According to a new study, risk of substance use and substance use disorders (SUDs) can be reduced with the pharmacological treatment of psychiatric disorders in childhood, most notably ADHD.
One of the most robust risk factors for developing SUD in young people is the presence of psychopathology. While pharmacotherapy is effective for the treatment of psychiatric disorders in children and adolescents, it is not clear how treatment affects subsequent risk for developing a substance use disorder in these youth. Timothy Wilens, MD, Chief of the Division of Child and Adolescent Psychiatry and the Co-Director of the Center for Addiction Medicine, recently published a systematic review of studies examining risk of substance use disorders in youth following treatment for psychiatric illness.
Wilens and colleagues identified peer-reviewed articles examining pharmacological treatments of psychiatric disorders in adolescents and young adults and the effect of treatment on subsequent risk for substance use, misuse, and substance use disorder. The review yielded 26 studies assessing the impact of pharmacotherapy on risk for later SUD in individuals with attention-deficit/hyperactivity disorder (ADHD, 21 studies), major depressive disorder (2 studies), and psychotic disorders (3 studies).
For individuals receiving treatment for ADHD, the majority of the studies reported reductions in risk of SUD. Patients were most commonly treated with stimulants, including methylphenidate, amphetamine, pemoline, and dextroamphetamine. Treatment often resulted in a robust reduction in risk. For example, Biederman and colleagues (2008) observed that treatment for ADHD had a significant protective effect (odds ratio [OR]: 0.15) for developing SUD in adolescence. Earlier onset (e.g., < 9 years of age) and longer duration of pharmacotherapy (e.g., > 6 years) were associated with the largest reductions in risk for later SUD.
The current literature indicates that pharmacological treatments for psychiatric disorders appear to mitigate the development of SUD, a finding which is most clearly documented in individuals treated for ADHD. The current findings add to the growing literature highlighting the importance of identifying and treating psychiatric disorders in childhood. Children with ADHD are two to three times as likely as children without this disorder to develop a substance use disorder. The current study shows that pharmacologic treatment significantly diminishes this risk. Furthermore, the findings indicate that earlier initiation and longer duration of treatment are associated with the greatest reductions in risk.
The specific mechanisms by which treatment of ADHD mitigates SUD risk are not well studied; however, there are multiple possible pathways. Pharmacological treatment of psychiatric symptoms may reduce the drive for self-medication with substances. Treatment may also reduce risk for certain behaviors (e.g., delinquency, academic failure) which may independently increase the risk for SUD. Future studies will help to clarify how treatment modulates risk and will help to design interventions which mitigate risk of substance use and substance use disorders.
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Taubin D, Wilson JC, Wilens TE. ADHD and Substance Use Disorders in Young People: Considerations for Evaluation, Diagnosis, and Pharmacotherapy. Child Adolesc Psychiatr Clin N Am. 2022 Jul;31(3):515-530.
Wilens TE, Woodward DW, Ko JD, Berger AF, Burke C, Yule AM. The Impact of Pharmacotherapy of Childhood-Onset Psychiatric Disorders on the Development of Substance Use Disorders. J Child Adolesc Psychopharmacol. 2022 May; 32(4):200-214.
