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Does Combined Stimulant and Psychosocial Treatment in Childhood Attention-Deficit/Hyperactivity Disorder Protect Against Future Substance Use?

Year: 2025

Type: article

Abstract: Objective Attention-deficit/hyperactivity disorder (ADHD) is a risk factor for future substance use. Stimulant medication has largely failed to demonstrate protection against future substance use but no studies have assessed whether combined stimulant and psychosocial treatment reduces future substance use compared to stimulants alone. Method This retrospective study used data from the Rochester Epidemiology Project, a medical records repository in Olmsted County, MN, to identify 1,541 children age ≤7 who were prescribed a stimulant for ADHD between 2003-2019. Forty percent (n=628) also received psychosocial treatment. Data on substance use after age 10 were gathered from the medical record until 2023, comprising up to 17 years of follow-up. Logistic regression compared substance use outcomes between the two treatment groups and multivariable models identified childhood factors associated with future substance use. Results Among 1,541 children with ADHD (median age 6.0 years [5.0, 7.0], 1,111 [72%] male, 1,225 [79%] white), 515 (33%) had documented substance use after age 10. Children who were older at initial treatment, had public insurance, history of trauma, or family history of substance use disorder diagnoses were more likely to use substances. While children who received combined treatment were less likely than those who received stimulants alone to use tobacco/nicotine (21% vs. 25%, aOR=0.86, p=0.033), there was no significant difference in excessive alcohol use (aOR=0.95, p=0.49), any cannabis (aOR=0.88, p=0.07), or other drug use (aOR=0.82, p=0.14). Conclusion One-third of children with ADHD went on to use substances. Combined stimulant and psychosocial intervention at baseline was associated with lower risk of tobacco/nicotine use but there was no difference in other substance use.

Source: JAACAP Open

DOI: 10.1016/j.jaacop.2025.05.004