Credit: Marine Corps.

While the exact number of adults with ADHD is unknown, it is estimated that 4% of the U.S. adult population is affected by ADHD. While most people can function very well and become successful despite their condition, ADHD is also associated with life-long impairments in several facets of life, including educational and professional achievements, self-image and interpersonal relationships. But one of the darkest sides of ADHD is its propensity for addiction.

Why ADHD can lead to substance abuse

Addiction is a global problem that affects people from all walks of life, irrespective of gender, financial status, skin color, sexual orientation, religion, or spiritual practice. According to the American Society of Addiction Medicine (ASAM), addiction is “a primary, chronic disease of brain reward, motivation, memory, and related circuitry,” which leads to dysfunctional behavior in order to provoke relief in spite of the negative consequences a person may attract.

“Addiction is an inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death,” according to a characterization on the ASAM website.

It’s these changes in the brain that make addiction so dangerous, causing a person to lose control over his or her use of substances. This also leads to subsequent problems at work, in relationships, and with one’s sense of self-worth and esteem.

Some people are more vulnerable to addiction than others. One primary factor which specialists have identified are adverse childhood experiences, which create their own brain changes. Research has also identified neurological conditions that make people prone to addiction, ADHD being one of them.

Attention-deficit hyperactivity disorder (ADHD) is a syndrome characterized by persistent patterns of inattention and/or impulsivity and hyperactivity that is inappropriate for a given age or developmental stage. The exact causes of ADHD are still unknown but the evidence so far suggests that dopamine neurotransmission dysfunction is at least partially responsible for the disorder’s symptoms. This dopamine link may also explain why ADHD often co-occurs with substance use disorders.

Symptoms of ADHD across lifespan. Credit: ADHD Institute.

The risk of drug and substance abuse is significantly increased in adults with persisting ADHD symptoms who have not been receiving medication. According to one study, ADHD is associated with a twofold increase in the risk of psychoactive substance use disorder. In addition, it is estimated that more than 25% of substance-abusing adolescents meet diagnostic criteria for ADHD. A 2004 survey found that 60% of the adults with ADHD have been addicted to tobacco while 52% have used drugs recreationally.

“One of the strongest predictors of substance use disorders in adulthood is the early use of substances, and children and teens with ADHD have an increased likelihood of using substances at an early age,” Dr. Jeff Temple, a licensed psychologist and director of behavioral health and research in the department of obstetrics and gynaecology at the University of Texas Medical Branch, told Health Line.

Bearing all of this in mind, clinicians working with patients that suffer from both ADHD and substance abuse may need to use a different approach than they would normally. While the treatment literature for ADHD in patients with substance use disorder is not well developed, the emerging trend is that medications effective for adult ADHD may be effective for adults with ADHD and co-occurring substance use disorder. Exercising regularly and having behavioral health checkups during treatment are also important.

The key seems to be starting ADHD treatment as early as possible, before a person has the chance to develop a substance use disorder during his or her teens. Although there is no “cure” for ADHD, there are accepted treatments that specifically target its symptoms. However, it is essential that ADHD treatment begins when the patient is sober, so some drug or alcohol detox may be required before treatment.

“A conservative approach for treating co-occurring ADHD and SUD would be to begin treatment with a non-stimulant pharmacotherapy, but if an adequate response is not obtained, consider stimulant pharmacotherapy. The decision regarding the use of stimulant medications for a patient with ADHD and a co-occurring substance use disorder should be made on the basis of a broad clinical assessment and an individual risk-benefit analysis. For many patients, psychostimulants can be used safely and effectively; however, careful monitoring during treatment is essential to ensure prescribed stimulants are being used in a therapeutic manner, and in the case of worsening substance use or when faced with evidence of the diversion of prescribed medication, treatment should be discontinued,” according to researchers at the New York State Psychiatric Institute.