Could ADHD Contribute to a Substance Use Disorder?

The relationship between ADHD and Substance Use Disorder (SUD) are becoming more closely associated. Timothy E. Wilens M.D. of Massachusetts General Hospital in Boston, authored a 2010 study revealing the link between being diagnosed with ADHD and later developing a substance use disorder. In this study, it is suggested that 15 to 25 percent of adults who have substance use disorders also have ADHD. Wilens claims that the risk of substance misuse for individuals with ADHD is “two to three times higher” than for people without ADHD.

With increased public interest motivating clinical research,  studies now focus on the chicken-or-the-egg scenario: Do the qualities of ADHD lead to addiction, or does the way ADHD is treated—often with drugs like Adderall and Ritalin — encourage substance misuse?

Many people are diagnosed with ADHD when they are adolescents, and it is rare that an adult is diagnosed. In fact, it can often be difficult to find much information about ADHD in adults. This could be because, until recently, Adult ADHD wasn’t thought to exist. Physicians thought it was a disorder of children that dissolved when they hit puberty.

The Centers for Disease Control and Prevention (CDC) estimates that 6.4 million children ages 4 to 17 have been diagnosed with ADHD in the United States—but as those kids grow up, doctors realized that the disorder did not go away with age. The problem is that ADHD manifests in different ways in adulthood. Hyperactivity, one of the qualities associated with the disorder, does seem to lessen as children get older. Unfortunately, one of the ways ADHD shows up in adults is through addiction. In a 2005 study, 20 to 40 percent of adults with ADHD had a history of substance misuse.

Researchers believe that people with ADHD may turn to substance misuse as a way of making up for the deficit of dopamine in their brains. Researchers also questioned whether common medications for ADHD, like Adderall and Ritalin, lead patients to a pattern of substance misuse.

Dr. Wilens found through his series of studies that non-medical misuse of prescription stimulants was associated with previous misuse of illicit substances as well as alcohol and marijuana dependence.

Several theories were proposed to explain the increased risk for substance use disorder in patients with ADHD. Genetically mediated personality traits, such as a novelty seeking and impulsiveness (common in both ADHD and SUD), could provide a connection and may result from common neurologic substrates. It has also been proposed that people with ADHD misuse addictive substances in an attempt to self-medicate the symptoms of the disorder.

So far, there’s very little evidence that treating ADHD increases the risk for substance misuse—instead, it reduces the risk. The results of a study of 25,000 ADHD patients reports that if an individual continues taking their medication, there is a continued reduction in the risk of substance misuse.

Appropriate treatment of ADHD symptoms with medication and behavior therapy may reduce the risk of development of substance use disorders. An important part of ADHD treatment and stimulant medication management includes screening for substance use disorders and providing guidance around the appropriate and safe use of stimulant medications. Individuals with co-occurring ADHD and active substance use disorders require a careful, individual risk or benefit assessment regarding the safety of prescribing a stimulant medication.

Jennifer is a Florida-based writer who strives to raise awareness for mental health and lifelong recovery from substance misuse and addiction. When she isn’t writing, she’s reading a book at the beach or park and playing her with her two Pomeranians.

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