Co-Occurring Disorders: ADHD and Addiction

Many people who develop substance use disorders (SUDs) also have co-occurring mental health conditions.¹Depression and various anxiety disorders, as well as attention deficit and hyperactivity disorder (ADHD), are among the most common co-occurring mental health conditions that are seen in combination with substance use disorders.¹ Studies have shown that for adults with SUDs, more than 15% also met the criteria for ADHD.²

This article will help you understand more about the relationship between ADHD and addiction, signs of ADHD, and how to get treatment for co-occurring disorders.

What is ADHD?

Attention deficit hyperactivity disorder, commonly referred to as ADHD, is a neurodevelopmental disorder often diagnosed in childhood. It can also be diagnosed in adolescence or adulthood.³ The challenges associated with ADHD in children often lead to problems at school and home.³

There are 3 types of ADHD:^{3, 6}

• Predominately Inattentive Presentation: Characterized by an inability to finish a task or stay organized, pay attention to details, or follow instructions.
• Predominately Hyperactive-Impulsive Presentation: Characterized by excessive talking or fidgeting, an inability to sit still, restlessness, or a lack of impulse control.
• Combined Presentation: When symptoms of the above 2 types of ADHD are equally present in a person.

The exact causes of ADHD are unknown; however, a few risk factors have been identified. The research appears to show a genetic risk factor in people with a diagnosis of ADHD.³ Other possible risk factors include brain injury, environmental factors (such as exposure to lead at a young age), premature delivery, substance use during pregnancy, and low birth weight.^{3, 6}

Symptoms Of ADHD

It is important to remember that only a physician or trained clinician can properly diagnose substance use disorders and mental health conditions. The diagnostic standard that healthcare providers use to appropriately diagnose ADHD and addiction (also known as substance use disorders), and other mental health disorders is the Diagnostic and statistical manual of mental health disorders, 5th Edition, commonly referred to as the DSM-5.⁴

ADHD is characterized by:^{3, 6}

• Inattention.
• Excessive daydreaming.
• Forgetfulness.
• Lack of impulse control.
• Over activity or fidgeting.
• Disorganization.

Specific examples of these characteristics include the following:^{3, 6}

• Often does not seem to listen when spoken to directly
• Often leaves seat in situations when remaining seated is expected
• Often unable to play or take part in leisure activities quietly
• Is often “on the go” acting as if “driven by a motor”
• Often talks excessively
• Often blurts out an answer before a question has been completed
• Often has trouble waiting their turn

Symptoms must also be determined to interfere with daily functioning or development.

Is ADHD Linked to Addiction?

People who are diagnosed with ADHD tend to have a higher lifetime prevalence of substance use disorder.^1,5 Substance use in people with ADHD typically starts earlier in life, recovery from SUDs tends to be slower, and the risk of attempting suicide is increased in those with co-occurring SUDs and ADHD.²

It’s well documented that people with ADHD strive to regulate their negative emotions by self-medicating with drugs or alcohol.⁵ While alcohol or other drugs may initially curb these emotions, over time, the negative aspects of misusing substances can create new challenges, and possibly lead to a substance use disorder.

In addition, the underlying ADHD symptoms they were trying to self-medicate in the first place could worsen. Therefore, early diagnosis and targeted interventions are important to help prevent additional negative consequences and co-occurring SUD in some people.⁵

Studies show that when ADHD is left untreated, it can have significant negative impacts. For instance, children diagnosed with ADHD who remain untreated can have a higher risk of developing other psychiatric disorders later in life, including various mood disorders and substance use disorders.⁸

Research shows that individuals with ADHD have twice the likelihood of developing an addiction to drugs over an addiction to alcohol in their lifetime; 27% and 12% respectively. Individuals with ADHD who present with hyperactivity-impulsivity symptoms and struggle with emotional regulation are even more at risk for misusing drugs and alcohol.⁵

Amphetamines and cannabis misuse were most widely reported among men and women with ADHD, followed by cocaine, benzodiazepines, and opioids.⁵ For example, if someone with ADHD feels overly excited or frustrated, they may try to self-soothe by using marijuana or other substances.⁵

Are ADHD Medications Addictive?

Stimulant medications are the most commonly prescribed treatment for ADHD.^{2, 7, 8} Stimulant medications increase dopamine and norepinephrine in the brain.⁷ In addition to raising one’s heart rate, blood pressure, and blood sugar, stimulant medications increase alertness, focus, and energy.⁷

There are 2 types of medications typically used to treat ADHD:^{7, 10}

• Dextroamphetamine/amphetamine combination (Adderall)
• Methylphenidate (Ritalin, Concerta)

When used as prescribed, these medications can be very effective in treating symptoms of ADHD and providing relief from associated symptoms.⁷

However, stimulants used in ADHD medications are considered Schedule II drugs, which means they have a high potential for misuse.⁹ As with many medications, long-term use can cause a person to develop a tolerance to the drug, where they need larger or more frequent doses to achieve the desired effects.⁷ When misused, stimulants can cause insomnia, increased anger, paranoia, or even heart problems.⁷

Treatment for Co-Occurring ADHD and Addiction

Nearly half of people who experience mental illness during their lifetime will also experience a substance use disorder and vice versa.¹

Treatment for co-occurring disorders is available; however, not all treatment programs and facilities are equipped to treat co-occurring substance use and mental health disorders. Treatment for any co-morbid mental health condition should be addressed simultaneously in SUD treatment to support more positive health outcomes.¹¹

Detox is the first step in any treatment program and helps manage the safe withdrawal from substances, which can include uncomfortable symptoms.¹³ However, detox is just the first stage of treatment and continued treatment should be encouraged to help support long-term abstinence.¹³ Based on the assessment of your co-occurring disorders, the appropriate course of treatment may fall into one of the following categories:¹²

• Outpatient Treatment: Recommended for people with mild to moderate SUD, outpatient treatment allows a person to reside at home and receive services at varying levels of intensity.
• Inpatient/Residential Treatment: Inpatient treatment is generally for those with more severe substance use disorders and co-occurring disorders. People reside at the facility for the duration of treatment.

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