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Substance Use Disorders and ADHD: 5 Key Facts and Additional Resources

February 1, 2023

Attention deficit hyperactivity disorder (ADHD) and substance use disorders (SUD) overlap considerably. About a quarter of adults with SUD have ADHD, and individuals with ADHD are three times more likely to develop a SUD.1 2 What’s more, SUD is often more severe in individuals with ADHD.3

Research confirms that ADHD treatment (i.e., stimulant medication) drastically improves symptoms of both conditions and outcomes for patients with ADHD and SUC. Still, pervasive myths about addiction and ADHD medication often impede treatment.

Below are five critical takeaways from Dr. Timothy Wilens’ ADDitude webinar, “Substance Use Disorder and ADHD: Safe, Effective Treatment Options,” broadcast on January 31, 2023, along with additional resources to help you better understand ADHD and SUD.

1. Does stimulant medication use increase the risk of addiction (to other substances and/or to stimulants)?

No. Using stimulants for ADHD does not cause addiction to stimulants or other substances, including cocaine, marijuana, and alcohol. In fact, the opposite is true: Treating ADHD with medication reduces the risk of substance abuse, especially when treatment starts early.4

ADHD Stimulants and Drug Dependence: Next Steps

2. Does untreated ADHD increase the likelihood of SUD?

Yes. Multiple long-term studies show that, compared to untreated individuals with ADHD, children and adults who are treated for ADHD are at decreased risk for developing substance use disorders.4

Risks of Untreated ADHD: Next Steps

3. Does stimulant medication help treat SUD as well?

Absolutely. For patients with ADHD and SUD, research shows that treating ADHD with stimulants improves a patient’s ability to stay in treatment for SUD — and treatment retention is the most important factor’s in a patient’s recovery.5

Stimulant Medications and Comorbidities: Next Steps

4. What ADHD treatment plan is best for people with SUD and ADHD?

Structured therapies that use cognitive behavioral therapy (CBT adapted for SUD and ADHD) and medication are most effective for treating individuals with ADHD and SUD.6 If a patient’s SUD is severe, or if the patient is high risk, a clinician may consider prescribing a non-stimulant or an extended-release stimulant rather than an immediate-release option that’s more prone to abuse. In all, past substance use history should not preclude patients with ADHD from receiving treatment with stimulants.

SUD and ADHD Treatment: Related Resource

5. What are the risks of marijuana use by teens and young adults with ADHD?

Marijuana is the drug most commonly misused by individuals with ADHD. Studies show that chronic marijuana use, especially if initiated in adolescence, is linked to neuropsychological impairment, persistent executive dysfunction, and other detrimental changes to brain function.7

ADHD Teens and Marijuana: Next Steps

Substance Use Disorders and ADHD: Next Steps

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Sources

1 Wilens T. E. (2004). Attention-deficit/hyperactivity disorder and the substance use disorders: the nature of the relationship, subtypes at risk, and treatment issues. The Psychiatric clinics of North America, 27(2), 283–301. https://doi.org/10.1016/S0193-953X(03)00113-8

2 Charach, A., Yeung, E., Climans, T., & Lillie, E. (2011). Childhood attention-deficit/hyperactivity disorder and future substance use disorders: comparative meta-analyses. Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 9–21. https://doi.org/10.1016/j.jaac.2010.09.019

3 Wilens, T. E., & Morrison, N. R. (2011). The intersection of attention-deficit/hyperactivity disorder and substance abuse. Current opinion in psychiatry, 24(4), 280–285. https://doi.org/10.1097/YCO.0b013e328345c956

4 Quinn, P. D., Chang, Z., Hur, K., Gibbons, R. D., Lahey, B. B., Rickert, M. E., Sjölander, A., Lichtenstein, P., Larsson, H., & D’Onofrio, B. M. (2017). ADHD Medication and Substance-Related Problems. The American journal of psychiatry, 174(9), 877–885. https://doi.org/10.1176/appi.ajp.2017.16060686

5 Kast, K. A., Rao, V., & Wilens, T. E. (2021). Pharmacotherapy for Attention-Deficit/Hyperactivity Disorder and Retention in Outpatient Substance Use Disorder Treatment: A Retrospective Cohort Study. The Journal of clinical psychiatry, 82(2), 20m13598. https://doi.org/10.4088/JCP.20m13598

6 Zulauf, C. A., Sprich, S. E., Safren, S. A., & Wilens, T. E. (2014). The complicated relationship between attention deficit/hyperactivity disorder and substance use disorders. Current psychiatry reports, 16(3), 436. https://doi.org/10.1007/s11920-013-0436-6

7 Tamm, L., Epstein, J. N., Lisdahl, K. M., Molina, B., Tapert, S., Hinshaw, S. P., Arnold, L. E., Velanova, K., Abikoff, H., Swanson, J. M., & MTA Neuroimaging Group (2013). Impact of ADHD and cannabis use on executive functioning in young adults. Drug and alcohol dependence, 133(2), 607–614. https://doi.org/10.1016/j.drugalcdep.2013.08.001

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