People with ADHD and Addiction: The Fascinating Connection
Nov 03, 2022
In This Article
Attention-deficit/hyperactivity disorder (ADHD) is a common neurological disorder, affecting approximately 8.1% of adults in the United States, and is characterized by difficulties with focus, motivation, impulse control, and hyperactivity (1). It is a neurodiverse condition, meaning that ADHD brains experience differences in function that distinguish them from non-ADHD, or neurotypical, brains. Decades of research have linked ADHD to addictive behaviors, including food addiction, gambling, sex addiction, and substance use disorder (2). So what does that link mean for ADHDers who struggle with substance use?
Studies have found that people diagnosed with ADHD in childhood are two to three times more likely to struggle with substance misuse — sometimes referred to as substance abuse — and addiction in adolescence and adulthood compared to the general population (2). A meta-analysis of multiple longitudinal studies — meaning studies that assessed ADHDers in childhood and then reassessed these same subjects years later — does not show a significant difference in rates of substance misuse across demographics like sex and race (3, 4).
Substance misuse rates are much higher among ADHDers with comorbid diagnoses of clinical depression and anxiety disorders. These psychological disorders are extremely common among people with ADHD. Approximately one-third of ADHDers experience major depressive disorder or dysthymia, and one in five have a co-occurring diagnosis of generalized anxiety disorder, panic disorder, or agoraphobia (5).
Many ADHD symptoms — including struggles with focus, motivation, energy, emotional regulation, and impulsive behavior — relate to reduced function in the brain’s reward system, which is the neurological system that fuels our motivation. This leads those with ADHD to seek intense stimulation and compels behavior that provides a sense of reward. These brains crave dopamine, the neurochemical associated with reward.
So how does this relate to addiction? A tendency toward impulsivity and reduced reward activity can cause ADHDers to engage in dysfunctional patterns of behavior like substance misuse. A 2021 study linked this cycle of neurological response to increased susceptibility to problem drinking, estimating that up to 43% of adults with ADHD may develop alcohol use disorder (AUD) over the course of their lives (6).
Substance misuse among ADHDers is often motivated by a struggle to cope with negative ADHD symptoms rather than a desire to “party” or achieve a high. Adolescents and young adults with undiagnosed or untreated ADHD are at particularly high risk for misuse of substances, including alcohol, cannabis, nicotine, and narcotics (7).
Louise, a recovering drug user, began abusing drugs in college, before her ADHD diagnosis: “I first tried cocaine at a party on campus. My friends were dancing and flirting and having a great time, but I went back to my dorm and did the homework I was behind on.” Soon, she was using cocaine regularly.
“Coke made my brain feel quiet and focused. I was going to parties to score coke and then taking it home to catch up on my classwork alone. I felt so guilty. I knew it was ‘bad,’ but I was more functional and focused than I’d ever been before. I knew it wasn’t sustainable, and it was dangerous and expensive.” Louise began seeing a therapist who recognized her drug use as a coping mechanism — she was self-medicating to manage the symptoms of her undiagnosed ADHD. For Louise, treating her ADHD alleviated her desire to use cocaine.
Stimulant medications carry an inherent risk of misuse. The most common stimulant medications prescribed to treat ADHD are methylphenidate (Ritalin) and amphetamine analogs (Adderall, Vyvanse). When taken in high doses, or crushed and inhaled or injected, these drugs can produce a euphoric high, similar to recreational stimulants.
This high is caused by an intense dopamine release — and this neurochemical reaction can be disastrous. For ADHD brains that crave dopamine, impulsive behaviors and potent rewards can spiral into a cycle of medication misuse. However, when stimulant medication is taken as prescribed, the positive effects on ADHD symptoms lead to a reduction in rates of substance misuse (8).
Prescription stimulants should only be taken according to your prescriber’s instructions. They should never be crushed, inhaled, or injected. If overuse of your medication is a concern, you may consider asking a trusted family member or friend to hold onto your medication and distribute it to you at the appropriate times. You might also use a timed medication safe, which will dispense your medication on a timer, one dose at a time.
Because people with ADHD may struggle to be consistent with taking their medications in general, it may be difficult to tell if you are overusing or abusing your meds. Some things to watch out for include:
- Running out of medication before your refill is due.
- Changes in mood, such as feelings of irritability or anxiety.
- Interruptions to your sleep schedule and eating habits.
Treating a substance use disorder with comorbid ADHD can be difficult, but with the right support, your chances for recovery are very good! It is important to know that addiction treatments that are effective for neurotypical people tend to be effective for people with ADHD too. But since neurological and behavioral differences are often at the root of substance misuse for ADHDers, experts agree that it is crucial to find appropriate treatment for your ADHD so you can stay sober (9).
Finding the right support for substance misuse and addiction can feel overwhelming, and when you add ADHD into the mix, it may feel even more complicated. But don’t despair — help is available!
- Talk to your healthcare providers about what you’re struggling with. Your general practitioner, psychiatrist, or therapist is a great place to start.
- Consider a substance use recovery program, such as SMART (smartrecovery.org) or Alcoholics Anonymous. There are many options for treatment programs out there, so you can find one that feels right for you.
- Online support groups for sobriety and ADHD support. Check out this list of substance use support resources!
Start assessment for alcohol useStart Assessment
Many adults with ADHD — particularly those who have struggled in the past with substance misuse and addiction — choose not to use stimulant medications to manage their symptoms. There are effective options for ADHD management beyond stimulants:
Ask your physician or psychiatrist what options you have for non-stimulant medications. Norepinephrine modulators, such as atomoxetine (Strattera) and viloxazine (Qelbree), alpha antagonists, including clonidine (Catapres) and guanfacine (Intuniv), and antidepressants, such as bupropion (Wellbutrin) are commonly prescribed for ADHD management.
Working with an ADHD coach or ADHD-informed counselor can help you to build skills and create strategies for addressing focus, motivation, and emotional regulation struggles that are common with ADHD.
The impact of ADHD symptoms can be minimized with a healthy lifestyle. Getting adequate and quality sleep, eating consistent and healthy meals, and exercising regularly have been found to have positive effects on executive function, focus, and emotional regulation related to ADHD.
No. While ADHDers are significantly more likely to struggle with substance misuse and addiction, those who receive appropriate treatments are actually statistically less likely to self-medicate with alcohol or drugs (10).
Sometimes! Genetic predispositions to risk-taking and novelty-seeking behaviors can increase a person’s vulnerability to both ADHD and substance misuse (11). However, neither ADHD nor substance use disorders are purely genetic, and they cannot be attributed to personality alone — experiences and exposure to certain environmental factors play a huge role in an individual’s relationship to substance use.
Abusing stimulant medication can be extremely dangerous and may even make your ADHD symptoms more difficult to manage. If you are abusing your ADHD meds, you should talk to your doctor right away about substance misuse counseling and safer treatment options, such as non-stimulant medications.
In some cases, yes. Many ADHDers with a history of substance misuse and addiction are able to use stimulants safely as a part of their treatment plan. As we mentioned before, studies have shown that ADHDers receiving stimulant medication treatments misuse alcohol and drugs at a significantly lower rate than those whose ADHD is untreated (12). Your doctor may take a pharmacological approach that minimizes the risk of medication misuse, such as prescribing extended-release stimulants, which are more difficult to misuse, or prescribing medication on a weekly or biweekly basis.
It is important to have an open and honest dialogue with your doctor when you are discussing ADHD and addiction. Make sure your doctor has your complete medical history, including your relationship to substances and addictive behavior as well as your experiences with ADHD and past treatments. You may ask your doctor for a referral to a substance misuse counselor or a neuropsychologist.
Some ADHDers who misused their medications in the past are able to stop and go back to taking their medications as prescribed. You may need extra support from loved ones, a counselor or therapist, or a support group. You may need a plan for coping with addictive urges or support to build skills that will alleviate your desire to misuse the medication. However, if you are abusing your medication, the best course of action is to discuss your options with your prescriber.
Addiction and substance misuse are incredibly common challenges for people with ADHD. If you are struggling with ADHD and addiction, know that you are not alone. While treating ADHD and comorbid addiction can be complex, there are many options for treatment, including medication, coaching, and lifestyle changes. With your doctor’s help, you can build a treatment plan that is effective and safe so you can be your healthiest self!
About The Author
Callie Williams is a writer, student, chef, and musician-artist living in California with her six-year-old daughter and their guinea pigs, Penelope and Pineapple. You can see more of her work at calliewilliams.com.