Wilens Timothy E, Adamson Joel, Monuteaux Michael C, Faraone Stephen V, Schillinger Mary, Westerberg Diana, Biederman Joseph
Pediatric Psychopharmacology Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Arch Pediatr Adolesc Med. 2008 Oct;162(10):916-21. doi: 10.1001/archpedi.162.10.916.
To examine the effects of early stimulant treatment on subsequent risk for cigarette smoking and substance use disorders (SUDs) in adolescents with attention-deficit/hyperactivity disorder (ADHD).
Case-controlled, prospective, 5-year follow-up study.
Massachusetts General Hospital, Boston.
Adolescents with and without ADHD from psychiatric and pediatric sources. Blinded interviewers determined all diagnoses using structured interviews. Intervention Naturalistic treatment exposure with psychostimulants for ADHD.
We modeled time to onset of SUDs and smoking as a function of stimulant treatment.
We ascertained 114 subjects with ADHD (mean age at follow-up, 16.2 years) having complete medication and SUD data; 94 of the subjects were treated with stimulants. There were no differences in SUD risk factors between naturalistically treated and untreated groups other than family history of ADHD. We found no increased risks for cigarette smoking or SUDs associated with stimulant therapy. We found significant protective effects of stimulant treatment on the development of any SUD (hazard ratio [HR], 0.27; 95% confidence interval [CI], 0.13-0.60; chi(2)(113) = 10.57, P = .001) and cigarette smoking (HR, 0.28; 95% CI, 0.14-0.60; chi(2)(111) = 10.05, P = .001) that were maintained when controlling for conduct disorder. We found no effects of time to onset or duration of stimulant therapy on subsequent SUDs or cigarette smoking in subjects with ADHD.
Stimulant therapy does not increase but rather reduces the risk for cigarette smoking and SUDs in adolescents with ADHD.
探讨早期使用兴奋剂治疗对患有注意力缺陷多动障碍（ADHD）的青少年后续吸烟风险及物质使用障碍（SUDs）的影响。
病例对照、前瞻性、5年随访研究。
波士顿麻省总医院。
来自精神科和儿科的患有及未患有ADHD的青少年。采用结构化访谈，由不知情的访谈者确定所有诊断。干预措施：对ADHD采用精神兴奋剂进行自然主义治疗。
我们将SUDs和吸烟开始时间建模为兴奋剂治疗的函数。
我们确定了114名患有ADHD的受试者（随访时平均年龄16.2岁），他们有完整的用药和SUD数据；其中94名受试者接受了兴奋剂治疗。除ADHD家族史外，自然主义治疗组和未治疗组之间的SUD风险因素没有差异。我们发现兴奋剂治疗与吸烟或SUDs风险增加无关。我们发现兴奋剂治疗对任何SUD的发生有显著的保护作用（风险比[HR]，0.27；95%置信区间[CI]，0.13 - 0.60；卡方(2)(113)=10.57，P = 0.001）和吸烟（HR，0.28；95% CI，0.14 - 0.60；卡方(2)(111)=10.05，P = 0.001），在控制品行障碍时这种保护作用依然存在。我们发现兴奋剂治疗的开始时间或持续时间对患有ADHD的受试者后续的SUDs或吸烟没有影响。
兴奋剂治疗不会增加反而会降低患有ADHD的青少年吸烟和患SUDs的风险。
