The Truth About Stimulant Medications for ADHD

With a Ph.D. in Pharmacology, I have spent 20 years in academia studying drug abuse behavior. So, when my son’s second-grade teacher suggested he was exhibiting symptoms of ADHD, I was not in a rush to jump right into a diagnosis and medicate him.

In 2010, the Centers for Disease Control and Prevention reported two-thirds of children are medicated for the treatment of ADHD. The primary medications used to treat the symptoms of ADHD are from a group of drugs known as stimulants. More than half of children with ADHD are treated with stimulants.

How Stimulant Medications Work

In 1937 American psychiatrist Charles Bradley made the unexpected discovery that an amphetamine reduced ADHD-like behaviors in children. Amphetamines are stimulant medications thought to alleviate the negative symptoms of ADHD primarily through regulating the brain neurochemicals, norepinephrine, and dopamine, which are decreased in certain brain regions in those with ADHD.

It is well known that abused stimulants, like cocaine and methamphetamine, increase dopamine in an area of the brain called the nucleus accumbens, which is responsible for the euphoric effects (the “high”) of these drugs. So, it is not surprising that there is concern surrounding the use of stimulant medications to treat ADHD in children.

However, preclinical research on ADHD stimulant medications found that at clinically relevant doses, the effect on the nucleus accumbens was minimal. Instead, the primary mechanism of action was the release of dopamine and norepinephrine in the prefrontal cortex, the brain region implicated in ADHD.

The prefrontal cortex is responsible for executive functioning, a neurological process important for planning, initiating tasks, time management, organization, and emotional control. Consistent with the preclinical studies, imaging studies in ADHD subjects show that the stimulant medication methylphenidate (Ritalin) increases functioning in the prefrontal cortex.

Alleviate ADHD Symptoms Without Euphoric Effects

Unfortunately, many individuals with ADHD do struggle with drug abuse. However, research suggests substance abuse disorder in ADHD individuals is likely related to their ADHD (risk-taking and impulsive behaviors) and not their treatment with stimulant medications.

Research may even indicate a protective effect of ADHD medications on substance abuse. There is at least a 30 percent decrease in illicit drug use in the ADHD population who take medication for their ADHD symptoms compared to those without an ADHD diagnosis. In addition, ADHD medications have been shown to decrease nicotine use, injuries, and suicides in the ADHD population.

The decreased levels of dopamine and norepinephrine likely involved in ADHD may contribute to the lack of euphoric effects of stimulant medications. Instead of increasing dopamine and norepinephrine enough to produce a euphoric effect, stimulant medications increase these neurochemicals to normal levels.

Adults with ADHD reported the “reinforcing” effects of methylphenidate were due to improvements in cognitive functioning (increased focus and concentration), whereas non-ADHD adults reported effects related to euphoria (liked the drug, it made them feel good); these effects in the non-ADHD population can lead to misuse.

College students’ nonmedical use of prescription stimulants is second only to marijuana use. College students typically use prescription stimulants to improve focus and concentration or to get “high.”

I admit I was concerned my son would have “friends” in school because he was on ADHD medication. Unfortunately, studies have shown students taking prescription medications for ADHD treatment are solicited by peers to give, sell, or trade their medications, even as early as elementary school.

Will your ADHD son/daughter become a drug abuser?

Not from taking stimulant medications for the treatment of their ADHD. For my son, treatment with stimulant medication led to an improved focus at school, improved handwriting, and less disappearing to the bathroom during school time to avoid doing classwork.

Although stimulant treatment can improve attention and focus, it will not affect the ability to learn or to apply learned concepts in a child with ADHD. My son has even said to me that taking his medication will not make him an “A” student and that he still needs to put in the effort to get good grades in school.