These findings diverge from the only meta-analysis on this topic conducted 10 years ago in which stimulant treatment for ADHD significantly reduced later substance problems.12 Although the original study was based on only 6 studies, it was highly influential as evidenced by its high citation rate and likely affected clinical and scientific attitudes and practice regarding the risk and benefit of treating ADHD with stimulant medication. Crucially, findings from the current meta-analysis, based on a larger sample of studies (including several unpublished studies), suggest no increased or reduced risk of treatment with stimulant medication on later alcohol and substance outcomes and that this pattern was robust to all substance types. In addition to the importance of understanding risk for clinically meaningful outcomes, such as substance abuse or dependence, this study suggests that the likelihood of substance initiation did not differ according to medication status. Given that children with ADHD may have an early substance initiation20,39 and concern that the use of medication may sensitize youth to future substance outcomes, these results find substance use to be unrelated to medication treatment.
