What people believe
Stimulant medications like methylphenidate and amphetamine are classified as controlled substances. This leads many people — including some parents and clinicians — to fear that prescribing stimulants for ADHD will create dependency or serve as a gateway to substance abuse. The concern is understandable on its surface: you are giving a person a substance that increases dopamine, and addiction involves the dopamine reward system.
What the evidence says
A landmark study by Chang and colleagues, published in the Journal of Child Psychology and Psychiatry, used Swedish national register data to examine stimulant ADHD medication and substance abuse risk. The conclusion: there was no indication of increased risk of substance abuse among individuals prescribed stimulant ADHD medication. The data instead suggested a long-term protective effect on substance abuse.1 Within-individual analyses showed that periods on stimulant medication were associated with significantly lower rates of concurrent substance abuse compared to periods off medication.
Multiple studies have replicated this finding. A 2024 review by the Child Mind Institute summarised the evidence: several studies found no connection between taking stimulant medication as a child with ADHD and substance abuse later in life. ADHD itself puts individuals at higher risk for substance use disorders — people with childhood ADHD are nearly twice as likely to develop a substance use disorder — but medication treatment reduces rather than increases that risk.2
A 2024 evidence synthesis by the VA Evidence Synthesis Program, covering studies of ADHD and substance use disorders, found no evidence of a difference in substance use disorder outcomes for people with ADHD prescribed stimulant medications compared to those not prescribed them.3 Treatment with stimulant medication prior to age 9 may actually decrease the likelihood of later substance abuse, according to research summarised by Timothy Wilens of Massachusetts General Hospital.4
The mechanism is logical: untreated ADHD involves impulsivity, risk-seeking behaviour, emotional dysregulation, and low frustration tolerance — all of which are risk factors for self-medication with alcohol, cannabis, or other substances. Adequately treating ADHD with stimulant medication reduces these risk factors, thereby reducing the downstream risk of substance abuse.
What to do instead
If you or your child has been prescribed stimulant medication for ADHD, the evidence does not support withholding treatment due to addiction fears. Untreated ADHD carries a higher substance abuse risk than treated ADHD. Clinicians should monitor for medication misuse as standard practice, but the fear of creating addiction should not prevent appropriate pharmacological treatment of a condition that, left untreated, produces its own significant risk.