Pubdate: Fri, 31 May 2013
Source: New York Times (NY)
Copyright: 2013 The New York Times Company
Contact: http://www.nytimes.com/ref/membercenter/help/lettertoeditor.html
Website: http://www.nytimes.com/
Details: http://www.mapinc.org/media/298
Author: Alan Schwarz

NO LINK SEEN BETWEEN CHILD STIMULANT USE AND LATER DRUG ABUSE

An analysis published Wednesday by the American Medical Association 
said children with attention deficit hyperactivity disorder who take 
stimulant medication do not have a lower risk over all for later 
substance abuse, contradicting the longstanding and influential 
message that such medicines tend to deter those with the disorder 
from abusing other substances.

The paper, written by three researchers at the University of 
California, Los Angeles, examined data from 15 previous studies on 
the subject and determined that, on average, medications like 
Adderall and Ritalin had no effect one way or the other on whether 
children abused alcohol, marijuana, nicotine or cocaine later in life.

A 2003 study in the journal Pediatrics had concluded that the 
introduction of stimulant medication to children with A.D.H.D. 
reduced the risk of such abuse later in life, a finding that has been 
repeated by doctors and pharmaceutical companies not only to assuage 
parents' fears of medication but also to suggest that the pills would 
protect their children from later harm.

"I always doubted the whole 'protection' argument, and I wasn't the 
only one, but that message was really out there," said Liz Jorgensen, 
an adolescent addiction specialist at Insight Counseling in 
Ridgefield, Conn. "Hopefully, this message will be heard loud and clear."

The study comes amid growing concern about the persistent rise in 
A.D.H.D. diagnoses and prescriptions for medication among children. A 
recent New York Times analysis of data collected by the Centers for 
Disease Control and Prevention found that 11 percent of all children 
ages 4 through 17 - 6.4 million over all - had received a diagnosis 
of A.D.H.D. from a medical professional. The diagnosis rate rose to 
19 percent for boys of high school age.

Stimulant medication is by far the most prevalent treatment for 
childhood A.D.H.D., with the vast majority of children at least 
trying medication and about 60 percent of them staying on it long 
term. Stimulants can drastically improve the lives of children with 
severe A.D.H.D. but are also increasingly abused by high school and 
college students for their jolts of focus toward schoolwork.

Side effects can include appetite and growth suppression, sleep 
disturbance and occasionally psychosis, especially when the 
stimulants are abused.

The paper released Wednesday in the journal JAMA Psychiatry analyzed 
data from studies conducted from 1980 to 2012, and included more than 
2,500 children with A.D.H.D. from the United States, Canada and 
Germany. They were followed from an average age of 8 into young adulthood.

Steve S. Lee, an associate professor of psychology at U.C.L.A. and 
the study's senior author, said the data had distinct limitations - 
primarily that his team knew only whether a child had ever taken 
medication at all, not at what age, which medication, how much or for how long.

Dr. Lee also acknowledged that while his study found no average 
effect of stimulant medication on future substance abuse, that net of 
zero could have resulted from the counterbalance of two groups: 
children who were deterred from later abuse (because they felt no 
need to self-medicate) and children whose use of stimulant medication 
desensitized them to other mind-altering substances.

"There may be subgroups based on gosh knows what factors that could 
alter that risk up or down - even though the effect right now is 
statistically zero," Dr. Lee said.

Ms. Jorgensen said her clinic sees several new cases each month of 
adolescents whose introduction to drugs came from an A.D.H.D. 
diagnosis and prescription.

"It teaches them very boldly that this is the way to feel different - 
this is the way to feel better," she said. "Aversion to prescription 
drugs can be lifted at that early age."
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MAP posted-by: Jay Bergstrom