing
risk of substance abuse was more robust in adolescence (5.8-fold
reduction in risk) than in adulthood (1.4-fold reduction in risk)
(Wilens et al.).
* Of similar interest, untreated adults with AD/HD have twice the
risk of developing substance abuse disorders, while it appears that
treatment reduces the risk to that observed in young adults who do not
have AD/HD (Wilens et al.).
To obtain additional information on both studies, please visit the
America! n Academy of Pediatrics website at www.aap.org.
Attention-Deficit/Hyperactivity Disorder (AD/HD) is characterized by
developmentally inappropriate impulsivity, attention, and in some cases,
hyperactivity. AD/HD is a neurobiological disorder that affects
three-to-five percent of school-age children and approximately
two-to-four percent of adults.
CHADD advocates a multimodal approach to the treatment of AD/HD
including parent training in diagnosis, treatment and specific behavior
management techniques, an appropriate educational program, individual
and family counseling when needed, and medication when required.