PEDIATRICS Vol. 104 No. 2 August 1999, p. e20

ELECTRONIC ARTICLE:
Pharmacotherapy of Attention-deficit/Hyperactivity Disorder Reduces Risk for Substance Use Disorder

Received Dec 18, 1998; accepted Mar 19, 1999.

Joseph Biederman^{*, §}, Timothy Wilens^*, Eric Mick^*, , Thomas Spencer^*, and Stephen V. Faraone^{*, §}

From the ^* Pediatric Psychopharmacology Unit, Massachusetts General Hospital;  Department of Epidemiology, Harvard School of Public Health; and ^§ Harvard Medical School, Boston, Massachusetts.

Objective.  To assess the risk for substance use disorders (SUD) associated with previous exposure to psychotropic medication in a longitudinal study of boys with attention-deficit/hyperactivity disorder (ADHD).

Methods.  The cumulative incidence of SUD throughout adolescence was compared in 56 medicated subjects with ADHD, 19 nonmedicated subjects with ADHD, and 137 non-ADHD control subjects.

Results.  Unmedicated subjects with ADHD were at a significantly increased risk for any SUD at follow-up compared with non-ADHD control subjects (adjusted OR: 6.3 [1.8-21.6]). Subjects with ADHD medicated at baseline were at a significantly reduced risk for a SUD at follow-up relative to untreated subjects with ADHD (adjusted OR: 0.15 [0.04-0.6]). For each SUD subtype studied, the direction of the effect of exposure to pharmacotherapy was similar to that seen for the any SUD category.

Conclusions.  Consistent with findings in untreated ADHD in adults, untreated ADHD was a significant risk factor for SUD in adolescence. In contrast, pharmacotherapy was associated with an 85% reduction in risk for SUD in ADHD youth.  Key words:  ADHD, pharmacotherapy substance use disorders.

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