Effect of Prior Stimulant Treatment for Attention-Deficit/Hyperactivity Disorder on Subsequent Risk for Cigarette Smoking and Alcohol and Drug Use Disorders in Adolescents

Abstract

Objective Controversy remains over the effect of stimulant treatment on later substance use disorders (SUD). To this end, we examined the risk imparted by stimulant treatment for attention-deficit/hyperactivity disorder (ADHD) on SUD and nicotine dependence in a study of girls with ADHD. Design case-controlled, prospective, five-year follow up study. Participants adolescent girls with and without ADHD from psychiatric and pediatric sources. Setting Massachusetts General Hospital. Blinded interviewers determined all diagnoses with structure interviews. Main exposure naturalistic treatment exposure with psychostimulants for ADHD. Outcomes We modeled time to onset of SUD and smoking as a function of stimulant treatment. Results We ascertained 114 subjects with ADHD (mean age at follow-up of 16.2 yrs) with complete medication and SUD data, of which 94 (82%) subjects were treated with stimulants. There were no differences in SUD risk factors between naturalistically treated and untreated groups other than family history of ADHD. We found no increased risks for cigarette smoking or SUD associated with stimulant therapy. We found significant protective effects of stimulant treatment on the development of any SUD (N = 113; HR = 0.27 (0.125–0.60), χ2=10.57, p=0.001) and cigarette smoking (N = 111; HR = 0.28 (0.14–0.60), χ2=10.05, p=0.001) that were maintained when controlling for conduct disorder. We found no effects of time of onset or duration of stimulant therapy on subsequent SUD or cigarette smoking in ADHD subjects. Conclusions Stimulant therapy does not increase, rather reduces the risk for cigarette smoking and SUD during adolescent years in girls with ADHD.

Trastorno por déficit de atención con hiperactividad y dependencia de sustancias depresoras. Una revisión

“…Son de interés para los clínicos los estudios los que describen que el tratamiento del TDAH con fármacos estimulantes previene el riesgo de desarrollar TUS, en hasta un 50% (Katusic et al, 2005;Wilens, Faraone, Biederman y Gunawardene, 2003;Wilens et al, 2008).…”

“…En un estudio controlado con placebo sobre los efectos de la atomoxetina en adultos con TDAH dependientes de alcohol, se ha demostrado que este fármaco se asocia a una mejoría de los síntomas del TDAH, sin embargo, los datos sobre los efectos en el consumo de alcohol fueron inconsistentes (Wilens et al, 2008). Al analizar la seguridad del fármaco, se observó que los pacientes alcohólicos con TDAH no difieren en la adherencia al tratamiento de los pacientes alcohólicos sin TDAH.…”

“…Of interest for clinicians are studies reporting that treatment of ADHD with stimulating drugs prevents the risk of developing SUD in up to 50% (Katusic et al, 2005;Wilens, Faraone, Biederman, & Gunawardene, 2003;Wilens et al, 2008).…”

“…In a placebo-controlled study on the effects of atomoxetine in alcohol-dependent adults with ADHD, it was shown that this drug is associated with improved symptoms of ADHD, however, the data on the effects on alcohol use were inconsistent (Wilens et al, 2008). On analyzing drug safety, it was found that alcoholic patients with ADHD do not differ in treatment adherence from alcoholic patients without ADHD.…”

Neuroscience: Rethinking rehab

“…Attention-enhancing drugs such as methylphenidate and atomoxetine boost the activity of key receptor systems in the prefrontal cortex, in particular those for noradrenaline and dopamine. Some evidence already suggests that patients with ADHD are less likely to go on to abuse drugs if they are receiving medication for their condition 7 . And earlier this year, a team led by Daina Economidou at the University of Cambridge, UK, reported that atomoxetine helped rats with an ADHD-like impulsivity to resist a relapse to cocaine-seeking 8 .…”