Category Archives: Adult ADHD

Does medication for ADHD lead to drug abuse? An ADHD specialist child psychiatrist speaks out.

  • “Is there an association between ADHD and drug abuse?”  Yes.  But the association is with the ADHD itself — NOT the medications we use to treat it.  Untreated ADHD clearly leads to higher rates of substance use.   Kids with ADHD are also more likely to also have conduct problems such as lying, stealing, and skipping school, and all these are are known to contribute to substance abuse.

    But not one study has ever shown that treatment with stimulant medication leads to substance abuse.In fact, research shows the opposite. In large, prospective studies conducted at SUNY Upstate Medical University, adolescents with ADHD who were NOT treated with stimulant medications had a 2 fold increased risk of developing a substance abuse disorder compared to adolescents treated with stimulants.

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    Another recent study published in the New England Journal of Medicine showed that people with severe ADHD symptoms were less likely to commit crimes when they were taking medications. People with ADHD in this study who took their medication had lower rates of criminal activity and were more likely to stay out of prison.

    Cutting the crime rate . . keeping adults out of jail. Now that’s effective pharmacotherapy! And for all my patients who just need some help studying for exams or organizing their lives — it’s not quite as dramatic, but it’s often life-changing.

    Let’s make sure the media conveys this important information — that ADHD treatment reduces substance use and crime.  And let’s put to rest the wrongful idea that ADHD medication causes drug abuse.

    It’s just not so.

© Copyright Roey Pasternak, MD 2014

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Filed under Adult ADHD, pharmacotherapy

NYC Child Psychiatrist Speaks Out on the “Myth of ADHD”

A response to Time Magazine Article, “ADHD Does Not Exist” by Richard Saul, MD

These days there’s always someone proclaiming against the diagnosis of ADHD.  For instance Dr Richard Saul, a neurologist writing recently in a Time Magazine article with the rather authoritative sounding title, “ADHD Does Not Exist.”  

My response?  Not so fast . . .

Yes, as Dr Saul points out, there are many disorders that can look like ADHD.  So does this mean that ADHD doesn’t exist? Absolutely not.  Let’s not paint with so wide a brush.  The real world is more subtle than that.

As an NYC child, adolescent, and adult psychiatrist, it’s particularly jarring to hear that ADHD doesn’t exist, since so many of the patients I see every day are dramatically helped by having their ADHD recognized and treated.

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For instance, Rebecca (not her real name) struggled every day in school from not being able to concentrate.  A decade of psychotherapy did nothing for this.  Finally when she became the mother of two young children, she was overwhelmed with the stress caused by forgetting and losing things she and her children needed.  

At her first visit with me, we discussed her current symptoms, and I also asked her in detail about other common symptoms of ADHD.  We reviewed her childhood experiences including her school history, and I took a thorough medical history as well.   I spoke with her primary care physician to make sure her laboratory studies were up to date and that there were no current medical problems. And after all this was done and I was convinced she had ADHD, we sat together and discussed treatment options.

Just knowing that there was an explanation for why she had such a hard time getting organized (you mean I’m not just lazy?) helped her immensely.  She chose to try a stimulant medication (they’re the most effective for most ADHD patients), and it took a few tries before we found the right one (Vyvanse) for her.

Her daily life has markedly improved.  So has her marriage.

I’d hate to have to tell her that her ADHD isn’t real.  And I don’t think she’d believe me.

I agree with Dr Saul that many doctors just throw stimulant medications at patients, without carefully checking to see whether it’s ADHD or something else (such as a sleep disorder or anxiety, or trauma).  But to me this just means that a patient should be careful to seek out a trained psychiatrist who is able to spend enough time finding out.  

I advocate for everyone to have a thorough evaluation with a psychiatrist — even better, a child psychiatrist, who is likely to be the most highly trained in diagnosing and treating ADHD.  These are the docs who through a proper evaluation can  tease apart what’s truly ADHD,  and what might be something else.

© Copyright Roey Pasternak, MD 2014


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