Stimulant Medication & Substance Use Disorder
Dr Shelley Hyman
According to the sensitisation hypothesis, increased exposure to stimulants (the first-choice medication treatment for ADHD), causes changes in the dopamine system which result in increased sensitivity to the reinforcing effects of these drugs. It has been suggested that this may lead to an increased risk of developing substance use disorders. Alternatively, recent evidence suggests that the use of stimulants can actually decrease the risk of developing substance use disorders, as they lower the severity of core symptoms of ADHD as well as the associated problems which lead to these disorders.
A study by Groenman and colleagues (2013) examined the effects that stimulant medication had on the development of substance use disorders in ADHD patients. The study was longitudinal, meaning it followed the patients across time (10-12 years), comparing them to controls who were healthy and taking various measures into account, including the age at which patients first used stimulant medication.
What Groenman and colleagues found was in disaccord with the sensitisation hypothesis, as they noted no difference between the healthy controls and those using stimulant medication when it came to the risk of developing a substance use disorder. They also compared these results to a non-stimulant treatment group and found that, compared to both the controls and the stimulant therapy group, they had greater risks of developing substance use disorders.
Additionally, they described a protective effect of stimulant medication against the development of substance use disorders in ADHD patients, and found that this effect was more prominent the younger the child was at first use. It should be noted, however, that this effect of age of first use decreases as age increases, and appears to reverse around the age of 18.
Thus it appears (despite common concerns), that there is no increased risk for children with ADHD in using stimulant medication when it comes to the development of substance use disorders.
- Groenman, A. P., Oosterlaan, J., Rommelse, N. N., Franke, B., Greven, C. U., Hoekstra, P. J., ... & Faraone, S. V. (2013). Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder. The British Journal of Psychiatry, 203(2), 112-119.