Commonly Co-Occurring: ADHD and Substance Abuse

Commonly Co-Occurring: ADHD and Substance Abuse

Those with attention deficit hyperactivity disorder (ADHD) are 2-3 times more likely to also develop a substance use disorder. In addition, an ADHD diagnosis often means earlier instances of substance use, faster addiction and a higher rate of relapse. In adults with a substance use disorder (SUD), as many as 20% may also have ADHD, which makes treating both a critical concern for recovery specialists. But since medication is often the most useful treatment for ADHD, can addicts safely take ADHD meds?

Early diagnosis and treatment can dramatically reduce the risk of developing an SUD or other co-occurring disorder, although depression and/or anxiety are common ADHD comorbidities. Prompt and continued treatment can help prevent a comorbid condition, but many people with nonstandard presentations may not get diagnosed as adolescents.

Understanding ADHD

ADHD is the most common neurodevelopmental disorder affecting children. Three main categories of behavior make up the basis for the disorder: hyperactivity, inattention and impulsivity. When untreated, ADHD is a chronic illness that can negatively impact academic, professional and social interactions. Poor self-esteem, anxiety and sensitivity toward criticism are often part of the condition and can worsen without treatment.

Most people with ADHD are diagnosed in childhood when hyperactive episodes and inattention cause problems in the classroom. However, due to a difference in presentation, girls are much less likely to receive a childhood diagnosis.

In general, an ADHD diagnosis falls into one of three categories. To get a diagnosis, a child needs to frequently display at least six of the symptoms for a specific type of ADHD, while an adult needs to display at least five.

Inattentive ADHD

  • Prone to careless mistakes at school or work; misses out on details
  • Struggles to stay focused on long-running tasks
  • Seems to be inattentive when spoken to
  • Fails to follow directions or finish tasks
  • Has executive function challenges surrounding task organization and time management
  • Practices avoidance surrounding boring tasks such as filling out forms or preparing reports
  • Misplaces everyday objects such as glasses or keys
  • Gets distracted easily.
  • Forgets to do daily activities, including hygiene habits such as brushing teeth or hair


  • Fidgets with hands or feet
  • Struggles to maintain a seated position
  • Runs, climbs or engages in physical play in inappropriate places
  • Doesn’t display good volume control
  • Seems to have boundless energy
  • Talks constantly or more than desirable
  • Frequently interrupts another speaker or attempts to answer questions without waiting for the questioner to finish
  • Finds it challenging to wait for their turn
  • Interrupts conversations or activities without permission


In a diagnosis of combination ADHD, a person qualifies for the clinical definitions of both hyperactive and inattentive ADHD. An adult must demonstrate at least 10 symptoms, split equally between the lists, while a child must display 12.

Link Between ADHD and Substance Abuse

While it’s clear there’s a link between ADHD and substance abuse, the exact cause of the connection isn’t yet known. However, research suggests that people with ADHD have similar neurobiological mechanisms to those who also have a substance use disorder. In addition, both tend to struggle with impulsivity and inattention. Anxiety and depression are common comorbidities with both SUDs and ADHD. In addition, an attempt to self-medicate may be part of the problem that results in a co-occurring disorder.

Since many people develop an SUD in adolescence and young adulthood, some researchers believe the link may be related to social pressures. Poor academic performance or low self-esteem might make those with ADHD more likely to give in to peer pressure the first time, and ADHD makes addiction happen more quickly.

Shared Risk Factors

There are numerous risk factors for developing an SUD, but many of them cross over with those involved in an ADHD diagnosis. Risks that both conditions share include:

  • Family history
  • Parental attitudes toward substance use
  • Incomplete parental oversight
  • Family rejection, particularly due to sexual orientation or gender identity
  • Peer groups that use recreational substances
  • Lack of connection/engagement with school or work
  • Struggles in an academic or work setting
  • Childhood sexual abuse
  • Mental health issues

Impact of Substance Abuse on ADHD

Substance abuse can have major impacts on those with ADHD and their treatment. Someone with untreated ADHD might seek out street drugs as an alternative to prescription medications. ADHD and meth use is one example where a person with ADHD might seek a stimulant to help reduce the intensity of their symptoms.

Alcohol abuse is also common for individuals with ADHD. Depression and anxiety can lead to many poor choices, including the overconsumption of alcohol. Those with ADHD may already struggle with impulsive decision-making, but substance abuse can exacerbate that tendency. Alcohol use alone can cause changes in the decision-making process. When added to an ADHD diagnosis, many people struggle in both short- and long-term scenarios.

Dopamine-seeking behaviors may cause someone with ADHD to overspend or gamble, ultimately leading to addiction. People with ADHD are generally more likely to develop an addiction, regardless of the substance being abused.

Can Addicts Safely Take ADHD Meds?

How do you treat ADD or ADHD safely? Medication and long-term recovery programs are often the best approaches. An integrated program that addresses both disorders at once is often used for treating ADHD and an SUD. Since ADHD meds and alcohol don’t mix well, it’s important to undergo medical detox before starting a treatment plan that includes medications.

When only the SUD is treated, people often relapse more quickly due to the difficulty of living with untreated ADHD. If only ADHD is treated, relapse is also more likely since many people with an SUD struggle with addiction even when treating their initial mental illness.

If you or a loved one may have ADHD and a substance use disorder, contact us at Restore Mental Health. We offer integrated treatment programs designed to get to the root of the problem and help you find long-term solutions. Talk with a mental health practitioner today to get started on your healing journey.