Do ADHD Stimulant Medications Have an Effect on Substance Use?

CONFERENCE REPORTER

The list of reasons a patient can develop substance use disorder is long, said Brooke Molina, MD, opening her talk at the American Professional Society for ADHD and Related Disorders conference in San Diego. Parents may often worry about the impact of attention deficit hyperactive disorder (ADHD) medications on the child’s risk of addiction, but as presenters Molina, Brian D’Onofrio, PhD, and Ryan Sultan, MD, outlined, medication use in childhood does not appear to predict substance use.¹

The call for longitudinal studies on ADHD medication from childhood beyond is ongoing, but Molina noted the field has a “continued desire for something that is not terribly feasible.”¹ Thus, researchers employ other methods along with more sparse clinical longitudinal samples to discuss the long term effects of stimulant use and its relation to substance use disorder. The clinical samples available with longitudinal data mostly include research-based diagnosis in childhood, are well-characterized clinically, are prospectively studied, and often measure substance use. Measuring substance use in these types of studies is important, Molina asserted, because elevated risk begins with use at a young age before substance use disorder develops, and it measures later in life consequences like SUD treatment. According to a 2024 national survey in the US, only 1 in 5 individuals who needed substance use treatment actually received care.²

From the research we do have, Molina pointed out that factors which drive ADHD treatment and substance use disorder may account for associations between the 2 conditions. Severity of symptoms, educational and social functioning, parental psychopathology, family involvement, and access to resources (education, income, social network) can impact both seeking ADHD treatment and risk of substance use disorder. Of some of the more well-known samples, most found a neutral association or protective effect of ADHD treatment in childhood and substance use.^3-5 In total from the samples she highlighted, Molina pointed out only 29% of participants were girls, underscoring the chronic underrepresentation of women in ADHD research.

Molina outlined the latest findings on substance use disorder from the Multimodal Treatment of ADHD (MTA) study, asking what many clinical studies are asking: is stimulant treatment in childhood and adolescence associated with later substance use or substance use disorder? The MTA study included 579 children with DSM-IV ADHD diagnoses aged 7 to 9, incorporating recent diagnostic criteria and a larger sample size. With 6 different sites involved, the sample was more diverse across geographic and cultural settings, allowing a more representative sample as well. Patients were randomized t medication management only, behavioral treatment only, combination treatment, and community referral groups. Looking at substance use in children from the MTA sample at mean age 17, differences between the ADHD groups and the local normative comparison group were statistically significant at multiple age points.^6,7

D’Onofrio continued the conversation about issues with current research, moving into the limitations of randomized controlled trials to evaluate the relation of ADHD medication in childhood to substance use in later life. He began by pointing out that these trials are not large enough to study rare but serious events, are not generalizable enough (especially because they do not represent comorbidity and impairment), and treatment settings are not as generalizable because they are so controlled. Instead, D’Onofrio suggested that large scale observational studies can be quite informative. They increase generalizability, are able to study rarer outcomes, and can be separated to examine subgroups. From some observational studies, the association between stimulant medication use and substance misuse was moderated by age of medication initiation and length of treatment.⁸ In fact, some indicated that stimulant medication was associated with reductions in more serious substance use issues (ie, needing to seek emergency care, death related to substances).⁸

Sultan concluded the session by providing case study examples with a focus on clinical considerations in prescribing stimulant ADHD medications. For an adolescent patient who has a strong family history of addiction, the pertinent clinical concerns may surround risk of medication diversion, risk of addiction, and if the patient would truly benefit from the medication. For a college student with anxiety symptoms who is using cannabis, primary concerns may be around relation of inattention to cannabis use, if stimulants will reinforce cannabis use, and potentially treating their anxiety incorrectly. Sultan noted that if this patient later presented with emerging substance disorder, removing ADHD treatment would increase risk, and integrated treatment would help stabilize SUD recovery.

References

1. Molina B, D’Onofrio B, Sultan R. Do Stimulant Medications Prevent Substance Use by People With ADHD: Untangling the Evidence for Clinical Application. Conference Proceedings of the American Professional Society for ADHD and Related Disorders. January 2026;15-18. San Diego, CA.

2. Kleinschmidt A. Release of the 2024 national survey on drug use and health: leveraging the latest substance use and mental health data to make America healthy again. Substance Abuse and Mental Health Services Administration. July 28, 2025. Accessed January 17, 2026. https://www.samhsa.gov/blog/release-2024-nsduh-leveraging-latest-substance-use-mental-health-data-make-america-healthy-again

3. Groenman AP, Schweren LJS, Weeda W, et al. Stimulant treatment profiles predicting co-occurring substance use disorders in individuals with attention-deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry. 2019;28(9):1213-1222.

4. Harty SC, Pedersen SL, Gnagy EM, et al. ADHD and marijuana-use expectancies in young adulthood. Subst Use Misuse. 2015;50(11):1470-1478.

5. Molina BSG, Howard AL, Swanson JM, et al. Substance use through adolescence into early adulthood after childhood-diagnosed ADHD: findings from the MTA longitudinal study. J Child Psychol Psychiatry. 2018;59(6):692-702.

6. Molina BSG, Hinshaw SP, Arnold LE, et al. Adolescent substance use in the Multimodal Treatment Study of Attention-Deficit Disorder as a function of childhood ADHD, random assignment to childhood treatments, and subsequent medication. JAACAP. 2013;52(3):250-263.

7. Multimodal Treatment of Attention Deficit Hyperactivity Disorder (MTA) Study. National Institute of Mental Health. https://www.nimh.nih.gov/funding/clinical-research/practical/mta/multimodal-treatment-of-attention-deficit-hyperactivity-disorder-mta-study

8. McCabe SE, Figueroa O, McCabe VV, et al. Is age of onset and duration of stimulant therapy for ADHD associated with cocaine, methamphetamine, and prescription stimulant misuse?. J Child Psychol Psychiatry. 2024;65(1):100-111.