Investigating the connection
According to a new report by the American Academy of Pediatrics (AAP), ADHD is linked to a marked increase in substance abuse. This data adds to an increasingly complex treatment landscape and provides evidence that early interventions to prevent addiction may be vital in children struggling with ADHD.
Joel L. Young, M.D., is the Medical Director of the Rochester Center for Behavioral Medicine outside of Detroit and teaches Psychiatry at Wayne State University School of Medicine. Trained at the University of Michigan, Dr. Young is certified by the American Board of Psychiatry and Neurology and holds added qualifications in geriatric and forensic psychiatry. In addition, he is a diplomate of the American Board of Adolescent Psychiatry.
Editor: Saad Shaheed
The ADHD-Substance Abuse Link
The American Academy of Pediatrics study, published in the July issue of Pediatrics, heavily relies upon a 2011 meta-analysis. That analysis found that children with ADHD are 300 percent more likely to smoke cigarettes during their teen years, twice as likely to abuse cocaine, and nearly twice as likely to become alcoholics. Children with ADHD are, on the whole, two and a half times more likely to develop substance abuse problems than children without the disorder.
According to the study, 23 percent of children who take ADHD stimulant medications have been asked to sell or trade their drugs. This exposes children to drug culture early, potentially exacerbating the risks of drug abuse. The study found that stimulant medications if prescribed early enough, can reduce the risk of substance abuse, but this puts pediatricians in a challenging position. They can prescribe a medication that treats ADHD and reduces substances abuse risk, but the medication is itself prone to abuse and may expose children to the temptation to buy and sell their stimulants. The AAP recommends the use of long-acting stimulants such as Concerta to reduce this risk.
Why Does ADHD Contribute to Substance Abuse?
ADHD doesn’t necessarily cause substance abuse. Instead, it exposes children to a host of risk factors that can steadily increase their risk of using illicit drugs. Likewise, ADHD increases the risk of addiction among users of illicit drugs. Research into this issue is still ongoing, but current research points to several causes.
People with ADHD are more impulsive, making them more vulnerable to the temptation to use drugs. This temptation is typically greater among people with untreated ADHD. This impulsivity conspires with other personality traits associated with ADHD to make substance abuse a tempting option. For example, many people with the disorder feel chronically bored and under-stimulated, making stimulants such as cocaine appealing options. Others struggle with depression or insomnia, which can increase the vulnerability to abuse of both prescription and illicit drugs.
All mental health conditions, including ADHD, increase the odds of abusing nicotine. Nearly half of people with a diagnosed mental condition smoke, and those with ADHD are no different. Research into this phenomenon is ongoing, but most doctors agree that smoking is a form of self-medication. People with ADHD may use nicotine to cope with stress, avoid unpleasant feelings, and manage boredom.
Other factors may also contribute to the temptation to use drugs. These include:
• Difficulties at school
• Troubled relationships with peers and family
• Poor self-esteem
• Poor decision-making skills
• Access and exposure to drugs and drug culture
The Challenge of Stimulant Drugs
Although the most recent study found that stimulants could reduce the lifetime risk of drug abuse, stimulants aren’t without risks. Indeed, the use of stimulants to treat ADHD is a major contributing factor in the ongoing public backlash against ADHD and ADHD treatment. Research suggests that stimulant drugs are highly addictive, particularly to teens and children. One recent study, for example, found that one in 10 students had used stimulants to improve their academic performance.
Doctors who prescribe stimulant drugs must be vigilant in monitoring for abuse. They may need to opt for less addictive drugs, or carefully monitor the dosage. Over time, children can develop a tolerance to ADHD drugs, and this tolerance can both reduce the efficacy of stimulants and lead to addiction. Active clinical management coupled with responsible parenting can reduce the risk.
Protecting Against Substance Abuse in Children With ADHD
Parents concerned about their ADHD children developing substance abuse problems should know that substance abuse is by no means an inevitability. Parents who wish to reduce their children’s risk of abuse should consider the following options:
• Count your child’s pills to ensure she’s not selling them or taking more than are prescribed.
• Talk openly and in an age-appropriate way about your child’s abuse drug use and addiction. Avoid scare tactics and threats; instead, encourage your child to speak honestly and to rely on you if he needs information or assistance.
• Give your child some alone time with his doctor to discuss any concerns he feels uncomfortable discussing in your presence.
• Act quickly if you think your child has ADHD. Early treatment can greatly reduce the risk of future substance abuse.
• Don’t use drugs, smoke, or drink around your child. Parents of addicts are more likely to raise addicted children.
• Remain actively involved in your child’s life so that you know her daily routine and can quickly detect a change suggestive of drug abuse.
• Praise your child for healthy friendships and positive life choices.
• Help your child practice saying “no” to drugs. Tell him it’s OK to lie if it keeps him off drugs. For example, “I tried marijuana before and didn’t like it” is a perfectly acceptable way to say “no,” even if it’s not true.
• Ask your child open-ended questions about his perspective on drugs and alcohol, and engage with him about his answers. Don’t punish him for his thoughts, or he won’t come to you if he needs help.
• Talk to your child about the media he consumes, and consider watching television and movies with him.
• Take drug abuse seriously. If your child abuses drugs, sells her ADHD pills or smokes, talk to a psychiatrist or mental health counselor who can help you get your child clean. The longer drug use goes on, the harder it is to reverse.
A risk factor is not the same thing as destiny, and ADHD does not have to be a sentence to drug abuse. With careful monitoring, intelligent parenting, and responsible medical practices, our society can steadily decrease the drug use rate among teens with ADHD.