ADHD Medication and Substance-Related Problems

Abstract

Objective Substance use disorders are major contributors to excess mortality among individuals with attention-deficit/hyperactivity disorder (ADHD), yet associations between pharmacological ADHD treatment and substance-related problems remain unclear. This study investigated concurrent and long-term associations between ADHD medication treatment and substance-related events. Method The authors analyzed 2005–2014 commercial healthcare claims from 2 993 887 (47.2% female) adolescent and adult ADHD patients. Within-individual analyses compared the risk of substance-related events (i.e., substance-use-disorder-related emergency-department visits) during months in which patients received prescribed stimulant medication or atomoxetine relative to that during months in which they did not. Results In adjusted within-individual comparisons, relative to periods in which they did not receive ADHD medication, male patients had 35% lower odds of concurrent substance-related events when receiving medication (odds ratio [OR] = 0.65, 95% CI, 0.64–0.67), and female patients had 31% lower odds of concurrent substance-related events (OR = 0.69, 95% CI, 0.67–0.71). Moreover, male patients had 19% lower odds of substance-related events two years after medication periods (OR = 0.81, 95% CI, 0.78–0.85), and female patients had 14% lower odds of substance-related events two years after medication periods (OR = 0.86, 95% CI, 0.82–0.91). Sensitivity analyses supported most findings but were less consistent for long-term associations among women. Conclusions These results provide evidence that receiving ADHD medication is unlikely to be associated with greater risk of substance-related problems in adolescence or adulthood. Rather, medication was associated with lower concurrent risk of substance-related events and, at least among men, lower long-term risk of future substance-related events.

Previously undiagnosed attention-deficit/hyperactivity disorder associated with poor metabolic control in adolescents with type 1 diabetes

“…It has been shown that stimulant medication reduces health risk behavior, such as alcohol and drug abuse and vehicle accidents among patients with ADHD. Similarly, medical treatment of ADHD among patients with type 1 diabetes might result in better metabolic control.…”

“…We concluded that the diabetes care should target the specific needs of these patients in order to ensure their quality of life and metabolic control and thus prevent long-term complications 30. It has been shown that stimulant medication reduces health risk behavior, such as alcohol and drug abuse31 and vehicle accidents32…”

Here/In This Issue and There/Abstract Thinking: Does This Answer Your Question?

“…1,2 While most of the data from empirical studies has been reassuring, 3 Quinn et al 4 set out to systematically address whether stimulants or atomoxetine increased substance use in adolescents and adults with ADHD. Using a novel within-individual design with health claims records of ∼3 million patients with ADHD, this study compared the risk of substance-related events (i.e., substance-related emergency room visits) during months in which patients received stimulant medication or atomoxetine relative to the risk during months in which they did not.…”

Amphetamine, but not methylphenidate, increases ethanol intake in adolescent male, but not in female, rats

“…Despite recent studies suggesting the relative advantages of the use of stimulants as treatment for ADHD (Dalsgaard, Kvist, Leckman, Nielsen, & Simonsen, 2014), yet see earlier work by Lambert and Hartsough (1998), there is still an ongoing discussion about the effects of these drugs upon the patient's risk of development of ethanol‐related or other drug‐related problems (Quinn et al., 2017). Late infancy (Pilatti, Godoy, Brussino, & Pautassi, 2013) and adolescence (Pilatti, Read, & Pautassi, 2017) are developmental stages in which ethanol initiation normatively occurs and in which treatments that alter developmental trajectories of dopamine (DA) or other transmitter systems are likely to facilitate the escalation toward ethanol abuse or dependence (Pascual, Boix, Felipo, & Guerri, 2009).…”