ADHD Meds: Risk of Abuse?


I’ve heard that putting kids with ADHD on prescription stimulants raises their risk for becoming illicit drug users. Is that true?

Evelyn G. St. Paul, MN

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Alan Wachtel, MD

Dr. Wachtel is a psychiatrist and noted expert in the treatment of ADHD. He is the author of The Attention Deficit Answer Book: The Best Medications and Parenting Strategies for Your Child.

When prescription stimulants are taken orally and in the approved dose and manner, they are not addictive. In fact, those who do not take medication for their ADHD have a significantly higher risk of substance abuse than those who do.

Prescription stimulants (such as Adderall; Ritalin; Vyvance; Concerta; and Focalin) are categorized as Schedule II drugs: controlled substances that are legal but are considered dangerous because of their potential for abuse and dependence and the traumatic impact they can have on those who abuse them.

All stimulants are different from each other with respect to impact, potential side effects, potency, duration, and how they work. As with all drugs, stimulants have potential side effects, such as weight gain, decreased appetite, wakefulness and talkativeness, even when taken properly.

Some people experience symptoms similar to those of withdrawal when they discontinue the use of stimulants all at once, instead of gradually. These discontinuation symptoms – depression, anxiety, fatigue, insomnia, irritability, headaches or mental “fog” – are not specific to stimulants, however; many people experience comparable “withdrawal trauma” when they stop taking medications that treat depression and anxiety, as well as chronic muscle, bone or diabetic nerve pain.

Misuse & Abuse

The misuse of stimulants is another story altogether. Taking stimulants without a prescription; with someone else’s prescription; in a manner or dose other than that prescribed; mixed with other drugs, such as alcohol, cocaine or marijuana; or just to feel euphoric can lead to substance use disorder and addiction. For example, when snorted, smoked or injected, stimulants cause an increased and rapid high, which has little to do with the improved alertness, energy, attention and productivity they are prescribed for. Stimulant misuse can also have serious medical consequences, such as heart, nerve or stomach complications, and can lead to psychosis, anger and paranoia. Continued misuse and abuse can lead to addiction and long-term side effects.

While taking stimulants will not turn your child into a drug addict, it is not a silver bullet of protection, shielding him from abusing drugs. A Harvard research study has shown, however, that only 25% of those taking prescription medications for their ADHD had a history of substance abuse, compared with 75% of those who were not being medicated. It is likely that those who were untreated for their ADHD were struggling in and out of school, felt powerless, and turned to drugs to self-medicate. On the other hand, because those who were receiving appropriate drugs for their ADHD were more tuned into their bodies and felt successful and good about themselves, they did not abuse their prescriptions or turn to illicit stimulants to help make them feel better.

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