Last week, I wrote about a particularly uninspiring article in the Wall Street Journal that referred to ADHD medications as a “quick fix.” Today, I want to follow up on one specific point from that article that I didn’t talk about in my last post: the suggestion that taking ADHD meds makes people more susceptible to addiction.
Per the article:
Medications can also have significant side effects, including addiction.
Hmm, so one of the “side effects” of ADHD meds is “addiction”? That’s a pretty strong claim! The article doesn’t cite any sources for that, which might leave you wondering: hasn’t anyone thought to do a study on this?
They have, of course. But it turns out that research on this topic doesn’t support the idea treating ADHD with stimulants is the first step to a substance problem. In fact, the findings suggest that the opposite is true: that treating ADHD with medication puts people at lower risk for substance abuse.
One of the largest studies on this topic comes from Sweden’s Karolinska Institutet. Using Sweden’s national medical records, the study examined all children and adults diagnosed with ADHD who had been born between 1960 and 1998, which turned out to be about 40,000 people.
From the years of 2006 to 2009, the study looked at these patients’ stimulant medication status, and their substance-related medical records. They found that ADHDers prescribed medication in 2006 had a 31 percent lower rate of substance-related hospital visits, death or crime. And the longer people were on meds, the lower their rates of substance abuse tended to be.
Now, I said that was one of the largest studies on this topic, but a 2017 study upped the ante by looking through the medical records of almost 3 million teenagers and adults with ADHD. It came to much the same conclusion: over a span of eleven years, the rate of substance-related events was 35 percent lower for male patients who were medicated and 31 percent lower for female patients.
Even after stopping medication, some of these benefits remained, with rates of substance-related events being 19 and 14 percent lower for male and female patients respectively two years later.
Most recently, a 2019 study tracked 303 children and teenagers with ADHD), taking note of their stimulant prescriptions and substance use. (Yes, I know, not quite as impressive as 3 million, but not every study can have 3 million participants!) Those who were prescribed stimulants early and at a high dosage were at lower risk for both substance problems and nicotine addiction than those who didn’t take stimulant medications, while those were were prescribed stimulants early and at a moderate dose were at lower risk for nicotine addiction. Those who were prescribed stimulants earlier were also at lower risk for nicotine addiction than those who were prescribed stimulants later.
Together, these results fly in the face of the myth that taking ADHD meds puts people on a path toward addiction. But the findings actually make a lot of sense.
Consider, for example, that people with untreated ADHD often self-medicate. Or that treating ADHD can make people less impulsive, more deliberate with their planning, and less likely to seek out immediate rewards.
Having ADHD symptoms in the first place makes people more likely to develop substance problems, so there’s a certain not-very-complicated logic to the idea that treating ADHD symptoms will reduce that risk. Hence why, according to a review published a few months ago, it often makes sense to prescribe stimulants to people who have both ADHD and substance problems.
As far as the issue of prescribing stimulants to children, specifically, there are, of course, multiple factors to weigh, which is why that decision is best made by the parents and children themselves, in consultation with mental health professionals. But scaremongering about stimulants and addiction shouldn’t be a factor. In fact, based on what we know, it’s more likely that not taking ADHD meds would lead to substance issues down the line rather than the other way around.