Written by Lawrence Diller, M.D. Lawrence Diller, M.D.
Category: Reviews Reviews
Published: 09 November 2009 09 November 2009
Pharmacotherapy of Attention-deficit/Hyperactivity Disorder Reduces Risk for Substance Use Disorder, Joseph Biederman, Timothy Wilens, et al. Pediatrics vol. 104, no. 2, August 1999.
The doctors at the Harvard pediatric psychopharmacology clinic make the claim in this article which has received some press notice that treatment with stimulants actually protects teens from abusing alcohol and drugs. The doctors, in their discussion, suggest that teen drug abuse may simply be self-medication for ADHD.
Unfortunately, the researchers do not make the case that treatment with medication prevents drug abuse. Rather the only conclusion that can be made based on their data is that treatment with medication is associated with lower rates of drug abuse in adolescents. However, it is not clear that the medication is the cause for the lower rates for the following reason. Young adolescents (and their families) who are willing to work with a doctor and cooperate in a treatment are different from those who will have nothing to do with either. Those kids willing to work with a doctor may be inherently less likely to abuse drugs just based on who they are and what their families are like. Indeed, at the beginning of the four-year treatment period 7 of 19 teens who did not take medication from the doctor were already abusing drugs while none of the 54 teens who did agree to take medication abused drugs. Seven more of the first group four years later abused while 14 of the second group wound up abusing. The parents of the teen group not involved with the doctors also seemed to have more problems with substance abuse themselves.
I continue to question any link between the medical use of stimulants in children and later abuse as adolescents, but I do not believe this study confirms my own clinical experience.