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Column originally published May 29, 2012

Long-Acting ADHD Medications Are Safe And Effective

Question: Both of our children have been diagnosed with ADHD. We know that they have inherited this condition from both of us. I was always a daydreamer, and I hated school. My husband was a class clown; he didn’t do much better in school than me although he is very smart. Like many in his family, he got into trouble with drugs and alcohol. It took him years to sober up and stay away from drugs. When we met with the doctor, she told us that our children need medicine. Their teachers are telling us that in spite of all the extra support that they have received, our children are getting farther and farther behind in their learning. We are in a real dilemma; we want our children to succeed in school and do better than us when they grow up. However, we are really scared of these ADHD pills. My husband remembers that he had bought some of these pills from his friends when he was in high school, and they gave him highs. We worry that these pills will take our children down the same path of addiction. Please give us your advice.


You are asking a very important question about ADHD medications: are they going to cause addiction in my children, and how big a risk is it? The short answer is no, ADHD medications do not cause addiction. On the contrary, they actually reduce the chance of addiction in those who have ADHD. Let me explain this to you here.

Attention Deficit Hyperactivity Disorder, commonly known as ADHD, is a genetic condition. Although I cannot make a diagnosis just by what you have described about yourself and your husband, there is a good chance that your children inherited the condition from both of you. Many people with ADHD are highly intelligent, but they often don’t perform as well in school because they cannot focus their attention, they are often disorganized, and they procrastinate when they have to do their homework and projects.

Addiction to drugs and alcohol is also very common in those with ADHD. The exact mechanism is still unclear; many who got addicted say that they like the way they feel when they drink or use drugs. Research has shown that those with ADHD who are not being treated, or who are under-treated with medication, are more likely to become addicted to drugs and alcohol.

On the other hand, there have been many stories of people abusing ADHD medications, especially fast-release Ritalin and Dexedrine. Many parents ask me this question when I discuss with them whether their children should receive ADHD medications or not. These medications will not make their children addicted to drugs and alcohol, and advances in the last ten years have also made these medications harder to be abused.

The most effective medicine for the treatment of ADHD is still stimulants. After decades of research and clinical experience, stimulants like Ritalin and Dexedrine are the most effective in treating the core symptoms of ADHD: difficulty paying attention, hyperactivity, and impulsiveness. What is new is that there are new formulations of Ritalin and Dexedrine that are more effective, and they last much longer than the fast-release versions available before. Most of the time, one dose in the morning will be effective all day, until after school and sometimes even into the evening.

On the Ritalin side, we have Concerta, Novo-Methyphenidate ER-C (also known as generic-Concerta), and Biphentin. These are all long-acting Ritalin, but there is some difference in absorption and duration of effect. Concerta is a caplet with 22% of fast-acting Ritalin on the outside, and two little chambers inside with Ritalin in a paste form that is released over 8-10 hours. Its effect is smooth and long; it can work for up to 10 hours. Occasionally, because of its long absorption, it can affect a child’s sleep.

Both Biphentin and generic-Concerta release about 40% of their medicine rapidly after ingestion. The remaining 60% is released over the following 6-8 hours. There is more medicine available in early part of the day. However, effectiveness of the medicine drops off in the afternoon. It may be difficult for the child to do his homework and participate in evening activities.

The other group of stimulant medicine is Dexedrine-based: Adderall XR and Vyvanse. Adderall XR is a combination of three closely related chemicals and formulated so that 40% of the medicine is fast-release, and the remaining is absorbed over 6-8 hours. Vyvanse, on the other hand, is a pro-drug of Dexedrine. Scientists have combined Dexedrine with an amino acid called L-lysine which requires an enzyme in our red blood cells to break them apart. Afterwards, Dexedrine can reach the brain where it works. As a result, Vyvanse works much longer and cannot be abused at all.

Several years ago, a non-stimulant medicine called Strattera was approved for treatment of ADHD. Because it is a non-stimulant, it cannot be abused. As a result, many parents opted for this medicine because it has no risk of addiction. However, clinical experience has shown that it is much less effective in controlling ADHD symptoms. As a result, it is mostly used when stimulant medications are not effective enough to control ADHD symptoms. Adding Strattera to stimulant medications can provide better control for the whole day, with much less side effect. Strattera is now available in generic formulation called atomoxetine.

I understand your worry, but I would suggest that you allow your physician to explore which medicine will help your children so that they can do their best in learning. It is important that they can pay good attention in school, and perform to the best of their ability. The medications will reduce their chance of becoming addicted to drugs and alcohol.