注意缺陷/多动障碍的兴奋剂治疗会引发日后的药物滥用吗？一项文献的荟萃分析综述。
Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature.
作者信息
Wilens Timothy E, Faraone Stephen V, Biederman Joseph, Gunawardene Samantha
机构信息
Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
出版信息
Pediatrics. 2003 Jan;111(1):179-85. doi: 10.1542/peds.111.1.179.
OBJECTIVE
Concerns exist that stimulant therapy of youths with attention-deficit/hyperactivity disorder (ADHD) may result in an increased risk for subsequent substance use disorders (SUD). We investigated all long-term studies in which pharmacologically treated and untreated youths with ADHD were examined for later SUD outcomes.
METHODS
A search of all available prospective and retrospective studies of children, adolescents, and adults with ADHD that had information relating childhood exposure to stimulant therapy and later SUD outcome in adolescence or adulthood was conducted through PubMed supplemented with data from scientific presentations. Meta-analysis was used to evaluate the relationship between stimulant therapy and subsequent SUD in youths with ADHD in general while addressing specifically differential effects on alcohol use disorders or drug use disorders and the potential effects of covariates.
RESULTS
Six studies--2 with follow-up in adolescence and 4 in young adulthood--were included and comprised 674 medicated subjects and 360 unmedicated subjects who were followed at least 4 years. The pooled estimate of the odds ratio indicated a 1.9-fold reduction in risk for SUD in youths who were treated with stimulants compared with youths who did not receive pharmacotherapy for ADHD (z = 2.1; 95% confidence interval for odds ratio [OR]: 1.1-3.6). We found similar reductions in risk for later drug and alcohol use disorders (z = 1.1). Studies that reported follow-up into adolescence showed a greater protective effect on the development of SUD (OR: 5.8) than studies that followed subjects into adulthood (OR: 1.4). Additional analyses showed that the results could not be accounted for by any single study or by publication bias.
CONCLUSION
Our results suggest that stimulant therapy in childhood is associated with a reduction in the risk for subsequent drug and alcohol use disorders.
目的
有人担心，对患有注意力缺陷多动障碍（ADHD）的青少年进行兴奋剂治疗可能会增加随后发生物质使用障碍（SUD）的风险。我们调查了所有长期研究，这些研究对接受药物治疗和未接受药物治疗的ADHD青少年进行了后续SUD结果检查。
方法
通过PubMed搜索所有关于儿童、青少年和成人ADHD的前瞻性和回顾性研究，这些研究包含儿童期接触兴奋剂治疗的信息以及青少年或成年期的后续SUD结果，并补充了科学报告中的数据。荟萃分析用于评估兴奋剂治疗与一般ADHD青少年随后发生SUD之间的关系，同时特别关注对酒精使用障碍或药物使用障碍的差异影响以及协变量的潜在影响。
结果
纳入了六项研究——两项在青少年期进行随访，四项在青年期进行随访——包括674名接受药物治疗的受试者和360名未接受药物治疗的受试者，随访时间至少为四年。优势比的合并估计表明，与未接受ADHD药物治疗的青少年相比，接受兴奋剂治疗的青少年发生SUD的风险降低了1.9倍（z = 2.1；优势比[OR]的95%置信区间：1.1 - 3.6）。我们发现，随后发生药物和酒精使用障碍的风险也有类似程度的降低（z = 1.1）。报告青少年期随访的研究对SUD发展的保护作用（OR：5.8）大于对成年受试者进行随访的研究（OR：1.4）。进一步分析表明，结果不能由任何单一研究或发表偏倚来解释。
结论
我们的结果表明，儿童期的兴奋剂治疗与降低随后发生药物和酒精使用障碍的风险有关。
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