May 23, 1999

Does Taking Ritalin as a Child affect the Risk of Adolescent Drug Abuse?

"Does Taking Ritalin as a Child for Treatment of ADD Increase or Decrease Subsequent Risk of Adolescent Drug Abuse? Studies of Ritalin's Role in Drug Abuse Produce Contradictory Findings," by Marilyn Chase, Wall Street Journal, May 18, 1999, p. B1.

The Wall Street Journal, among the leading newspapers in the country, has arguably followed the Ritalin story over the years more closely than any other public news source. In this article the reporter once again raises parents' worst fears about using Ritalin in ADD -- putting their children at increased risk for subsequent drug abuse as adolescents. For many years addicts themselves have talked about their sensitization to stimulants based upon their receiving Dexedrine or Ritalin from a doctor as a child.

However, no study has been able to document this trend. Unfortunately, the Wall Street Journal reporter uses the unpublished work of long time researcher, Nadine Lambert, from the University of California, Berkeley to justify the claim of increased risk. To Lambert's credit she has followed 500 children for 26 years prospectively, an incredible achievement of longevity and perseverance unusual in academic research. She feels strongly based upon her work that that Ritalin predisposes youth to drug abuse later on. But a serious flaw in her study makes her assertion suspect at least from a scientific point of view.

Lambert does not provide a control group of children who had ADD (hyperactivity in the 1970s) who did not receive medication. Her comparisons are between a group of troubled kids who were treated with Ritalin and a group of normal kids. Thus, we can't say whether the higher rates of drug abuse in the treated group are a result of their inherent problems or treatment with Ritalin. The critical absence of an ADD untreated group makes this study interesting but not definitive (and as yet not surviving the rigors of peer review to be published in a medical or psychology journal).

In the same Wall Street Journal article, Timothy Wilens of the Harvard Pediatric Psychopharmacology Clinic attempts to refute Lambert's study with one of his own to be published in Pediatrics shortly. In it he claims that giving Ritalin in adolescence actually protects these children from abusing drugs on their own. I haven't seen the details of his study but I would suspect there will be a similar problem of comparisons. Even if there is an untreated group of ADD teenagers to compare unless we know the details of why they didn't take medication we may still not know whether medication helps or not. Those teens willing to take medication from a doctor may be very different from the rebellious kids who will have nothing to do with a doctor prescribing stimulants.

There are other concerns about Ritalin's predisposing influences on drug use in adolescence. Animal rat studies have shown that rats preexposed to Ritalin will addict quicker to the drug when given a chance compared to rats who never experienced Ritalin. Several studies of different animals show brain changes in the receptor site of synapses for Ritalin after the animals have taken only two or three doses of the drug. It is unclear whether either of these types of studies have a clinical significance for children and teenagers. On the other hand, there have been many episodes where adults have become addicted to stimulants while taking them under a doctor's care (for example for weight control).

Given all this uncertainty, I feel the clinical evidence, at this time, for Ritalin predisposing a child to addiction is weak at best. This has not been my experience nor the experience of many other doctors who have prescribed the stimulants to children for the last sixty years. However, prescribing stimulant medication to teenagers and adults certainly carries some risk because unlike the children, they can and sometimes do abuse the drug. I believe with my patients this is very rare but still requires very close supervision and responsibility on the part of both the patient and physician.

Reviewed 5/23/99

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