Researchers have long debated whether the childhood condition attention-deficit hyperactivity disorder (ADHD) increases the odds of getting involved in substance use or developing substance use disorder. Part of this debate is centered on the impact of using stimulant medications to ease the symptoms of ADHD. In a study published in July 2014 in the journal Addictive Behaviors, researchers from the University of Florida looked at the substance-using behaviors of adults with a history of ADHD. These researchers concluded that, among other things, people with such a history commonly initiate substance use at an earlier age than people who lack an ADHD history.
ADHD and Stimulant Medications
ADHD is characterized by two main types of problems: unusually hyperactive/impulsive behavior and unusual difficulty focusing attention on others or one’s surroundings. Some affected people primarily have symptoms of hyperactive/impulsive behavior, while others primarily have inattention-related symptoms. A third subgroup of affected individuals has a mixture of hyperactive/impulsive symptoms and inattention-related symptoms. As a rule, ADHD arises in early childhood, although some people don’t receive an accurate diagnosis until they’re much older. In a significant number of cases, symptoms of the disorder still exert their influence in adulthood.
Stimulant medications for attention-deficit hyperactivity disorder typically contain one of two main active ingredients: a non-amphetamine-based substance called methylphenidate or a combination of amphetamine and a chemical relative called dextroamphetamine. When used properly, these medications apparently do not substantially increase the odds that a person with ADHD will experience short- or long-term problems with substance abuse or substance addiction. In fact, proper use of an ADHD medication may actually lower the odds that a person with the disorder will later experience serious substance problems.
Stimulant Medication Misuse and Abuse
Unfortunately, significant numbers of people misuse their ADHD stimulant prescriptions, supply stimulants to others who don’t have a prescription or use stimulants in the absence of a prescription. Anyone who misuses a stimulant medication boosts his or her odds of developing problems with diagnosable abuse or addiction. Together, prescription stimulants constitute the third most commonly misused class of medications in the U.S., according to figures compiled by the federal Substance Abuse and Mental Health Services Administration. Approximately 0.5 percent of all American preteens, teenagers and adults use one of these substances for nonmedical reasons in the average month.
Impact of an ADHD History
In the study published in Addictive Behaviors, the University of Florida researchers used an examination of 941 adults from the Baltimore area to explore the impact that an ADHD history has on substance use. All of the study participants were either African American or European American and had a history of substance intake. A total of 124 participants reported a personal history of diagnosable ADHD, while the remainder of the participants reported no such history. The researchers asked the members of both groups to report the age when they first started using a range of substances. In addition, they gathered information on each individual’s current involvement in substance use, including behaviors known to increase the chances of contracting HIV (the human immunodeficiency virus).
After comparing the group with an ADHD history to the group without an ADHD history, the researchers concluded that the people in the ADHD group were substantially younger when they started using four addictive substances: marijuana, cigarettes/nicotine, cocaine and alcohol. They also concluded that, in the present, the study participants with a history of ADHD were more likely to take part in substance-related activity (specifically, use of IV drugs and the sharing of IV needles) known to seriously increase the risks for HIV transmission and the transmission of other dangerous or potentially lethal microorganisms.
The study’s authors explicitly viewed their work in the context of the gateway theory of substance use. This theory holds that the intake of certain relatively harmless substances increases the odds of later moving on to the use of more dangerous substances. The authors believe that a history of ADHD can potentially speed up the transition to the use of harder drugs. They also believe that an ADHD history may help predict more severe substance-related problems in adult drug or alcohol users.