Effect of prior stimulant treatment for attention-deficit/hyperactivity disorder on subsequent risk for cigarette smoking and alcohol and drug use disorders in adolescents.
OBJECTIVE
To examine the effects of early stimulant treatment on subsequent risk for cigarette smoking and substance use disorders (SUDs) in adolescents with attention-deficit/hyperactivity disorder (ADHD).


METHODS
Case-controlled, prospective, 5-year follow-up study.


METHODS
Massachusetts General Hospital, Boston.


METHODS
Adolescents with and without ADHD from psychiatric and pediatric sources. Blinded interviewers determined all diagnoses using structured interviews. Intervention Naturalistic treatment exposure with psychostimulants for ADHD.


METHODS
We modeled time to onset of SUDs and smoking as a function of stimulant treatment.


RESULTS
We ascertained 114 subjects with ADHD (mean age at follow-up, 16.2 years) having complete medication and SUD data; 94 of the subjects were treated with stimulants. There were no differences in SUD risk factors between naturalistically treated and untreated groups other than family history of ADHD. We found no increased risks for cigarette smoking or SUDs associated with stimulant therapy. We found significant protective effects of stimulant treatment on the development of any SUD (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.13-0.60; chi(2)(113) = 10.57, P = .001) and cigarette smoking (HR, 0.28; 95% CI, 0.14-0.60; chi(2)(111) = 10.05, P = .001) that were maintained when controlling for conduct disorder. We found no effects of time to onset or duration of stimulant therapy on subsequent SUDs or cigarette smoking in subjects with ADHD.


CONCLUSIONS
Stimulant therapy does not increase but rather reduces the risk for cigarette smoking and SUDs in adolescents with ADHD.
Pediatric Psychopharmacology Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA. twilens@partners.org
Timothy E
TE
Wilens
Joel
J
Adamson
Michael C
MC
Monuteaux
Stephen V
SV
Faraone
Mary
M
Schillinger
Diana
D
Westerberg
Joseph
J
Biederman
D000293:Adolescent; D000294:Adolescent Behavior; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000523:psychology; D001294:Attitude to Health; D016022:Case-Control Studies; D000697:Central Nervous System Stimulants / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology* / Q000523:psychology; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology*; D013997:Time Factors
D000697:Central Nervous System Stimulants