ADHD and the path to substance use disorders

People with attention-deficit hyperactivity disorder (ADHD) are up to 2.5 times more likely to also live with a co-occurring substance use disorder (SUD). In addition, one in four people who seek treatment for substance use-related problems also show symptoms of ADHD.

Researchers have found significant links between the two conditions, and many unique factors that come with living with ADHD can increase your risk of using substances to cope.

Unfortunately, living with SUD on top of ADHD can make treatment more complex. Using substances may bring some temporary relief, but it typically only makes things worse in the long run. By getting a diagnosis and treatment for both substance use disorder and ADHD, you can overcome the vicious cycle of these co-occurring conditions.

Why are people with ADHD more likely to use drugs and alcohol in unhealthy ways?

People with ADHD are more likely to live with substance use disorder, with up to 50% of people with ADHD experiencing substance use issues.

The reasons for this are still being studied, but it’s clear that there’s a link. In most cases, ADHD develops first. ADHD is a neurodevelopmental condition, which means that its symptoms first appear during childhood. SUD symptoms may not appear until later, in adolescence or adulthood.

This doesn’t mean that ADHD is a direct cause of substance use disorder. The causes of SUD are complex and include a genetic predisposition, as well as exposure to environmental traumas and stressors.

Some factors that could explain the link between ADHD and substance use include:

Self-medication

People with undiagnosed ADHD may turn to drugs and alcohol as a way to self-medicate their symptoms. For example, they may rely on illicit stimulant drugs to find temporary relief from ADHD symptoms. Or they may use substances to cope with the frustration and overwhelm that living with ADHD, especially undiagnosed ADHD, can often bring. This is called the “self-medication hypothesis” of substance use.

Co-occurring conditions

People with ADHD are also more likely to live with other mental health conditions, like depression, which could make the risk for substance use disorder even higher. For example, people with co-occurring ADHD and conduct disorder are four times more likely to also have SUD. 

Self-medication could come into play as well. Depression can be very painful to live with, and people with ADHD and co-occurring depression may use substances as a way to escape the pain.

Impulsivity

People with ADHD — particularly the hyperactive-impulsive or combined types — often experience heightened levels of impulsivity. This typically happens because of the way ADHD affects the brain. In particular, ADHD affects the prefrontal cortex, which is responsible for more complex tasks like problem solving and self-control.

Because ADHD can cause people to have more difficulty controlling their impulses, it may be harder for them to say no to alcohol or recreational drugs — especially as adolescents.

Neurobiological factors

Research suggests that there may be some neurobiological commonalities between ADHD and substance use disorder. In other words, both conditions may affect the same areas and circuits in the brain. 

In addition, ADHD can affect dopamine levels, which could make people with ADHD more likely to seek out drugs and alcohol as a way to increase dopamine. This could at least partly explain why these two conditions appear so frequently together.

Third variable factors

There may also be third variable factors that increase the risk for both SUD and ADHD. For example, early life trauma can increase your risk of developing both conditions later in life. There may also be some shared genetic traits between these two conditions. Scientists are still learning, but it’s possible that the same things that cause one condition can also cause the other.

How does substance use disorder affect ADHD symptoms?

Unfortunately, people with these two conditions can get locked in a vicious cycle. Research has found that, in the long term, heavily using substances can worsen ADHD symptoms like impulsivity and inattention. For example, one review determined that cannabis use can worsen ADHD symptoms for some people. 

This could be for many different reasons, including:

• Executive dysfunction: Certain substances, including alcohol, have been shown to worsen executive functioning — a set of complex cognitive skills like reasoning and decision making. People with ADHD already face challenges in executive functioning because of the way the condition affects their brains. So, when the effects of alcohol and ADHD are combined, problems with executive functioning may become more severe.
• Impulsivity: Substances can make you more impulsive, which people with ADHD already face challenges with. Worse impulse control could mean riskier behaviors, which could be dangerous in some situations.
• Emotional dysregulation: People with ADHD often have trouble with emotional regulation, which is the ability to manage your own emotions. Emotions can become overwhelming, which could lead to outbursts of anger or frustration. Using substances also affects your self-regulation skills and makes you more likely to have emotional outbursts.
• Sleep: Many substances lead to sleep disturbances. For example, you may be unable to sleep or find yourself waking up in the middle of the night. Sleep and ADHD are closely linked, and not getting enough restful sleep can make ADHD symptoms much worse.

In addition to the way substance use affects ADHD symptoms directly, it can also worsen symptoms of co-occurring mental health conditions, like depression and anxiety. People with substance use disorder are much more likely to experience psychosis or live with depression, bipolar disorder, PTSD, and other conditions. These are all mental health conditions likely to appear together with ADHD, so this could complicate treatment even further.

Comprehensive treatment for ADHD and substance use disorder

Researchers have found that having ADHD can lead to more severe and long-lasting substance use challenges. This means that getting the right treatment is even more important if you live with both conditions. It’s possible to manage both substance use disorder and ADHD, but when one or the other is left untreated, your symptoms may worsen in a vicious cycle. That’s why it’s essential to address both.

Treatment for co-occurring ADHD and SUD may include:

Therapy

A qualified therapist can help you untangle the ways ADHD and substance use have come together to affect your life. They can provide a safe and nonjudgmental space to explore how ADHD may have led you to self-medicate with substances. A therapist can also teach you new skills to cope with the more uncomfortable symptoms of ADHD and fight drug or alcohol cravings.

One randomized controlled trial found that cognitive behavioral therapy (CBT) sessions addressing both substance use and ADHD were effective in reducing symptoms of both conditions. This specific CBT intervention consisted of motivational counseling sessions, relapse prevention sessions, and skills training sessions to help people manage the symptoms of both ADHD and SUD. 

Medication

Medication is also often used to treat ADHD, but some research suggests that it’s only mildly helpful for co-occurring substance use disorder. Some treatment providers may not prescribe certain types of medications with the potential for abuse if you live with active substance use issues. However, according to most research, untreated ADHD is more likely to be a risk factor for SUD than ADHD medication. 

Be honest with your provider about your history of substance use. They can weigh the risks and benefits to make the treatment decision that’s best for your unique situation.

Find care with Rula

Living with ADHD can be challenging, and many people find themselves in the trap of using drugs and alcohol to self-medicate. But these substances aren’t true treatment for ADHD and can make your symptoms worse in the long run.

Professional mental health treatment can help you equip yourself with new tools to cope with ADHD symptoms in healthier ways without relying on drugs and alcohol. At Rula, we have therapists with over 80 different clinical specialties, including ADHD and substance use disorder. Get matched with an experienced therapist today.

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