Attention-deficit/hyperactivity disorder (ADHD) is a serious mental health issue. From the name, it’s easy to think this condition is a set of behavioral problems. But those are just the symptoms. In reality, ADHD comes from a neurochemical imbalance—and it’s remarkably similar to the brain chemistry of addiction.
If you’re considering treatment for ADHD and addiction, you can start by learning how they relate to each other.
The Brain Chemistry of Addiction and ADHD
People with ADHD have much a higher risk of addiction.1 This is true across age groups, affecting both adults and teens with ADHD.2 Experts agree that the 2 conditions have “a shared biological background.” Specifically, both addiction and ADHD have an impact on dopamine, which is a neurotransmitter.
Dopamine relates to the brain’s reward system.3 This naturally occurring chemical is released when you do something pleasurable. The brain defines “pleasure” broadly: your dopamine might increase when you buy a new pair of shoes, get a job, or eat a cookie. And when an activity feels good, you’re more likely to do it again.
That can be very healthy. For example, you can get dopamine from exercise.4 Your brain is quite literally wired to make you want to work out. But there’s a downside to dopamine. Plenty of activities—like substance use—feel good while doing serious damage to your health. And for people with ADHD, dopamine might already be hard to come by.
The Biology of ADHD
If you have ADHD, it may take extra effort to concentrate, sit still, or complete important tasks. This often interferes with relationships, schoolwork and career. In severe cases, people with ADHD can qualify for disability benefits.5 But it also comes with some advantages. Like any other type of neurodivergence, this condition changes the way you see the world. And your unique insight can be a strength.
Biologically, people with ADHD can’t regulate dopamine levels.6 This condition affects at least one of the genes responsible for that process. And that, experts say, “makes it difficult for neurons to respond to dopamine.”
In other words, even if you have healthy dopamine levels, it may not feel that way. So things that “should” be pleasurable might not always feel as good as you want them to.
If nothing feels good enough, it makes sense to go looking for new types of stimulation. This may explain the link between ADHD and risk-taking.7
Drug use falls neatly into this category.
Dopamine and Addiction
Over time, addiction makes the brain less sensitive to dopamine.8 At first, your brain starts associating drugs with a sense of reward. The act of taking drugs triggers a release of dopamine, whether or not the drug itself does.
As you get used to this repeated flood of dopamine, you’ll feel less satisfaction from taking drugs. This effectively increases your tolerance to the drug, so you need to take more of it to achieve the same result. At the same time, you start feeling less pleasure from other activities. So even if you no longer enjoy the sensation of being high, you might still feel driven to take drugs.
These behaviors quickly become a vicious cycle. Psychiatrist and dopamine expert Dr. Anna Lembke explains that for people in this state, joy is often out of reach. “Now, our drug of choice doesn’t even get us high,” she says. “It just makes us feel normal.”9
But if you have ADHD, addiction recovery might not be enough to break the cycle. You might stop taking drugs, but still feel unsatisfied with your life. In order to heal from these co-occurring disorders, it’s important to find treatment for both of them.
Treatment for ADHD and Addiction
ADHD is often diagnosed in children10 even if you showed no signs of it in childhood.
Because of these complexities, you might need different types of treatment in different stages of recovery. And after you complete rehab, you may benefit from ongoing care for addiction, ADHD, or both. Certain therapies are especially helpful for people with these diagnoses.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is a popular treatment for many mental health conditions. And a wealth of data supports CBT as a therapy for ADHD and addiction.11 This framework focuses more on practical skills than it does on emotional processing. Your therapist will teach you coping strategies for dealing with difficult thoughts, urges, social situations, and more. In between sessions, you’ll try them out in your daily life.
Integrated Cognitive Behavioral Therapy
As the name implies, integrated cognitive behavioral therapy (ICBT) integrates components of CBT12 and other treatment methods. Patients learn about their condition, practice mindfulness, and learn flexible thinking skills. You’ll use a workbook, and your therapist will give you homework assignments to complete between sessions. This format empowers clients to develop practical skills and put them to use in real-life situations.
ICBT is a highly effective treatment for co-occurring ADHD and addiction.13 One study even found it to be more effective than other forms of CBT. ICBT can also treat post-traumatic stress disorder (PTSD).14 However, like most types of talk therapy, ICBT focuses on mental, emotional, and behavioral issues. Since ADHD is also a neurochemical issue, many people need medical treatment as well.
Medication for ADHD
Prescribing medication to treat co-occurring ADHD and addiction15 is a controversial issue. If a patient has ADHD without addiction, prescription stimulants are the standard treatment. But stimulants are highly addictive. Because of this, experts disagree about the best course of action.
This controversy even affects people with ADHD who have no history of drug abuse. Some sources caution against treating ADHD with stimulants16 because of the risk of future addiction. Others say prescribed stimulants protect against addiction,17 because they empower patients to manage symptoms in a healthy way.
During addiction recovery, taking medication of any kind can be complicated. Tell your doctor about your history before you start a new prescription. Together, you can make a plan to keep yourself safe. For example, they might only prescribe you a few pills at a time, and ask you to come back into their office before you can get more.
Whatever treatments you pursue, it’s essential for you to get an official diagnosis first. That can be surprisingly difficult, especially for people of certain demographics.
Getting an Accurate Diagnosis
Because of the overlapping symptoms of ADHD and addiction,16 doctors can’t always distinguish between them. This means that if you already have an ADHD diagnosis, you might need to start addiction treatment before you can get one. Most rehabs start their program with thorough assessments, so it’s relatively easy to get assessed for ADHD while you’re in residential treatment. Some doctors even recommend screening everyone in addiction treatment for ADHD.18
In some populations, though, ADHD is harder to diagnose. There are several possible reasons for this. Many clinicians have a preconceived image of what ADHD patients look like. This makes it easy to miss the symptoms when they present in a different way. It can also be hard to differentiate between ADHD and other mental health issues.
ADHD in Teens
For children and teens with ADHD,19 early diagnosis is key. That’s because children with more severe ADHD symptoms are at a greater risk of developing addiction later on. However, ADHD symptoms may not appear before puberty.20 And because even healthy teenagers go through behavioral changes, that timing can make it difficult for parents to notice a problem. While this can be an issue for teens of any gender, it’s most common among young women.
Women With ADHD
Data suggests that up to 75% of women with ADHD may be undiagnosed.21 That might be because women with ADHD often show different symptoms22 than clinicians expect.
For example, one study found that women were more likely to be inattentive than hyperactive. Inattention primarily affects the person feeling it. Your inability to focus on your book won’t distract a stranger at a bus stop. But hyperactivity, which is common in men with ADHD, can be disruptive in a group setting. Both clinicians and patients’ loved ones commonly miss “internalizing” symptoms like inattentiveness. Instead, women with ADHD are often misdiagnosed with bipolar disorder, anxiety, or depression.
Differentiating Between ADHD and Anxiety
ADHD and anxiety23 often go hand in hand. While ADHD is not an anxiety disorder,24 they can present with similar symptoms. For instance, either condition might get in the way of finishing your homework. In people with ADHD, that’s probably because you just can’t focus. On the other hand, people with anxiety might be able to focus, but afraid of getting it wrong.
ADHD can also cause anxiety. That’s because its symptoms make it harder to achieve your goals. Some people get anxious about the impact ADHD has on their lives. Without proper treatment, it’s all too easy to get stuck in this loop.
If you have both of these conditions, it’s important to get the right diagnosis before taking medication. Otherwise, you’ll risk making your symptoms worse. ADHD patients commonly take stimulants, which can increase anxiety.25 Stimulants may still be a good fit for some people with anxiety disorders—it all depends on your specific health history. You can work closely with your doctor to design a care plan that meets your needs.
ADHD May Be a Risk Factor for Depression
There’s less of an overlap between the symptoms of ADHD and depression, but they have a strong correlation. People with ADHD often develop depression26 later in life, even if they grow out of childhood ADHD symptoms.
There may be a genetic link between these conditions. And people with ADHD and depression often have other mental health issues, like addiction or trauma. Recovering from these co-occurring disorders is complex. You may require specialized care, and ongoing treatment even after rehab.
Post-traumatic Stress Disorder
Everyone experiences trauma differently. Something that feels like just a bad day to you might be deeply traumatizing for someone else. And your personal history can make you more or less likely to develop post-traumatic stress disorder (PTSD).
ADHD increases your risk of developing PTSD27 in response to trauma. That’s especially true for people with both ADHD and alcohol addiction.28 And data shows that people with ADHD experience a higher number of traumatic events, whether or not they develop PTSD.
If you have trauma symptoms, you might benefit from trauma-informed care (TIC). TIC is a general approach to treatment, not a specific type of therapy. This means you can get trauma-informed care for ADHD, addiction, PTSD, and any other concerns you’re seeking help for.
Many Roads to Recovery
Everyone’s recovery is unique, and that’s doubly true for people with co-occurring disorders. Your provider will help you design a care plan that accounts for your various goals.
The act of healing can empower you to understand the depth of your emotional experience. That’s how it happened for Peach Perkins.
Peach is in recovery from ADHD, alcohol and drug addiction,29 as they explained on the podcast ADHD Aha! But it took them almost a year of sobriety to understand how those conditions worked together. At first, they thought addiction was “the thing preventing me from doing a good job at work. Now I can really go all in. And I was still at work, just my eyes were crossed and I still couldn’t do what I needed to do. That wasn’t what was in my way.” After that realization, they were able to get an official ADHD diagnosis. With the right diagnosis, they finally got the treatment they needed—and you can too.
Find Balance in Treatment for ADHD and Addiction
ADHD is often, but not always, a life-long condition. Recovery usually doesn’t mean getting rid of your symptoms entirely. Instead, you’ll learn to manage them in a healthier way. And those coping skills can make it easier to heal from co-occurring diagnoses like addiction.
Learn more about rehab programs for ADHD, including their locations, pricing, insurance coverage, and more.
- Davis, Caroline, et al. “Attention-Deficit/Hyperactivity Disorder in Relation to Addictive Behaviors: A Moderated-Mediation Analysis of Personality-Risk Factors and Sex.” Frontiers in Psychiatry, vol. 6, Apr. 2015, p. 47. PubMed Central, https://doi.org/10.3389/fpsyt.2015.00047. [↩]
- Schellekens, Arnt F. A., et al. “Often Overlooked and Ignored, but Do Not Underestimate Its Relevance: ADHD in Addiction – Addiction in ADHD.” European Addiction Research, vol. 26, no. 4–5, 2020, pp. 169–72. www.karger.com, https://doi.org/10.1159/000509267. [↩]
- Watson, Stephanie. “Dopamine: The Pathway to Pleasure.” Harvard Health, 20 July 2021, https://www.health.harvard.edu/mind-and-mood/dopamine-the-pathway-to-pleasure. [↩]
- “Five Surprising Ways Exercise Changes Your Brain.” Greater Good, https://greatergood.berkeley.edu/article/item/five_surprising_ways_exercise_changes_your_brain. Accessed 14 Dec. 2022. [↩]
- Is ADHD A Disability? https://www.disability-benefits-help.org/disabling-conditions/adhd-and-social-security-disability. Accessed 14 Dec. 2022. [↩]
- Blum, Kenneth, et al. “Attention-Deficit-Hyperactivity Disorder and Reward Deficiency Syndrome.” Neuropsychiatric Disease and Treatment, vol. 4, no. 5, Oct. 2008, pp. 893–918. PubMed Central, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2626918/. [↩]
- Shoham, Rachel, et al. “ADHD-Associated Risk Taking Is Linked to Exaggerated Views of the Benefits of Positive Outcomes.” Scientific Reports, vol. 6, no. 1, Oct. 2016, p. 34833. www.nature.com, https://doi.org/10.1038/srep34833. [↩]
- The Neurobiology of Substance Use, Misuse, and Addiction | Surgeon General’s Report on Alcohol, Drugs, and Health. https://addiction.surgeongeneral.gov/executive-summary/report/neurobiology-substance-use-misuse-and-addiction. Accessed 14 Dec. 2022. [↩]
- Hu, Elise, and Audrey Nguyen. “Too Much Pleasure Can Lead to Addiction. How to Break the Cycle and Find Balance.” NPR, 4 Apr. 2022. NPR, https://www.npr.org/2022/03/31/1090009509/addiction-how-to-break-the-cycle-and-find-balance. [↩]
- Braaten, Ellen. “5 Things Parents and Teachers Need to Know about ADHD.” Harvard Health, 27 Oct. 2017, https://www.health.harvard.edu/resources/5-things-parents-and-teachers-need-to-know-about-adhd-2017102712643. and teens, and some people grow out of their symptoms. But that’s not true for everyone. And recent data shows that you can develop ADHD as an adult, ((“‘Late-Onset’ ADHD May Emerge in Young Adults.” Psychiatric Times, https://www.psychiatrictimes.com/view/late-onset-adhd-may-emerge-young-adults. Accessed 14 Dec. 2022. [↩]
- Zulauf, Courtney A., et al. “The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders.” Current Psychiatry Reports, vol. 16, no. 3, Mar. 2014, p. 436. PubMed Central, https://doi.org/10.1007/s11920-013-0436-6. [↩]
- Capone, Christy, et al. “Integrated Cognitive Behavioral Therapy (ICBT) For PTSD and Substance Use in Iraq and Afghanistan Veterans: A Feasibility Study.” Journal of Traumatic Stress Disorders & Treatment, vol. 3, no. 4, 2014, p. 1000134. PubMed Central, https://doi.org/10.4172/2324-8947.1000134. [↩]
- van Emmerik-van Oortmerssen, Katelijne, et al. “Integrated Cognitive Behavioral Therapy for ADHD in Adult Substance Use Disorder Patients: Results of a Randomized Clinical Trial.” Drug and Alcohol Dependence, vol. 197, Apr. 2019, pp. 28–36. PubMed, https://doi.org/10.1016/j.drugalcdep.2018.12.023. [↩]
- McGovern, Mark. Integrated Cognitive Behavioral Therapy for Co-Occurring PTSD and Substance Use Disorders. Clinical trial registration, NCT01457404, clinicaltrials.gov, 23 Oct. 2015. clinicaltrials.gov, https://clinicaltrials.gov/ct2/show/NCT01457404. [↩]
- Mariani, John J., and Frances R. Levin. “Treatment Strategies for Co-Occurring ADHD and Substance Use Disorders.” The American Journal on Addictions / American Academy of Psychiatrists in Alcoholism and Addictions, vol. 16, no. Suppl 1, 2007, pp. 45–56. PubMed Central, https://doi.org/10.1080/10550490601082783. [↩]
- Chardée A. Galán, M. S., and PhD Kathryn L. Humphreys. “ADHD and Substance Use: Current Evidence and Treatment Considerations.” Psychiatric Times, vol. 34, no. 8, Aug. 2017. www.psychiatrictimes.com, https://www.psychiatrictimes.com/view/adhd-and-substance-use-current-evidence-and-treatment-considerations. [↩] [↩]
- APA PsycNet. https://psycnet.apa.org/record/2013-43688-006. Accessed 14 Dec. 2022. [↩]
- Matthys, Frieda, et al. “[Summary of the practice guideline for the diagnosis and treatment of ADHD in adolescents and adults with addictions].” Nederlands tijdschrift voor geneeskunde, vol. 157, no. 24, Jan. 2013, p. A6025. [↩]
- “Severity of ADHD in Children Increases Risk of Drug Use in Adolescence, Says Longitudinal Study.” Https://Www.Apa.Org, https://www.apa.org/news/press/releases/2003/08/adhd-drugs. Accessed 14 Dec. 2022. [↩]
- Ostojic, Dragana, and Carlin J. Miller. “Association Between Pubertal Onset and Symptoms of ADHD in Female University Students.” Journal of Attention Disorders, vol. 20, no. 9, Sept. 2016, pp. 782–91. DOI.org (Crossref), https://doi.org/10.1177/1087054714535249. [↩]
- Walters, Anne. “Girls with ADHD: Underdiagnosed and Untreated.” The Brown University Child and Adolescent Behavior Letter, vol. 34, no. 11, Nov. 2018, pp. 8–8. DOI.org (Crossref), https://doi.org/10.1002/cbl.30337. [↩]
- Quinn, Patricia O., and Manisha Madhoo. “A Review of Attention-Deficit/Hyperactivity Disorder in Women and Girls: Uncovering This Hidden Diagnosis.” The Primary Care Companion for CNS Disorders, vol. 16, no. 3, 2014. www.ncbi.nlm.nih.gov, https://doi.org/10.4088/PCC.13r01596. [↩]
- Pliszka, Steven R. “ADHD and Anxiety: Clinical Implications.” Journal of Attention Disorders, vol. 23, no. 3, Feb. 2019, pp. 203–05. DOI.org (Crossref), https://doi.org/10.1177/1087054718817365. [↩]
- ADHD and Anxiety: What’s the Connection? 15 May 2017, https://www.medicalnewstoday.com/articles/315303.
[↩] - Stimulants – Alcohol and Drug Foundation. https://adf.org.au/drug-facts/stimulants/. Accessed 14 Dec. 2022. [↩]
- Riglin, Lucy, et al. “ADHD and Depression: Investigating a Causal Explanation.” Psychological Medicine, vol. 51, no. 11, Aug. 2021, pp. 1890–97. Cambridge University Press, https://doi.org/10.1017/S0033291720000665. [↩]
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[↩] - Luderer, Mathias, et al. “ADHD Is Associated with a Higher Risk for Traumatic Events, Self-Reported PTSD, and a Higher Severity of PTSD Symptoms in Alcohol-Dependent Patients.” European Addiction Research, vol. 26, no. 4–5, 2020, pp. 245–53. www.karger.com, https://doi.org/10.1159/000508918. [↩]
- ADHD and Substance Abuse: ADHD Aha! Podcast. https://www.understood.org/en/podcasts/adhd-aha/adhd-and-substance-abuse-peachs-story. Accessed 14 Dec. 2022. [↩]
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