AD/HD and Stimulant Medication Abuse

by Wendy Richardson, MA, MFT, CAS

(The following article has been adapted from my book, The Link Between ADD & Addiction, Getting the Help You Deserve, (1997) Piñon Press, and my new book When Too Much Isn't Enough, Ending The Destructive Cycle of AD/HD and Addictive Behavior, to be released in January (2005) Piñon Press.)

Treating adults and children with medication has been, and continues to be the subject of great controversy. Even in the face of years of scientific research, advances in understanding how these medications work, and significant improvement in the quality of life for millions around the world, there are still those who question, doubt, and attack the role that medication provides in the treatment of AD/HD.

Even more controversial is treating recovering alcoholics and addicts with stimulant medication. The "evils" of Ritalin have been the target of the media for years. Fear, which is often caused by the lack of accurate information, fuels anti-Ritalin and anti-medication groups. The media, which thrive on controversy, have recently been providing more accurate and scientific information when covering medications to treat AD/HD. Non-biased information that is based on sound research with proven results diminishes fear of the unknown, and squelches myths about the effective use of medication to treat AD/HD.

Stimulant Abuse and Addiction

There has been a flurry of high profile media about the abuse of stimulant medications. Many of these articles or shows focus on young people abusing Ritalin, Adderall, and Dexedrine. The truth is; these medications can be abused and the abuser can become addicted. Unfortunately the media tends to draw erroneous conclusions, such as, the use of stimulant medication to treat AD/HD causes drug addiction.

Most cases of stimulant abuse are among adolescents and adults who are not being treated for AD/HD. These are people that will abuse almost any drug if given the chance. Adderall and Dexedrine, are abused by people who are trying to get a high similar to speed. Ritalin, however, is often abused as a last resort because it doesn't give the user the euphoria they crave.

Although rare, drug addicts and alcoholics abuse stimulant medication by taking more than prescribed, or by grinding it up to inhale or to mix with water and inject. Some of these people learned how to present as though they had AD/HD in order to obtain stimulants. In most cases, these people had been given large prescriptions with little or no ongoing treatment for AD/HD or addiction.

Facts About Stimulant Medication

Unfortunately, many still hold the inaccurate belief that treating AD/HD with stimulant medication leads to substance abuse later in life, when in fact the opposite appears to be true.

• Untreated AD/HD is a risk factor for developing a substance use disorder later in life. (Biederman et al. 1997, Wilens et al. 1997, Hechtman and Weiss. 1985, Wilens et al. 2003)
• Treating AD/HD with stimulant medication appears to reduces risk of later substance use disorders by half. (Wilens et al. 2003)
• Concurrent treatment for coexisting conditions if they are present (bipolar, anxiety disorders, obsessive thought patterns)

Comprehensive Treatment for Those with Addiction

A comprehensive treatment plan is the most effective way to avoid medication abuse or addiction relapse. Medication should not be used as the sole treatment for AD/HD. Taking pills to rebalance your neurotransmitters is not enough. This means that your AD/HD, eating disorders, other co-occurring conditions and/or addictions are treated at the same time. If you stray away from your addiction recovery, you will be at greater risk to relapse. If you don't receive adequate treatment for your AD/HD, you're at greater risk for relapse. A comprehensive treatment plan is one that contains the following components:

• AD/HD treatment in the form of education, coaching, and support groups
• Regular visits with your doctor and close medication management
• Therapy or counseling regarding AD/HD and recovery issues
• Involvement in addiction recovery programs
• Family and relationship counseling when needed

Taking Medication Versus Street Drugs

Here are some important differences between taking prescribed medication and using street drugs.

• Stimulant medication is taken orally, at specific times, in dosages that do not create a "high" or euphoria.
• Due to the low dosage and lack of euphoria, most people do not develop a tolerance to stimulant medication.
• The dosage and quality of medication will not vary. Street drugs can be diluted or cut with baby powder, ephedrine, and who knows what.
• Street amphetamines produce a "high" as a result of much higher doses (several hundred times higher), and the route of administration (smoking, snorting, injecting).
• The intense euphoria produced by high doses of street amphetamines can cause cravings for more and quickly lead to addiction.
• Unlike street drugs, your intake of stimulant medication will be closely monitored by your doctor and other members of your support system.

Conclusion

Many substances including sugar have the potential to be abused by certain individuals. A genetic predisposition for addiction is not the only cause of addiction. Who becomes addicted and who doesn't is determined by a variety of factors. Environment, stress, trauma, life circumstances, and coexisting conditions such as depression, anxiety, post traumatic stress disorder (PTSD), and AD/HD are important contributing factors.

Stimulant medication such as Adderall, Dexedrine, and Ritalin are abused by those who are drug seeking, or addicted. Most people who take stimulant medication to treat their AD/HD do not abuse it. As a matter of fact, the greater problem is that they forget to take it.

Research indicates that those with untreated AD/HD are at greater risk to self-medicated with substances. Stimulant medication has a protective effect for some with AD/HD and decreases self-medicating. Medication should not be used as the sole treatment for AD/HD. A comprehensive treatment plan is the most effective way to avoid medication abuse or addiction.

References

Biederman, J., Wilens, T., Mick, E., Faraone, S.V., Weber, W., Curtis, S., Thornell, A., Pfister, K., Jetton, J.G., & Soriano, J. (1997). Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 21-29.

Blum, K., Cull, J., Braverman, E., Comings, D. (1996). Reward deficiency syndrome. American Scientist, 84, 132-145.

Bonci, A., Bernardi, G., Grillner, P., Mercuri, N.B. (2003). The dopamine-containing neuron:maestro or simple musician in the orchestra of addiction. Trends Pharmacological Science, 24, 4, 172 April.

Hechtman, L. (1985). Adolescent outcome of hyperactive children treated with stimulants in Childhood: a review, Psychopharmacol Bul, 21:178-191.

Hechtman, L, Weiss, G. (1986). Controlled prospective fifteen year follow-up of hyperactives as adults: non medical drug and alcohol use and anti-social behaviour. Can J Psychiatry, 31:557.

Richardson, W. (1997). The link between ADD and addiction: Getting the help you deserve. Colorado Springs: Piñon Press.

Thompson, L.L., Riggs, P.D., Mikulich, S.K. & Crowley, T.J. (1996). Contribution of ADHD symptoms to substance abuse problems and delinquency in conduct-disordered adolescent. Journal of Abnormal Child Psychology, 24, 325-347.

Whitman, B. (2000). Adult outcomes for persons with attention deficit/hyperactivity disorder. In Accardo, P., Blondis, T., Whitman, B., & Stein, M. (Eds.) Attention Deficits and Hyperactivity in Children and Adults: Diagnosis, treatment, management. 2nd ed., Revised and expanded. New York: Marcel Dekker, Inc.

Wilens, T. E., Faraone, S. V., Biederman, J., & Gunawardene, S. (2003). Does Stimulant Therapy Of Attention-Deficit/Hyperactivity Disorder Beget Later Substance Abuse? A Meta-Analytic Review Of The Literature. Pediatrics, 111(1), 179-185.

Wilens TE, Biederman J, Bredin E, Hahesy AL, Abrantes A, Neft D, Millstein R, Spencer TJ. (2002). A Family Study Of The High-Risk Children Of Opioid- And Alcohol-Dependent Parents. The American Journal On Addictions. Winter, 11(1):41-51.

About the Author: Wendy Richardson, M.A., MFT, CAS is a Licensed Marriage, Family Therapist, and Certified Addiction Specialist in private practice in Soquel, California. Wendy is the author of The Link Between ADD & Addiction, 1997, Piñon Press. She has contributed chapters on AD/HD to books focusing on criminology and on women with AD/HD. She has also authored numerous articles on AD/HD and co-occurring conditions. She is a consultant, trainer, and is a frequent presenter at national AD/HD, addiction, criminal justice, and learning disorder conferences.