ADHD and Substance Abuse
Are Stimulant Drugs for ADHD Addictive? continued...
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.
How are Alcoholism and Drug Abuse Treated in People with ADHD?
It's important to remember that not everyone with ADHD will develop an alcohol or substance abuse problem. In adults who do develop a problem, doctors suggest treatment with nonstimulant medications, including medicines such as guanfacine or atomoxetine, and sometimes also certain antidepressants such as Norpramin and Wellbutrin.
Whether Ritalin and other stimulants are effective treatments for ADHD patients with substance abuse problems is less clear. These drugs may be useful when prescribed in a long-acting form and in a controlled way to minimize the risk for becoming physically dependent on or misusing them. Individual or group therapy, as well as 12-step support groups, can also be an important part of the substance abuse program for people with ADHD.