Does Childhood Treatment of ADHD With Stimulant Medication Affect Substance Abuse in Adulthood?

One of the most controversial issues in childhood psychiatry is whether the wide-spread use of stimulant medications to treat children with attention deficit hyperactivity disorder (ADHD) increases the risk of substance abuse in adulthood.Part of the rationale for this concern is that stimulant medications (methylphenidate and amphetamine) share with drugs of abuse the ability to increase dopamine concentration in the nucleus accumbens, which is the neural mechanism considered crucial for their reinforcing effects (1).Indeed, methylphenidate and amphetamine are sometimes abused in some settings (2).This misuse can produce dependence.Another reason for concern is the timing of exposure.Human epidemiological studies have shown that the earlier an individual is exposed to substances with abuse potential, such as alcohol and nicotine, the greater the risk of drug abuse and dependence in adulthood (3).However, the opposite perspective has also been proposed-that stimulant treatment of children and adolescents with ADHD may reduce the risk of later substance abuse (4).Considering that individuals with ADHD are at higher-than-normal risk for substance abuse (5), it is urgent that these two perspectives be addressed properly, yet relatively few clinical studies have done so.