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Timothy E. Wilens, MD; Joel Adamson, BA; Michael C. Monuteaux, ScD; Stephen V. Faraone, PhD; Mary Schillinger, BA; Diana Westerberg, BA; Joseph Biederman, MD

Arch Pediatr Adolesc Med. 2008;162(10):916-921.

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).

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

Setting  Massachusetts General Hospital, Boston.

Participants  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.

Main Outcome Measures  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; ²₁₁₃ = 10.57, P = .001) and cigarette smoking (HR, 0.28; 95% CI, 0.14-0.60; ²₁₁₁ = 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.

Conclusion  Stimulant therapy does not increase but rather reduces the risk for cigarette smoking and SUDs in adolescents with ADHD.

Author Affiliations: Pediatric Psychopharmacology Program, Massachusetts General Hospital, Harvard Medical School, Boston (Drs Wilens, Monuteaux, and Biederman, Mr Adamson, and Mss Schillinger and Westerberg); and Departments of Psychiatry and of Neuroscience and Physiology, State University of New York Upstate Medical University, Syracuse (Dr Faraone).