Table 16Relationship between stimulant treatment for ADHD and later substance abuse and dependence

StudyNicotine
Huss 2008
N=215
Children with ADHD
Mean age at follow-up: 21.75 years
Mean years to follow-up: 12.6 years
No difference in rate or age of first cigarette, or rate of nicotine abuse or nicotine dependence. Time to nicotine abuse significantly greater in stimulant group, by 2 years, 1 month (P=0.049)
Wilens 2008
N=114
Females with ADHD
Mean age at follow-up: 16.2 years
Mean years to follow-up: 5 years
Stimulant use found protective; hazard ratio, 0.28; 95% CI, 0.14 to 0.60
Biederman 2008
N=112
Males with ADHD
Mean age at follow-up: 22 years
Mean years to follow-up: 10 years
Controlling for conduct disorder; nicotine dependence hazard ratio, 1.1; 95% CI, 0.6 to 2.1
Burke 2001
N=164
Boys with disruptive behavior disorders
Mean age at follow-up: 13-15 years
Mean years to follow-up: NR
Regression did not find stimulant use to significantly associated with tobacco use in adolescence (odds ratio, 2.19; P=0.061)
StudyAlcohol
Blouin 1978
N=42
Hyperactive children
Follow-up age 13-14 years
Mean years to follow-up: 5 years
39.3% of those MPH IR group had used alcohol once or twice vs. 21.4% of untreated group. Current users: MPH IR group 46. 4% vs. untreated 26.4%.
Biederman 1997 and 2003
N=212
Children with ADHD
Follow-up >5 years
Stimulants found protective; alcohol abuse or dependence OR 0.16 (confidence intervals not given)
Biederman 2008
N=112
Males with ADHD
Mean age at follow-up: 22 years
Mean years to follow-up: 10 years
Controlling for conduct disorder: Alcohol abuse hazard ratio, 1.1; 95% CI, 0.6 to 2.1; dependence hazard ratio, 1.0; 95% CI, 0.5 to 2.4. Duration of alcohol abuse was longer in those who had received stimulant treatment.
Paternite 1999
N=121
Children with hyperactivity
follow-up = age 21-23
Holding age at diagnosis and childhood symptoms constant, no statistically significant correlations with alcoholism, although authors indicate a trend towards higher dose of MPH may be related to lower rates of alcoholism
Goksoyr 2008
N=91
Mean age stimulant group: 21.6
Mean age control group: 30.8
Mean years to follow-up: NR
Stimulant exposed 23% vs. non-exposed 38%; P=NS
StudySubstance abuse
Wilens 2008
N=114
Females with ADHD
Mean age at follow-up: 16.2 years
Mean years to follow-up: 5 years
Substance use disorder (hazard ratio, 0.27; 95% CI, 0.13 to 0.60)
Biederman 2008
N=112
Males with ADHD
Mean age at follow-up: 22 years
Mean years to follow-up: 10 years
Controlling for conduct disorder: Abuse hazard ratio, 1.6; 95% CI, 0.8 to 3.2; dependence hazard ratio, 1.0; 95% CI, 0.4 to 2.6. Age at initiation of stimulant, or duration of stimulant not significantly associated with substance use disorders. Previous reports from this group had found stimulant use protective.
Goksoyr 2008
N=91
Mean age stimulant group: 21.6
Mean age control group: 30.8
Mean years to follow-up: NR
Adults with ADHD seeking stimulant treatment; those with history of stimulant exposure as children compared with those without such history. Stimulant exposed 23% vs. non-exposed 49%; P<0.05

Abbreviations: ADHD, attention deficit hyperactivity disorder; NR, not reported; NS, not significant.

From: Results

Cover of Drug Class Review: Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder
Drug Class Review: Pharmacologic Treatments for Attention Deficit Hyperactivity Disorder: Final Update 4 Report [Internet].
McDonagh MS, Peterson K, Thakurta S, et al.
Portland (OR): Oregon Health & Science University; 2011 Dec.
Copyright © 2011 by Oregon Health & Science University.

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