Updated 20 September 2019

Do ADHD meds increase substance abuse risk?

A new study found that the risk of later substance abuse was lower when kids with ADHD started medicines such as Ritalin and Adderall earlier and took them for longer.

Parents often worry that their children who take stimulants to treat ADHD may be at higher risk for substance abuse later.

Different odds

Now, a surprising new study finds that risk was actually lower when medicines such as Ritalin and Adderall were started earlier and taken longer.

"Most notably, the risk of substance use in adolescents who had been treated at an earlier age and for a longer duration with stimulant ADHD medications was the same as for the general population of children," said study leader Sean Esteban McCabe. He is research faculty chair at the University of Michigan Institute for Research on Women and Gender.

Read: What happens when kids with ADHD take Ritalin and Concerta?

"The study found that the odds of reporting any substance use were over two times more likely among individuals who reported later onset [age 15 or older] and shorter duration [two years or less] of prescription stimulant medication therapy for ADHD as compared to those who initiated early [age 9 or younger] and for longer duration [six years or more]," McCabe said.

The researchers evaluated more than 40,000 high school seniors, including more than 3,500 who were prescribed stimulant medication for ADHD and 1,300 who were prescribed non-stimulant medicine.

The researchers gathered information on medication use and whether or not the teens had engaged in binge drinking, cigarette smoking, marijuana or cocaine use.

Findings seem counterintuitive

"Later initiation of stimulant medication for ADHD, shorter duration of use, and the use of non-stimulant medication for ADHD were all associated with increased substance use during adolescence," McCabe said.

But the study can't prove cause and effect, the researchers said.

Read: Ritalin abuse runs riot in South African schools

According to background information in the study, nearly one in eight high school seniors in the United States has used stimulant or non-stimulant medication for ADHD. Medication can help with the symptoms of ADHD, a brain disorder marked by hyperactivity, impulsivity and lack of attention.

While the new findings might seem counterintuitive, McCabe said the results actually reinforce the importance of early detection of ADHD and continuous treatment.

"Some experts have asserted that early detection and appropriate medication management may decrease core ADHD symptoms, such as impulsivity, and may promote adaptive behaviour that could reduce substance use and substance use disorders later in life," he said.

Another paediatrics expert agreed.

'Gateway drugs'

"This study provides parents and physicians with further reassuring evidence that prescribing stimulant medications to grade-school children with ADHD is not associated with an increased risk of later substance use at age 18," said Dr Andrew Adesman, chief of developmental and behavioural paediatrics at Cohen Children's Medical Centre of New York, in New Hyde Park.

Read: SA has one of the highest prescription rates of ADHD medication

"Although some parents have expressed the fear that Ritalin and other stimulant medications could be 'gateway drugs' that put children with ADHD at even greater risk for later substance abuse problems, this well-designed analysis of a large national sample clearly shows that this is not the case," Adesman added.

While it could be possible that some of the children using the stimulant drugs later were experimenting and did not actually have ADHD, McCabe said that information was beyond the scope of the study. The findings do suggest that precautions are needed when prescribing ADHD medicines for older teens, including an assessment of substance use history and ongoing monitoring, he said.

Parents can do much to reduce the risk of substance abuse by their kids, McCabe said. If they suspect ADHD, getting their child checked out early can help get them the treatment they need. Parents can also be good role models in the use of their medicines, he said.

The study was published in the June issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

Read more:

What is ADHD?

Causes of ADHD

Treating ADHD


Ask the Expert

ADHD Expert

Dr Renata Schoeman has been in full-time private practice as a general psychiatrist (child, adolescent and adult psychiatry) since 2008, currently based in Oude Westhof (Bellville). Renata also holds appointments as senior lecturer in Leadership (USB) and as a virtual faculty member of USB Executive Development’s Neuroleadership programme. She serves on the advisory boards of various pharmaceutical companies, as a director of the Psychiatric Management Group (PsychMG) and is the co-convenor of the South African Society of Psychiatrist (SASOP) special interest group for adult ADHD, and co-founder of the Goldilocks and The Bear Foundation ( She is passionate about corporate mental health awareness and uses her neuroscience background to assist leaders in equipping them to become balanced, healthy and dynamic leaders that take their own and their team’s emotional, intellectual, social health and physical needs into account. Renata is academically active and enjoys research and collaborative work, has published in many peer-reviewed journals, and has presented at local and international congresses. She is regularly invited to present at conferences and to engage with the media. During her post-graduate studies, she trained at Harvard, Boston in neurocognition and neuroimaging. Her awards include, amongst others, the Young Minds in Psychiatry award from the American Psychiatric Association, the Discovery Foundation Fellowship award, a Thuthuka award from the NRF, and a MRC Fellowship. She also received the Top MBA student award and the Director’s award from USB for 2015. She was a finalist for the Businesswomen’s Association of South Africa’s Businesswoman of the Year Award for 2016, and received the Excellence in Media Work award from SASOP during 2016.

Still have a question?

Get free advice from our panel of experts

The information provided does not constitute a diagnosis of your condition. You should consult a medical practitioner or other appropriate health care professional for a physical exmanication, diagnosis and formal advice. Health24 and the expert accept no responsibility or liability for any damage or personal harm you may suffer resulting from making use of this content.

* You must accept our condition

Forum Rules