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Childhood ADHD Treatment and the Risk of Teenage Drug Abuse

by Anthony Kane, MD

Many parents of ADHD children are worried about giving their children medication to treat their children’s ADHD. There are many reasons for their concern, but one of the greatest concerns is the fear that parents have that they are setting up their children to have a future drug abuse problem.

Most parents know thatADHD teens have a much higher level of drug abuse than their normal counterparts. Parents have also heard theories that taking drugs like Ritalin increases the risk of drug abuse. The idea is that routinely taking Ritalin, which is actually very similar to cocaine, will expose children to habitual drug taking and will make them more open to experimenting with hard drugs when they become teenagers.

These theories were first proposed by physicians. The ideas were later picked up and expanded upon by distributors of natural treatments for ADHD and are used to play upon the fears of parent in order to sell their ‘drug free’ alternatives.

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So the question is, is there a connection with Ritalin and other stimulant medication use in children and future drug abuse problems? That is what we are going to explore in this article.

Ritalin Treatment and Future Drug Abuse

The truth is that this question has been researched and we have a very clear answer. In fact, researchers have found a very strong connection between childhood use of Ritalin and other stimulant medication to treat ADHD and the risk of future drug abuse in ADHD teenagers.

However, the results are exactly the opposite of what most parents think. Use of stimulant medication in ADHD children does not increase the risk of future drug abuse. It reduces the risk of drug abuse, and reduces it dramatically.

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In 1999, a study funded by National Institute on Drug Abuse and the National Institute of Mental Health compared three groups of boys - those with ADHD who had been treated with stimulants, those with ADHD who had not been treated with stimulants, and those without ADHD. The researchers followed the children to determine their susceptibility to substance use disorder.

This research project was a combined effort of researchers at Massachusetts General Hospital, Harvard School of Public Health, and Harvard Medical School. The scientists divided 212 boys into three groups and followed them for several years. The first group consisted of 56 boys with ADHD who received on the average four years of drug treatment for their ADHD. The second group was made up of 19 boys also with ADHD, but who received no drug treatment for their condition. The third group consisted of 137 boys who did not have ADHD.

When the boys were 15 or older, they were evaluated for substance abuse disorders involving alcohol, marijuana, hallucinogens, stimulants, or cocaine.

(I want to point out that there is a difference between substance abuse and a substance abuse disorder. Substance abuse is recreational use of medications. This may include inappropriate use of alcohol or other drugs. This is fairly common in our society and does not always indicate a significant problem. Our real concern is when recreational use of medication becomes a disorder. A substance abuse disorder is where the person continues to use a mood- or behavior-altering substance despite the fact that this substance causes significant problems in the person's life.)

Results of the study were fairly dramatic. 18 percent of children without ADHD had at least one substance abuse disorder, when surveyed in their mid teens. The group of ADHD children who received medical treatment faired almost as well. Only 25 percent of that group had at least one substance abuse disorder.

However, among the ADHD children that did not receive medical treatment, 75 percent of that group had at least one substance use disorder during the follow up study.

This study suggests that if your child has ADHD and does not take medication, he is three times as likely to get seriously involved with drugs, than if he does receive medication.

Other researchers have found that the younger age that medical treatment began, the lower the risk of a future drug abuse problem.

Other Risk Factors

Other factors have been identified that predict a higher risk of future drug abuse.

Wilens found that the two biggest indicators of future substance abuse disorder in ADHD children were coexistent conduct disorder and coexistent bipolar disorder. Other researchers found that with regard to conduct disorder, IQ played a factor. Children with conduct disorder and high IQ scores were more likely to later develop a drug problem. In contrast, in children who did not have a conduct disorder, those with a lower IQ were more likely to develop a substance abuse disorder.


Most parents are concerned about starting their ADHD children on stimulant medications. This is for a variety of reasons and many of these reasons are valid. However, what many of these well meaning parents fail to consider is that there are concrete risks involved with not starting their children on drug treatment. One very measurable risk is the risk of future drug involvement.

Parents must consider that the risk of future drug abuse gets larger the longer they withhold medical treatment from their children. The risk becomes three times as great when they withhold medical treatment completely from their ADHD children. If ADHD is complicated by conduct disorder or bipolar disorder there is even a greater chance of future drug abuse developing.

So if your child has ADHD it could be that giving medication may not be the best approach. But you should know that not giving medication also carries with it some danger. Be sure you or whoever is managing the treatment of your child considers all the risks before you make your decision.

Anthony Kane, MD

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