Substance Abuse and ADHD

Attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) frequently occur together. This is referred to as a dual diagnosis or co-occurring disorders.^1,2 One study found that 15.2% of individuals with adult ADHD met The Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) criteria for an SUD.³ On the other hand, among individuals with an SUD, 10.8% met the criteria for adult ADHD.³

One reason for this co-occurrence may be that patients with ADHD and substance use disorders tend to begin experimenting much earlier in life with drugs and alcohol when compared with individuals without ADHD.⁴

Learn more about each disorder and how effective treatment can help to manage symptoms of both and help you or a loved one work toward long-term recovery from drug and/or alcohol addiction.

What is ADHD?

ADHD is a type of neurodevelopmental disorder that usually develops during childhood and can last into adulthood.⁵ It is characterized by changes in the brain that affects a person’s focus, impulse control, and activity levels. ^1,5

The following 3 key behaviors are indicative of ADHD:^1,6

• Inattention: Difficulty with staying on task, maintaining focus, and organization that isn’t attributed to a lack of understanding or being resistant to taking direction.
• Hyperactivity: Excessive movement (fidgeting or talking too much), especially in situations where it is inappropriate.
• Impulsivity: Engaging in risky or dangerous behavior, acting without thinking of the consequences, or having trouble controlling impulses.

However, not everyone experiences all 3 key behaviors. A diagnosis is based on symptoms of key behaviors that have occurred within the past 6 months.⁶ ADHD is diagnosed as one of three types: hyperactive/impulsive type, inattentive type, or combined type.⁶

Children who primarily illustrate 6 symptoms (5 for adults) of inattention are diagnosed with inattentive type ADHD. ⁶ Those with 6 symptoms (5 for adults) of hyperactivity and impulsivity would lead to a diagnosis of hyperactive/impulsive ADHD, while people who display a mix of all 3 behaviors would be diagnosed with a combined type. ⁶ Most children have the combined type of ADHD.¹

Who is at Risk of Developing ADHD?

Factors that can increase one’s risk for developing ADHD include: ^1,6

• Family history of ADHD.
• Alcohol, tobacco, or drug use during pregnancy.
• Exposure to environmental toxins during pregnancy or early childhood.
• Low birth weight or premature delivery.
• Injury to the brain.

ADHD is more commonly diagnosed in males but females with ADHD are more likely to have problems primarily with inattention.¹ Approximately 8.4% of children and 2.5% of adults are diagnosed with ADHD.⁶

Signs and Symptoms of ADHD

Though individuals may experience behaviors associated with ADHD in their everyday lives, an individual may be diagnosed with ADHD should they experience frequent, more severe symptoms for longer than 6 months.²

A person with ADHD often has difficulty controlling symptoms, which typically affect their ability to function socially, at school, or at work.^1,2,5 Signs and symptoms of ADHD can include:¹ 

Inattention:

• Overlooking details, making careless mistakes at work or in school.
• Not listening when being spoken to.
• Issues sustaining attention.
• Easily distracted.
• Forgetting things often.
• Problems organizing tasks, activities, materials or belongings.
• Avoiding tasks that include mental focus.

Hyperactivity-Impulsivity:

• Fidgeting and squirming often.
• Non-stop talking.
• Leaving their seats when expected to stay seated.
• Climbing or running around in situations where it is inappropriate.
• Inability to play in silence or engage quietly in hobbies.
• Issues waiting for their turn, often interrupts or intrudes others.

Approximately two-thirds of people who have ADHD are diagnosed with another condition.^1,2 The most common co-occurring conditions associated with ADHD include learning disabilities, anxiety and depression, obsessive compulsive disorder (OCD), bipolar disorder and substance use disorders.^1,2

What is a Substance Use Disorder?

Substance abuse occurs when alcohol or other drugs are used in a harmful or dangerous way.⁷ Substance abuse may lead to addiction and the development of a substance use disorder (SUD).⁸ An SUD involves a variety of physical, psychological, and behavioral symptoms that interfere with a person’s ability to function normally.⁹ A person is diagnosed with an SUD if they meet a specific number of criteria outlined by the DSM-5.⁹

In 2018, about 20.3 million Americans aged 12 or older had a substance use disorder.¹⁰ Of those, about 14.8 million had an alcohol use disorder and approximately 8.1 million had a drug use disorder.¹⁰ Addiction to drugs and/or alcohol is a chronic medical disease that can be successfully managed with professional treatment.¹¹

Treatment includes therapy provided in a variety of settings, such as individual, group, and family counseling to help participants overcome addiction and understand the behaviors that led to it in the first place.^11,12 Medication may also be added to the treatment regimen to manage symptoms of withdrawal or any additional underlying medical issues.^11,12

Because relapse rates are similar to other chronic medical illnesses (e.g., hypertension, diabetes), ongoing maintenance and long-term aftercare support are essential to managing a substance use disorder.¹¹

Co-Occurring Substance Use Disorder and ADHD

Often described as disorders of disinhibition, ADHD and co-occurring substance use disorder may share an underlying vulnerability.¹³ In addition, features of ADHD may contribute to the use of illicit drugs and alcohol abuse.¹³ When ADHD symptoms co-occur with those of a substance use disorder, the severity of impairment of each disorder is likely to increase.¹⁴ 

When compared to adults without ADHD, those with ADHD often are also diagnosed with additional mood disorders(e.g., anxiety, antisocial personality disorder) and are at an increased risk of substance abuse.¹⁵ Research shows that among the core ADHD behaviors, individuals displaying symptoms of hyperactivity/impulsivity are more likely to abuse illicit substances while those with inattention symptoms show a greater dependence on alcohol.¹⁵

Though the exact cause of ADHD is unknown, evidence supports dysfunction of the dopamine system may be partially responsible for the disorder.³ The development of a substance use disorder is also linked to dopamine, which suggests common factors that lead to co-occurring ADHD and substance use disorder.³

In some individuals, if ADHD isn’t treated, it can increase the risk of abusing substances as a way of managing symptoms.^16,17 This is known as self-medicating and may provide temporary relief but can ultimately exacerbate symptoms of either disorder.¹⁵

Among individuals already abusing alcohol or drugs, it is important to distinguish between an independent ADHD diagnosis versus a substance-induced impairment.¹³ Many psychoactive substances can cause similar effects that are seen in people with ADHD such as problem-solving issues, impulsivity or a lack of sustained attention.¹³

Treatment for ADHD and Substance Use Disorders

A co-occurring ADHD and substance use disorder can benefit from an integrated approach to treatment, which means that both conditions are treated simultaneously.^4,12 Left unmanaged, either condition could eventually worsen the treatment outcome of the other by increasing substance use or exacerbating the mental health symptoms. Developing a comprehensive treatment plan to address ADHD and drug and/or alcohol addiction helps individuals more effectively manage symptoms.^4,12,13

What is Detox and Withdrawal?

Medical detox is often the starting place on the road to recovery from alcoholism or drug addictions.¹² Symptoms of withdrawal can be unpleasant and—especially in the instances of benzodiazepine, opioid, or alcohol dependence—can be potentially dangerous when detoxing.^18,19

Benzodiazepine withdrawal symptoms may include panic attacks, hand tremor, heart palpitations, increased tension and anxiety, or more serious issues such as seizures and psychotic reactions.¹⁸ Signs and symptoms of opioid withdrawal include dysphoria, nausea, insomnia, abdominal cramping, fever, vomiting and diarrhea.²⁰

While detoxing from alcohol, symptoms withdrawal may cause individuals to experience impaired attention, visual and/or auditory hallucinations, and/or seizures.¹⁹ Proper medical management can help you stay as safe and comfortable as possible while dealing with the symptoms of withdrawal by easing any discomfort and/or addressing serious health conditions that may occur during the process.²¹

Levels of Care Within Treatment

Following the successful completion of detox, an inpatient or outpatient rehab program and long-term aftercare planning will help you work toward sobriety and the ability to successfully manage symptoms of ADHD.

Within an integrated treatment plan, psychotherapies may be used to treat both disorders.^13,16 Techniques that are especially helpful in treating co-occurring ADHD and an SUD are cognitive-behavioral therapy, motivational enhancement, and contingency management.^4,16 Incorporating self-help meetings such as Narcotics Anonymous and Alcoholics Anonymous may also further support recovery efforts.⁴

Medications to Treat SUDs and ADHD

Medication-assisted treatment can be helpful for those with a dual diagnosis.^12,13,16 In severe cases of alcohol withdrawal, pharmacological treatment is often employed including the use of FDA-approved benzodiazepines and barbiturates.^22,23

Other meds may be used within recovery programming to treat alcoholism such as disulfiram, naltrexone, and acamprosate.²⁵ For those struggling with opioid addiction, methadone, buprenorphine and naltrexone are effective pharmacotherapies.²⁴

The most prescribed medications for ADHD are stimulants which make it easier for nerve receptors in the brain to communicate with each other.² However, stimulant medications have a potential for misuse and diversion, so prescribers may utilize non-stimulant medications in cases of co-occurring SUD and ADHD.^3,13 If stimulants are used, prescribers may offer extended-release formulations or monitor use more closely.^3,13

Regardless of which prescription drugs are used, a combination of psychotherapeutic interventions and medications is suggested when treating individuals with ADHD and substance use disorders.⁴

Get Help Now

If you or someone you care about is struggling with co-occurring ADHD and substance use disorder, it may be time to seek professional help. American Addiction Centers (AAC) is a nationwide provider of addiction treatment specializing in evidence-based mental health care.

We are dedicated to making recovery accessible to every person in need and are available 24/7 to discuss your treatment options with you. Call our admissions navigators to learn more about our programs and how you can begin to work toward recovery today.

Struggling with a mental health issues and an addiction to drugs and/or alcohol is a lot to deal with on your own. We’re here for you and understand that making the call to get treatment can be scary. But we’ll be with you every step of the way, you’re not alone.

Sources

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2. National Alliance on Mental Illness. Attention deficit hyperactivity disorder.

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4. Mariani, J.J., & Levin, F.R. (2007). Treatment strategies for co-occurring ADHD and substance use disorders. The American Journal on Addictions, 16(Suppl 1), 45-56.

5. Centers for Disease Control and Prevention. (2020). What is ADHD?

6. American Psychiatric Association. (2017). What is ADHD?

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8. MedlinePlus. (2016). Drug Use and Addiction.

9. American Psychiatric Association. (2013). Diagnostic and Statistical Manual Of Mental Disorders (5^th ed.). Arlington, VA: American Psychiatric Publishing.

10. Substance Abuse and Mental Health Services Administration. (2019). Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health.

11. National Institute on Drug Abuse. (2018). The science of drug abuse and addiction: The basics.

12. National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (3rd edition).

13. Galán, C.A., & Humphreys, K.L. (2017). ADHD and substance use: Current evidence and treatment considerations. Psychiatric Times, 34(8), 1-3.

14. Miranda, A., Colomer, C., Berenguer, C., Roselló, R., & Roselló, B. (2016). Substance use in young adults with ADHD: Comorbidity and symptoms of inattention and hyperactivity/impulsivity. International Journal of Clinical and Health Psychology, 16(2), 157-165.

15. National Alliance on Mental Illness. (2017). Substance use disorders.

16. Harstad, E., & Levy, S. (2014). Attention-deficit/hyperactivity disorder and substance abuse. Pediatrics, 134(1), 293-301.

17. U.S. National Library of Medicine. (1994). The benzodiazepine withdrawal syndrome. Addiction;89(11):1455-9.

18. UpToDate. (2020). Management of moderate and severe alcohol withdrawal syndromes.

19. Substance Abuse and Mental Health Services Administration. (2006). Detoxification and Substance Abuse. Treatment Improvement Protocol. (TIP) Series, No. 45. HHS Publication No. (SMA) 15-4131.

20. Tarascon Publishing. (2019). Tarascon Pocket Pharmacopoeia, 2019 Deluxe Lab-Coat Edition.

21. Martin, K., Katz, A. U.S. National Library of Medicine. (2016). The Role of Barbiturates for Alcohol Withdrawal Syndrome. Psychosomatics; 57(4): 341-347.

22. American Family Physician. (2016). Medications for Alcohol Use Disorder.

23. Substance Abuse and Mental Health Services Administration. (2020). TIP 63: Medications for Opioid Use Disorder.

24. MedlinePlus. (2018). Opiate and opioid withdrawal.

25. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition.