Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2013 Jul;70(7):740-9.
doi: 10.1001/jamapsychiatry.2013.1273.

Stimulant medication and substance use outcomes: a meta-analysis

Kathryn L Humphreys  1 , Timothy Eng, Steve S Lee
Affiliations
Meta-Analysis

Stimulant medication and substance use outcomes: a meta-analysis

Kathryn L Humphreys et al. JAMA Psychiatry. 2013 Jul.

Abstract

Importance: Psychostimulant medication is an efficacious treatment for childhood attention-deficit/hyperactivity disorder, yet controversy remains regarding potential iatrogenic effects of stimulant medication, particularly with respect to increasing susceptibility to later substance use disorders. However, stimulant treatment was previously reported to reduce the risk of substance problems.

Objective: To meta-analyze the longitudinal association between treatment with stimulant medication during childhood and later substance outcomes (ie, lifetime substance use and substance abuse or dependence).

Data sources: Studies published between January 1980 and February 2012 were identified using review articles, PubMed, and pertinent listservs.

Study selection: Studies with longitudinal designs in which medication treatment preceded the measurement of substance outcomes.

Data extraction and synthesis: Odds ratios were extracted or provided by the study authors. Odds ratios were obtained for lifetime use (ever used) and abuse or dependence status for alcohol, cocaine, marijuana, nicotine, and nonspecific drugs for 2565 participants from 15 different studies.

Main outcomes and measures: Random-effects models estimated the overall association, and potential study moderators were examined.

Results: Separate random-effects analyses were conducted for each substance outcome, with the number of studies ranging from 3 to 11 for each outcome. Results suggested comparable outcomes between children with and without medication treatment history for any substance use and abuse or dependence outcome across all substance types.

Conclusions: These results provide an important update and suggest that treatment of attention-deficit/hyperactivity disorder with stimulant medication neither protects nor increases the risk of later substance use disorders.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.
Effect of medication treatment on the risk of alcohol abuse or dependence in children with attention-deficit/hyperactivity disorder.
Figure 2.
Figure 2.
Effect of medication treatment on the risk of cocaine abuse or dependence in children with attention-deficit/hyperactivity disorder.
Figure 3.
Figure 3.
Effect of medication treatment on the risk of marijuana abuse or dependence in children with attention-deficit/hyperactivity disorder.
Figure 4.
Figure 4.
Effect of medication treatment on the risk of nicotine dependence in children with attention-deficit/hyperactivity disorder
See this image and copyright information in PMC

Comment in

References

    1. Greenhill LL, Pliszka S, Dulcan MK, et al. ; American Academy of Child and Adolescent Psychiatry. Practice parameter for the use of stimulant medications in the treatment of children, adolescents, and adults. J Am Acad Child Adolesc Psychiatry. 2002;41(2)(suppl):26S–49S. - PubMed
    1. O’Brien JM, Felt BT, Van Harrison R, Kochhar PK, Riolo SA. Attention-Deficit Hyperactivity Disorder Guidelines for Clinical Care. Ann Arbor: University of Michigan Health System; 2005.
    1. Kollins SH. Comparing the abuse potential of methylphenidate versus other stimulants: a review of available evidence and relevance to the ADHD patient. J Clin Psychiatry. 2003;64(suppl 11):14–18. - PubMed
    1. Kollins SH. A qualitative review of issues arising in the use of psycho-stimulant medications in patients with ADHD and co-morbid substance use disorders. Curr Med Res Opin. 2008;24(5):1345–1357. - PubMed
    1. Kollins SH, MacDonald EK, Rush CR. Assessing the abuse potential of methylphenidate in nonhuman and human subjects: a review. Pharmacol Biochem Behav. 2001;68(3):611–627. - PubMed

Publication types

MeSH terms

Substances