Attention-deficit/hyperactivity disorder (ADHD) has great potential for disrupting the lives of adolescents, young adults, and their families. Our patients suffering from ADHD and their parents turn to us in primary care for guidance regarding treatment, often with great fear based on misconceptions and myth. One of their greatest concerns is whether stimulant treatment will turn them or their child into a drug addict. This Editor's Choice Supplement provides a valuable synthesis of studies that have addressed this concern in recent years. Its conclusions are of great value for us in counseling families about stimulant treatment.
The data are very reassuring: the individual studies reported by Biederman (4 years of follow-up) and Fischer and Barkley (13 years of follow-up) and the meta-analysis of 7 studies by Faraone and Wilens overwhelmingly support the conclusion that, compared with no pharmacologic treatment, stimulant use is protective against rather than a risk for later substance abuse. Those receiving stimulant treatment later engage in substance abuse at only half the rate expected. Although studies to date have been naturalistic follow-up in design rather than randomized trials, the cumulative sample size and relative consistency of results strengthen the conclusions.
Kollins, in a review of animal and human neuropharmacologic studies, provides insight into the mechanisms by which stimulants, particularly methylphenidate, act on the brain and the rationale by which methylphenidate has less abuse potential than other stimulants.
A final key finding that emerges in the Supplement is the importance of conduct disorder in the development of substance abuse. Conduct disorder clearly predisposes individuals, especially those with ADHD, to abuse substances. Early ADHD treatment, if it might prevent the development of a conduct disorder, may provide an additional protective mechanism. Clearly, our evolving understanding of these relationships, and the new reassuring insights conveyed in this Supplement, have great practical and public health value for us in daily practice.
Larry Culpepper, MD, MPH
Editor in Chief
The Primary Care Companion to the Journal of Clinical Psychiatry