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Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder

  • Annabeth P. Groenman (a1), Jaap Oosterlaan (a2), Nanda N. J. Rommelse (a3), Barbara Franke (a4), Corina U. Greven (a5), Pieter J. Hoekstra (a6), Catharina A. Hartman (a6), Marjolein Luman (a2), Herbert Roeyers (a7), Robert D. Oades (a8), Joseph A. Sergeant (a2), Jan K. Buitelaar∗ (a9) and Stephen V. Faraone∗ (a10)...

Extract

Background

Attention-deficit hyperactivity disorder (ADHD) is linked to increased risk for substance use disorders and nicotine dependence.

Aims

To examine the effects of stimulant treatment on subsequent risk for substance use disorder and nicotine dependence in a prospective longitudinal ADHD case–control study.

Method

At baseline we assessed ADHD, conduct disorder and oppositional defiant disorder. Substance use disorders, nicotine dependence and stimulant treatment were assessed retrospectively after a mean follow-up of 4.4 years, at a mean age of 16.4 years.

Results

Stimulant treatment of ADHD was linked to a reduced risk for substance use disorders compared with no stimulant treatment, even after controlling for conduct disorder and oppositional defiant disorder (hazard ratio (HR) = 1.91, 95% Cl 1.10−3.36), but not to nicotine dependence (HR = 1.12, 95% Cl 0.45−2.96). Within the stimulant-treated group, a protective effect of age at first stimulant use on substance use disorder development was found, which diminished with age, and seemed to reverse around the age of 18.

Conclusions

Stimulant treatment appears to lower the risk of developing substance use disorders and does not have an impact on the development of nicotine dependence in adolescents with ADHD.

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Copyright

Corresponding author

Stephen Faraone, Department of Psychiatry and Behavioral Sciences, SUNY Upstate Medical University, 750 East Adams St., Syracuse, NY 13210, USA. Email: sfaraone@childpsychresearch.org.

Footnotes

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These authors contributed equally to the work.

Declaration of interest

J.O. has been on the advisory board of Shire and UCB Pharmaceuticals and he has received an unrestricted grant from Shire. H.R. is a member of an advisory board of Shire and has received research funding and conference attendance support from Shire and Eli Lilly. R.D.O. has received research funding and conference attendance support from Shire. P.J.H. has received honoraria for advice from Eli Lilly and Shire. J.A.S. is a member of the advisory board of Shire and Eli Lilly, has received a research grant from Lilly and speaker fees from Shire, Lilly, Janssen-Cillag and Novartis. In the past 3 years, J.K.B. has been a consultant to/member of the advisory board of/and/or speaker for Janssen Cilag BV, Eli Lilly, Bristol-Myers Squibb, Shering Plough, UCB, Shire, Novartis and Servier. In the past year, S.V.F. received consulting income and/or research support from Shire, Otsuka and Alcobra and research support from the National Institutes of Health (NIH). In previous years, he received consulting fees or was on advisory boards or participated in continuing medical education programmes sponsored by: Shire, McNeil, Janssen, Novartis, Pfizer and Eli Lilly.

Footnotes

References

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Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder

  • Annabeth P. Groenman (a1), Jaap Oosterlaan (a2), Nanda N. J. Rommelse (a3), Barbara Franke (a4), Corina U. Greven (a5), Pieter J. Hoekstra (a6), Catharina A. Hartman (a6), Marjolein Luman (a2), Herbert Roeyers (a7), Robert D. Oades (a8), Joseph A. Sergeant (a2), Jan K. Buitelaar∗ (a9) and Stephen V. Faraone∗ (a10)...
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eLetters

Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder

Rohit Verma, Assistant Professor
18 April 2014

Sir,We read with great interest the article by Groenman et al. [1] which brings forth one of important facet concerning substance use in attention-deficit hyperactivity disorder (ADHD).

The authors suggested through the GEE model, that the risk of developing substance use disorder (SUD) reverses after 18 years of age suggesting it to be probably being mediated by modulation in parental support. However, here we wish to raise concern for this conclusion as a possible biased finding since the researchers have included subjects exposed intermittently or for short duration to stimulants along with those exposed continuously (n=358) which may have falsely led to the results. Possibly, analysis of combined no stimulant treatment group (stimulant-naive and those with short or inconsistent stimulant use) to stimulant treatment group for age variable (as had been done in the correlation analysis) may have validated the statement.

In what appears to be a printing mistake, Table 1 the percentage of males in no-stimulant group is incorrectly mentioned as 9.0%, which must be higher given the value of n in this group (36/61).

Meta-analysis also concludes that treating ADHD during childhood reduces the incidence of SUD by half, while failure to treat doubles the risk for SUD [2]. We concur with the authors that stimulant treatment impact on nicotine dependence should be interpreted with caution warranting future larger sample longer term prospective studies also inspecting the role of non-stimulant medications in modulating SUD in ADHD.

References:

1.Groenman AP, Oosterlaan J, Rommelse NNJ, et al. Stimulant treatment for attention-deficit hyperactivity disorder and risk of developing substance use disorder. Br J Psychiatry 2013;203:112-9.

2.Verma R, Balhara YP, Mathur S. Management of attention-deficit hyperactivity disorder. J Pediatr Neurosci 2011;6:13-8.

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Conflict of interest: None declared

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