ADHD and Substance Misuse

ADHD is one of the most common neurodevelopmental disorders and involves difficulties with focus, impulsivity, and self-regulation. Research suggests a link between ADHD and substance use disorders (SUDs), with individuals diagnosed with ADHD being at a higher risk of engaging in substance use and developing dependency.

 Numerous studies have shown that individuals with ADHD are more likely to experience substance use problems compared to their peers without ADHD. Some studies indicate that adolescents and adults with ADHD are 1.5 to 2 times more likely to develop substance use disorders, particularly with nicotine, alcohol, and cannabis (Lee et al., 2011). This increased risk is thought to come from the core symptoms of ADHD—impulsivity and inattention—which can carry an increased risk of behaviours such as substance use.

Research by Wilens et al. (2011) notes that approximately 15-25% of adults with a history of ADHD are affected by SUDs. The study also shows that individuals with ADHD and concurrent SUDs often have a more severe course of addiction, experiencing more functional impairments and challenges with treatment adherence.

Risk factors

Several risk factors contribute to the heightened vulnerability to substance use among people with ADHD. These include:

Impulsivity and Sensation Seeking: The impulsive traits associated with ADHD, including sensation-seeking and reduced inhibition, can increase the use of substances as an impulsive activity or symptom relief (Rohde et al., 2005).

Self-Medication Hypothesis: Some individuals with ADHD may use substances to self-medicate. For instance, they might use nicotine to improve focus or alcohol to reduce anxiety, both of which are common coping strategies in the absence of effective treatment (Kollins, 2008).

Environmental and Genetic Factors: Genetics are understood to play a role in both ADHD and SUDs, with shared heritable traits that could predispose individuals to both conditions. Environmental factors, such as high-stress, peer influence, and adverse childhood experiences, can further exacerbate the risk (Elkins et al., 2007).

Adolescents vs Adults

Adolescents with ADHD are at a higher risk of experimenting with substances earlier than their peers, which could lead to faster progression from experimental use to dependence. e. Furthermore, studies have shown that untreated ADHD symptoms in adolescence can increase the risk of SUDs in adulthood (Chang et al., 2012).

In adulthood, the combination of ADHD and SUDs can result in challenges related to workplace performance, interpersonal relationships, and mental health stability.

Treatment

• Pharmacotherapy: Stimulant medications are the primary treatment for ADHD, but their potential for abuse presents challenges for patients with co-occurring SUDs. Non-stimulant alternatives, such as atomoxetine, may be safer options for treating ADHD without contributing to substance misuse.
• Psychosocial Interventions: Behavioural therapies, such as CBT for ADHD focus on improving executive function and self-regulation skills. CBT helps develop coping strategies to reduce impulsivity and manage cravings, which could reduce the risk of relapse (Stevenson et al., 2012).
• Motivational Interviewing (MI): MI is especially effective in addressing ambivalence about substance use, helping individuals gain motivation for sobriety. Combined with CBT, MI can be useful in reducing substance use while providing the necessary skills to manage ADHD symptoms effectively (Barkley, 2015).

References

• Barkley, R. A. (2015). Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Publications.
• Chang, Z., Lichtenstein, P., & Larsson, H. (2012). The effects of childhood ADHD symptoms on early-onset substance use: A Swedish twin study. Journal of Abnormal Child Psychology, 40(3), 425-435.
• Elkins, I. J., McGue, M., & Iacono, W. G. (2007). Prospective effects of attention-deficit/hyperactivity disorder, conduct disorder, and sex on adolescent substance use and abuse. Archives of General Psychiatry, 64(10), 1145-1152.
• Kollins, S. H. (2008). ADHD, substance use disorders, and psychostimulant treatment: Current literature and treatment guidelines. Journal of Attention Disorders, 12(2), 115-125.
• Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review. Clinical Psychology Review, 31(3), 328-341.
• Rohde, L. A., & Halpern, R. (2005). Comorbidity of attention deficit hyperactivity disorder and substance use disorder. Current Drug Abuse Reviews, 1(3), 245-255.
• Wilens, T. E., Faraone, S. V., & Biederman, J. (2011). Attention-deficit/hyperactivity disorder and co-occurring substance-use disorders in adults. Journal of Clinical Psychiatry, 52(10), 702-707.