What Is the Relationship Between ADHD and Substance Abuse?

The relationship between attention deficit hyperactivity disorder (ADHD) and substance abuse is a complicated one. People who struggle with both issues face a more complex path to recovery.

ADHD

Attention deficit hyperactivity disorder is a condition that makes it difficult for an individual to continually pay attention or control impulses. A person having ADHD may constantly be active and struggle with feelings of restlessness. They may find it difficult to control their energy levels and physical movement. 

ADHD is very prevalent in the U.S., with approximately 8.4 percent of children exhibiting signs of the disorder, and around 2.5 percent of adults exhibiting signs. Because symptoms of the condition are so varied, and because many adults may have the disorder but are never diagnosed, these estimates may be lower than the actual numbers. 

The co-existence of ADHD and substance use disorders in adults is also prevalent. 

Individuals with ADHD are more likely to struggle with a substance use disorder. According to a 2017 article in Psychiatric Times, “The presence of comorbid disorders is often the rule rather than the exception in individuals with ADHD.”

Presentations of ADHD

ADHD is considered a neurobehavioral disorder. The core characteristics include hyperactivity, distractibility, impulsive behavior, and inability to pay attention. 

Medical professionals usually categorize the “presentation” of ADHD into three categories. No matter which presentation is assigned to an individual, the diagnosis is the same: attention deficit hyperactivity disorder. The presentation will help the practitioner decide on the best treatment approach. 

The presentations of ADHD are:

1. Inattentive

• Unable to pay close attention
• Makes mistakes because of not being able to pay attention
• Easily distracted
• Time management problems
• Difficulties completing tasks
• Continually losing items and forgetting to fulfill obligations
• Unable to listen to or follow directions

1. Predominantly hyperactive-impulsive

• Unable to remain still or seated
• Excessive talking and fidgeting
• Appears impatient
• Tendency to disrupt conversations, games, and activities
• Creates excessive noise 

1. Combined

• Displays tendencies from both inattentive and predominantly hyperactive-impulsive presentations

ADHD Treatment 

ADHD is considered the most common childhood mental health disorder. It is estimated to affect between five and 11 percent of children.

While thought of as a disorder that affects primarily children, ADHD and its symptoms —which can make day-to-day life and personal obligations and goals harder to manage — often continue into the teen years and adulthood. 

Children, teenagers, and adults who struggle with ADHD may not receive the treatment they need. Individuals may receive medication but not learn necessary coping and life skills. Some may be misdiagnosed with other mental health conditions or receive no appropriate treatment at all. 

Those who have ADHD may feel frustrated by their inability to live in a more organized and focused manner. Some may develop other conditions, including depression and substance use disorders (SUDs), as a result. This is just one of many links between ADHD and substance abuse.

Effects of These Co-Occurring Disorders 

The relationship between ADHD and substance abuse is evident in studies relating to ADHD and children, teenagers, and young adults. More research has been done about the disorder in these age groups. They reveal an increased likelihood of substance abuse among sufferers of attention deficit hyperactivity disorder. 

According to a study published in 2014 by the American Academy of Pediatrics, compared to those without ADHD, children with ADHD were:

• Twice as likely to have a long history of nicotine use.
• Nearly two times more likely to meet diagnostic criteria for alcohol abuse and dependency.
• About 1.5 times more likely to abuse marijuana.
• Almost twice as likely to abuse cocaine or develop a cocaine dependency.
• More than 2.5 times as likely to develop a substance use disorder.

The study found that ADHD was associated with individuals developing a substance use disorder at an early age and a higher likelihood of using a variety of substances. 

The research also found that the diagnosis of ADHD as a child was associated with an increased risk of the individual developing a substance use disorder in their 20s and 30s. 

Reasons Behind the Connection

Although research clearly demonstrates a link between ADHD and substance abuse, the exact reason for this connection is still not fully understood, and research on this is ongoing. There are several factors that are usually cited for the connection between ADHD and substance abuse. 

• Disinhibition: Both ADHD and substance abuse are characterized by disinhibition — defined as “a lack of restraint manifested in disregard of social conventions, impulsivity, and poor risk assessment.” Because both conditions share this characteristic, an individual who struggles with one may also be more likely to develop the other.

• Impulsivity: Another factor is the impulsive behavior that is a common trait of people with ADHD , which may make them more likely to try drugs and substances.
  
  Other characteristics of ADHD, like feeling chronically bored, may act in concert with this impulsivity to increase the likelihood to develop a substance abuse problem. For example, an individual with ADHD may feel understimulated. In a moment of impulsivity, they may take a stimulant. 

• Dopamine: One theory on the connection between ADHD and substance abuse relates to the brain chemical dopamine, which plays an important role in the pleasure and reward sensations as well as in cognitive functions. Some research has shown that individuals with ADHD metabolize dopamine differently than those who do not have ADHD, and as a result, they have lower dopamine levels.
  
  Because many drugs increase dopamine levels, some think it is a possibility that individuals who are suffering from both ADHD and substance abuse are actually self-medicating to self-correct their dopamine levels.

• Medications: There’s also a connection between the medications prescribed to teenagers and young adults diagnosed with ADHD and substance abuse. Medications commonly prescribed for ADHD include habit-forming stimulants like Adderall and Ritalin. These drugs are often highly sought after by these age groups, known for their speed-like effects. They are often bought and sold as a recreational or “study” drug.
  
  According to the previously referenced American Academy of Pediatrics study, 23 percent of children and teenagers who were prescribed ADHD medication were asked to sell or trade their medication. This indicates a likelihood that those with ADHD are introduced to drug culture at a younger age.

• Life problems: Difficulties that result from ADHD symptoms, like trouble at school or work and low self-esteem as a result of not being able to control the condition, can contribute to an individual turning to drugs or substance abuse in an attempt to escape the overwhelming problems caused by their disorder.

Treatment for ADHD and Substance Abuse

In order to effectively treat ADHD and substance abuse problems, most medical professionals first try to distinguish between underlying ADHD symptoms and ADHD-like symptoms caused by substance abuse.

This can be difficult, as long-term use of some substances can result in side effects that mimic those of the disorder. Excessive and long-term marijuana use, for example, can result in problems like motivation troubles, organizational difficulties, and inability to pay attention. 

Medications may be used by professionals treating a dual diagnosis of ADHD and substance abuse. Since many of the medications commonly prescribed for ADHD are stimulants that are habit-forming and prone to abuse, medication management is crucial. 

Psychotherapy is always recommended in the treatment of ADHD and substance abuse. 

Through ongoing therapy, a professional will help an individual identify underlying emotional problems that may be related to their ADHD and contributed to their substance abuse problem. They will address issues that were the result of unresolved frustrations and problems related to their lifelong struggle with ADHD. 

A comprehensive therapy program will also help an individual struggling with both ADHD and substance abuse problems to develop necessary life skills. These coping skills will help them succeed not only in addiction recovery but also in life after treatment.

Conclusion

ADHD is a prevalent mental health disorder that can make it difficult for an individual to organize and manage their life effectively. Individuals who live with ADHD are more likely to develop substance abuse problems.

There are multiple theories on why this connection exists, and research continues on the subject. One thing the medical community is clear on is that recovery requires integrated treatment of these disorders. Treatment must include therapy to address underlying mental health issues as well as coping skills for dealing with day-to-day life.

SOURCES

(August 2017) ADHD and Substance Use: Current Evidence and Treatment Considerations. Chardee A. Galan, MS and Kathryn L. Humphreys Ph.D. Psychiatric Times. Retrieved February 2019 from https://www.psychiatrictimes.com/special-reports/adhd-and-substance-use-current-evidence-and-treatment-considerations

(November 2018) What to Know About ADHD. Rachel Nall. Medical News Today. Retrieved February 2019 from https://www.medicalnewstoday.com/articles/323667.php

(July 2014) Attention-Deficit/Hyperactivity Disorder and Substance Abuse. Elizabeth Harstad and Sharon Levy. American Academy of Pediatrics. Retrieved February 2019 from http://pediatrics.aappublications.org/content/134/1/e293

(May 2009) Treatment Strategies for Co-Occurring ADHD and Substance Use Disorders. John J. Mariani, M.D. PubMed Central. Retrieved February 2019 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676785/

(July 2014) ADHD and Substance Abuse. Joel L. Young M.D. Psychology Today. Retrieved February 2019 from https://www.psychologytoday.com/us/blog/when-your-adult-child-breaks-your-heart/201407/adhd-and-substance-abuse