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Adhd and Substance Abuse

ADHD and Substance Abuse The Evidence Of Substance Abuse With ADHD The purpose of this paper is to identify the link between ADHD and substance abuse. Substance abuse is a true threat to people who are diagnosed with psychological disorders. Among the questions of precursors to substance abuse, lies the hypothesis that individuals diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) may become addicted to drugs or alcohol. Multiple studies have been done to either prove or disprove this hypothesis. This paper will discuss the results of those studies and demonstrate whether this hypothesis stands true or false.

ADHD is a disorder characterized as a chronic neurobehavioral problem. The exact etiology is unknown, however, it is believed that inherited genetic factors, environmental factors, lead exposure, dysfunctioning dopaminergic or noradrenergic neurotransmitters can be possible causes. Symptoms of ADHD are inattention and impulsitivity-hyperactivity. Children diagnosed with ADHD are at risk for academic, behavioral, and social functioning difficulties. These risk factors usually manifest themselves in both childhood and adolescent years. Treatments are available, but nonetheless, have been controversial since their evolution.

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ADHD first came to light in 1845 in a children’s book called The Story Of FidgetyPhillip, written by Dr. Heinrich Hoffman (Sircy & Stojanoski, 2008). A British physician, Dr. George Still described the disorder as a medical problem, and not a disciplinary problem. He published multiple articles and lectured his belief to many of students. Eventually, in 1937, Dr. Charles Bradley began prescribing stimulants to treat this disorder in children. It wasn’t until 1987, that the disorder earned its recognition by the American Psychiatric Associations (APA).

Since the late 1980’s, when ADHD was observed by the APA, there haven’t been many studies on the possible link to substance abuse until the early 1990’s. These studies such as Mannuzza et al. , and Bierderman et al. , have attempted to prove their theories that either stimulant therapy does or does not lead to substance abuse. The results are both compelling and unbelievable at the same time. Stimulant therapy is the first choice next to behavioral therapy in children with ADHD. It is pertinent to understand how stimulants work on a child in order to interpret the results of the study.

The medications used to treat ADHD work in a paradoxical effect. Medications such as Adderall and Ritalin work differently in children then in adults. With children, these medications interrupt the reuptake mechanisms of dopaminergic neurons. The effects are decrease in motor restlessness, enhanced attention span and mood. In adults, there are still like side effects, however, adults become sleepless and have an increase in euphoric moods. There is also an increase in mental alertness. The interpretation of these symptoms will shed light onto the correlation of stimulant therapy and substance abuse.

The study performed by Bierderman et al. , compares subgroups of children with ADHD who received treatment with stimulants in childhood or adolescents with children who did not receive treatment (James, Swanson & Volkow 2008). The study revealed that treatment with stimulants did not reduce the risk of substance abuse. It did, however, show that stimulant treatment delayed the potential use of substances. Rather than using substances early in life, subjects eventually abused drugs or alcohol in the later years of life. In the study conducted by Mannuzza et al. the age that treatment was initiated was correlated with the age of substance abuse. This study was small and involved subgroups of children. These two groups where either given or not given stimulant medications. The groups were formed by age groups of two to six years and eight to twelve years. The results of the study demonstrated that children who started stimulant treatment early, had the least chance of abusing drugs or alcohol ion adult years. On the other end, children who started stimulant therapy later, in the eight to twelve year range, became more likely to abuse drugs, especially cocaine.

Another aspect of the study described that in some of the children who abused drugs, their substance abuse behavior was mediated by antisocial personality disorder. This finding alone demonstrates a negative side effect of stimulant therapy in the treatment of ADHD. There is a study that tested the effects of stimulant therapy in both girls and boys. This study was significant since boys are six to nine times more likely to be diagnosed with ADHD then girls. The study was a population-based cohort study of 5,718 children. The groups were identified as treated ADHD group and untreated ADHD group.

Children in the treated group were given stimulants and/or a combination of tricyclic antidepressants. Upon completion of the study, approximately eighteen and a third years, the results were finalized. Untreated subjects showed a higher substance abuse rate of approximately seven to eight percent. The more interesting aspect is that gender specifically. Girls showed no significant difference between both groups. On the other hand, boys who received stimulant therapy, showed a difference of fifty four percent abuse rate to the one hundred percent abuse rate of those who were untreated.

This study proved that there is a protective effect to initiating stimulant therapy to children with ADHD, especially boys. Some psychiatrists believe that ADHD alone cannot be compared with substance abuse. It is the belief that a comorbid diagnosis of Conduct Disorder (CD) leads to the evident substance abuse. Several studies have been performed on the relationship between CD/ADHD and substance abuse. Some studies debunk the idea that the two are related, and others prove a direct correlation between both disorders.

A study done in a large community of adolescent twins found that substance abuse in ADHD was entirely accounted for by a comorbid diagnosis of CD. Another study demonstrated that once the correlation of ADHD and CD was made, the relationship between ADHD and substance abuse alone was almost non-existent. The only downfall of the second study is that it had no group with only CD to test their findings that CD alone contributes to the use of drugs or alcohol. Members of the Department of Psychology of the University of Kentucky conducted a study of symptoms of hyperactivity-impulsivity-inattention (HIA) and conduct problems (CP).

The symptoms are that of ADHD and CD, however are renamed to be sure no to misrepresent the study or its findings. The study took a form of surveys through a ten to twelve year span, and eventually led to laboratory studies at the end of the study. Upon completion, the data was analyzed and interpreted to numbers. Initially, it seemed that HIA made a significant contribution towards tobacco and hard drug use. When CP was analyzed in the first step of analysis, it demonstrated a higher frequency of substance use in general and more frequent dependence symptoms.

As further evaluation took place, CP continued to make a significant contribution to all substance abuse and dependence symptoms. As the final correlations were analyzed, the results were evident. First, the study demonstrated that young adults with HIA symptoms alone had a dependence more on tobacco(Schachar 2009). Secondly, young adults with CP symptoms alone showed a relative dependence on both hard drugs and tobacco, however the frequency of dependence was not as often. Finally, subjects with both HIA and CP symptoms revealed the highest dependence behaviors in both hard drugs and tobacco.

Attention Deficit Hyperactivity Disorder is a real disease. It affects more boys than girls. It can be treated either by behavior modification or pharmacotherapy. The implications of this disorder is that children will grow up to become dependent on tobacco and/or hard drugs. The reason of this implication is the use of stimulant therapy. The belief is that stimulants that contain amphetamines have the potential for dependency in later years. However, multiple studies have proven that early initiation of stimulant therapy reduces the risks of substance abuse in later adult years.

References                                                                        Sircy, R. & Stojanoski, A. (2008). ADHD treatment and the risk of substance abuse. The American Journal of The Nurse Practitioner, 33(4), 33-66. Volkow, N. D. , & Swanson, J. M. (2008). Does childhood treatment of ADHD with? stimulant medication affect substance abuse in adulthood? American Journal of? Psychiatry, 165, 553-555.? Schachar, R. (2009). ADHD in children, adolescents, and adults. Childhood Neurologic? Disorders in Adulthood, 15(6),  pages 78-97. doi: 10. 1212/01. CON. 0000348879. 09070. 21


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