by John Koutas, MD
The beneficial short-term effects of ADHD medication on symptoms of ADHD and associated problems have been demonstrated in numerous studies. Although ADHD symptoms often persist from childhood into adulthood, discontinuation of ADHD medication is common, especially in adolescence and early adulthood. In the present study, the authors used Swedish population-based data to investigate the association between the use of ADHD medication and criminality.
A total of 25, 656 patients were identified with a diagnosis of ADHD. Using the Prescribed Drug Register, data was collected to establish treatment periods of ADHD medications, both stimulants and atomoxetine, with no more than 6 months between two consecutive prescriptions. The main outcome was any conviction for a crime comparing times the same individual was and was not taking medications.
The results showed that, among men, the crime rate was reduced by 32% during treatment periods. A similar association was observed among women, with a reduction in the crime rate of 41%. The authors concluded that there appears to be an inverse association between pharmacological treatment for ADHD and the risk of criminality.
In contrast to randomized, controlled trials, pharmacoepidemiologic studies such as the present study face the potential confound between the effect of a medication and the indications for the drug. In other words, patients who are receiving treatment are different from those who are not receiving treatment, usually because they are more symptomatic and have coexisting disorders. Poorer outcomes among individuals not currently using pharmacotherapy could be related to factors that can accompany indivuals who are currently “out of treatment” such as lack of contact with mental health professionals or supportive parents or partners. The authors creatively addressed these potential issues by analyzing criminality rates among patients who had discontinued SSRIs instead of ADHD medications. The authors found no association between criminality rates and SSRIs discontinuation. The authors only briefly mention the possible effect of comorbid substance abuse on the findings. Effective ADHD pharmacologic treatment has been associated with decreased substance abuse, and, of course, substance abuse is associated with criminality (including, even possession), so substance abuse may be an unaccounted for moderator in these results as well. The impact of stimulants in decreasing criminality in patients with ADHD may be due to their effect in decreasing impulsivity. If stimulants do, in fact, decrease criminality in patients with ADHD, then stimulants are a relatively low financial cost to society compared with the consequences of increased criminal behavior.
Lichtenstein P, Halldner L, et al. Medication for Attention-Deficit Hyperactivity Disorder and Criminality. NEJM 2012: 367 Nov 22: 2006-2014.