Stimulant Treatment Not Related to Abuse Risk

Just a brief note regarding a recently published article from the American Journal of Psychiatry on stimulant medication and future substance abuse risk. This article appears well timed as there has been recent concern (realistic or not) about both introducing a drug culture to kids through ADHD treatment and the actual abuse of stimulants in adolescents and young adults.

What we do know for sure is that ADHD kids are at increased risk of substance abuse. The AJP longitudinal study found that those who are being properly treated for their ADHD were actually at a decreased risk of future substance abuse (this is not a big surprise if you know the biology behind the disorder). The earlier they received proper medical support the less risk they were at of abuse.

You can read the press release on the article by CLICKING HERE or read the full article in:

• Title: Age of Methylphenidate Treatment Initiation in Children With ADHD and Later Substance Abuse: Prospective Follow-Up Into Adulthood
• Author: Salvatore Mannuzza, Rachel G. Klein, Nhan L. Truong, John L. Moulton III, Erica R. Roizen, Kathryn H. Howell, and Francisco X. Castellanos
• Journal: American Journal of Psychiatry May 2008 (Available online now).
• Abstract: Objective: Animal studies have shown that age at stimulant exposure is positively related to later drug sensitivity. The purpose of this study was to examine whether age at initiation of stimulant treatment in children with attention deficit hyperactivity disorder (ADHD) is related to the subsequent development of substance use disorders. Method: The authors conducted a prospective longitudinal study of 176 methylphenidate-treated Caucasian male children (ages 6 to 12) with ADHD but without conduct disorder. The participants were followed up at late adolescence (mean age=18.4 years; retention rate=94%) and adulthood (mean age=25.3; retention rate=85%). One hundred seventy-eight comparison subjects also were included. All subjects were diagnosed by blinded clinicians. The Cox proportional hazards model included the following childhood predictor variables: age at initiation of methylphenidate treatment, total cumulative dose of methylphenidate, treatment duration, IQ, severity of hyperactivity, socioeconomic status, and lifetime parental psychopathology. Separate models tested for the following four lifetime outcomes: any substance use disorder, alcohol use disorder, non-alcohol substance use disorder, and stimulant use disorder. Other outcomes included antisocial personality, mood, and anxiety disorders. Results: There was a significant positive relationship between age at treatment initiation and non-alcohol substance use disorder. None of the predictor variables accounted for this association. Post hoc analyses showed that the development of antisocial personality disorder explained the relationship between age at first methylphenidate treatment and later substance use disorder. Even when controlling for substance use disorder, age at stimulant treatment initiation was significantly and positively related to the later development of antisocial personality disorder. Age at first methylphenidate treatment was unrelated to mood and anxiety disorders. Conclusions: Early age at initiation of methylphenidate treatment in children with ADHD does not increase the risk for negative outcomes and may have beneficial long-term effects.

A Note on Net News

Quite some time ago I set up news feeds that send me all the latest news on ADHD, Autism, Asperger's, and LD's. In fact, a lot of the reports I provide on here initially come from the results of that research. What strikes me though is the amount of opinion pieces I see that are passed off as legitimate news articles. In fact many reports from reputable sources are little more than press releases.

Take THIS ARTICLE on nutrition and Autism for Medical News Today (MNT).

Let's look at the problems here:

• This is clearly a press release. When was the last time you saw an unbiased article that provides direct links to only one side of the argument?
• There is no author listed. If you wrote something professionally you usually want to take credit for it.
• It is full of loaded language .. Ms. M is presented as a nutrition expert. But the Mayo Clinic nutritionists are not.
• Not only is there a website posted that examines only one side of the argument, but Ms. M is clearly looking at a book tour and workshops. As a reader I have to ask if this is an advertisement.
• There is no sources provided other than the book which is being promoted.

I don't have a problem with press releases. I do have a problem with them being presented as news. The unfortunate truth is that I am able to view this and see it for what it is, but an everyday parent is not. I would not share my opinion on nutrition based pushes for treatment of neurological and learning difficulties (and I have opinions) without sourcing them, and that is why you won't read them here.

Now take a look at THIS ONE from Medical News Today discussing a longitudinal study that found no increased risk of substance abuse for ADHD medication users. It's still not perfect (it is also a press release without saying it is one.. perhaps that's MNT's fault) but it is sourced with references that are PEER REVIEWED and easily verified.

The difference is pretty clear. It is unfortunate that parents have to be such educated consumers in our field, but they need to know that the publishing side of treatment is big business.