ADHD and Substance Abuse
Are Stimulant Drugs for ADHD Addictive?
Parents sometimes worry whether the stimulant drugs their children are taking to treat ADHD (such as Ritalin) are themselves addictive. Stimulant medications work by raising levels of a chemical messenger called dopamine in the brain, which helps improve focus and attention -- skills that people with ADHD often find difficult to master.
Dopamine also affects emotion and the feeling of pleasure, creating a "high" that makes people want more. Because cocaine and other street drugs also raise dopamine levels, there has been concern that ADHD stimulants might be similarly addictive. Ritalin's ability to increase energy and focus has even led some people to refer to it as the "poor man's cocaine."
There have been reports of people using ADHD stimulants that weren't prescribed for them. People have crushed and snorted Ritalin tablets or dissolved the drug in water and taken it intravenously. Studies show that abusing Ritalin can lead to dependence on the drug. When carefully taken as prescribed, though, Ritalin is less likely to be addictive in children or adults.
In large doses -- greater than what is typically prescribed for ADHD -- Ritalin does have effects similar to those of cocaine. However, researchers have found marked differences between the two drugs. One of the factors that leads to addiction and drug abuse is how quickly a drug raises dopamine levels. The faster dopamine levels go up, the greater the potential for abuse. One researcher found that Ritalin takes about an hour to raise dopamine levels in the brain, compared to only seconds with inhaled cocaine. The doses of Ritalin and other stimulants used to treat ADHD tend to be lower and longer-acting, which reduces the risk of addiction. Long-term use of all stimulants can sometimes lead to a phenomenon called tolerance -- that is, higher doses are needed to achieve the same effect of a controlled substance. If and when this happens, a doctor may then be more likely to consider using nonstimulant medicines to treat ADHD.
Does Taking Stimulants for ADHD Lead to Substance Abuse Problems?
Many parents are concerned that giving their children stimulants to treat ADHD might lead the children to start experimenting with other types of drugs. Several studies have set out to investigate the possible link between prescribed ADHD stimulant medication and substance abuse problems, and there doesn't appear to be a strong connection.
One of the longest-term studies, which followed 100 boys with ADHD for 10 years, showed no greater risk for substance abuse in boys who took stimulant drugs compared to those who didn't take the drugs. An earlier study by the same authors even suggested that stimulant use might protect against later drug abuse and alcoholism in children with ADHD by relieving the ADHD symptoms that often lead to substance abuse problems. The earlier the stimulants are started, the lower the potential for substance abuse down the road.