Attention deficit hyperactivity disorder (ADHD) is a lifelong mental condition that affects how a person understands and interacts with the world. Mental health conditions like this, and many others, can cause stress and sadness when the individual has a hard time being part of the world around them. This, in turn, can lead to substance abuse problems. With high levels of both ADHD and substance use disorder (SUD) represented across the population, it is important for clinicians to know how and why these two conditions overlap.
What Is ADHD?
ADHD is a disorder of the brain characterized by inattention, cognitive trouble, and impulsivity issues. About 3 million people every year reportedly have ADHD; about one in 10 children, between the ages of 5 and 17 years old, receive a diagnosis of ADHD. It is one of the most common childhood disorders, although some people do not receive a diagnosis for this condition until they are adults. There are three primary issues displayed by those who have ADHD.
- Inattention: The individual is unable to focus on tasks, wanders away from tasks, lacks persistence to complete projects, and struggles with being disorganized. These problems have nothing to do with being defiant toward authority or a lack of understanding.
- Hyperactivity: The person moves around constantly, has a large amount of physical energy that is unused, and has trouble physically controlling themselves even when it is inappropriate to move about in certain situations. In adults, this may manifest as extreme restlessness.
- Impulsivity: The individual will make hasty choices or perform actions without fully thinking them through. The person may have trouble being patient, desire a reward immediately, or have trouble delaying gratification. This may put them at increased risk for harm, especially adolescents or adults who become involved with addictive substances.
Types of ADHD may involve more symptoms related to inattention or hyperactivity and impulsivity. When they are diagnosed with ADHD, most children have combined types. If the condition is not diagnosed in childhood, however, adults with untreated ADHD will struggle much more with school, employment, and social interactions. This can impact the person’s self-esteem and sense of wellbeing.
To receive a diagnosis of ADHD, a person must see a medical professional who has experience diagnosing and working with people who have the condition. Symptoms of hyperactivity, inattention, and impulsivity must have occurred or recurred consistently for a long time and cause the person to fall behind developmentally based on their age. Most medical professionals require symptoms reported by adolescents and children to have been present for most of their lives, usually prior to age 12. The doctor will ask questions and perform some physical examinations to rule out any potential underlying cause that might have brought these symptoms forward.
Like any mental health disorder, ADHD is not caused by any one specific thing; instead, it’s caused by a combination of several factors and potential triggers. Some of these include:
- Cigarette smoking or alcohol use during pregnancy
- Exposure to other environmental toxins during pregnancy
- Low birth weight
- Exposure to lead or other toxins at a young age
- Brain injuries at a young age
As a person ages, symptoms from ADHD will change over time. Young children tend to display more hyperactivity and impulsivity symptoms while attention difficulties will become more apparent once the child enters school. Adolescents with undiagnosed ADHD will have trouble interacting with their peers and may develop antisocial behaviors to compensate. Leading into adulthood, symptoms of ADHD, especially untreated, may include:
- Chronic forgetfulness
- Frequently tardy or late
- Low self-esteem
- Difficulty in professional or job environments
- Trouble controlling anger
- Frequently frustrated
- Consistent boredom
- Mood swings
- Trouble maintaining relationships
- Substance abuse
A combination of prescription stimulants and psychotherapy has shown the most effectiveness in treating most people with ADHD. While people who have been diagnosed with ADHD have great medical treatments available to them, those who do not have an official ADHD diagnosis but struggle with symptoms may use drugs or alcohol to self-medicate. This is especially true if the person has developed a secondary mood disorder, like depression or anxiety, due to constant stress and social pressure.
What Is Substance Abuse, and How Does It Relate to ADHD?
Addiction, according to the American Society of Addiction Medicine (ASAM), is a chronic disease of the brain, which involves changes in neurotransmitter release and absorption, affecting the reward center of the central nervous system. Spikes in dopamine and serotonin release caused by intoxicating substances like alcohol, heroin, or cocaine can lead a person to compulsively seek out and consume these substances.
Like other mental health and behavioral conditions, there is no one root cause of addiction; instead, a combination of genetics, environment, family history, and exposure to drugs or alcohol can influence whether or not a person becomes addicted to a substance. Mental health problems put people at a much greater risk for developing a substance use disorder because they may subconsciously attempt to self-medicate their symptoms. The Substance Abuse and Mental Health Services Administration (SAMHSA) found that, in 2014, there were 7.9 million adults over the age of 18 in the US who had reported co-occurring disorders. This includes those with ADHD and substance abuse issues.
How Do ADHD and Substance Abuse Interact?
A 2014 study originally published in Current Psychiatry Reports stated that substance abuse typically develops in adolescence, with about 9 percent struggling with drug abuse and 6 percent developing alcohol use disorder. This leads to about 30 percent of adults in the US struggling with some form of addiction or substance use problem. About 5 percent of adults and 6-9 percent of children worldwide have diagnosed ADHD. Children with ADHD are twice as likely to develop a comorbid SUD compared to the general population, and nicotine dependence was one of the most reported substance problems among those with ADHD.
The study also reported that adolescents with ADHD often abused central nervous system (CNS) depressants to attenuate their mood and even to help them calm down enough to sleep. Some evidence suggests that structural abnormalities present in the brain of a person with ADHD could put them at greater risk for developing a SUD if they begin to impulsively abuse drugs or alcohol. One survey suggested that about 25 percent of adults who struggle with ADHD have comorbid alcohol or drug abuse problems.
Some parents worry that getting their children medical treatment with prescription stimulant drugs will put them at risk for developing later substance use disorders. If the child does not receive appropriate therapeutic attention from a psychotherapist or counselor, this may occur; however, adolescents and adults with ADHD are not likely to abuse their medications if they begin treatment at an early enough age.
Long-Term Harm from Both ADHD and Substance Abuse
The general consensus among medical professionals is that ADHD develops in childhood, and it is important to diagnose and begin treatment during childhood. Too many adults have not received an appropriate diagnosis. In addition to consistently feeling frustrated, disappointed, and angry with themselves and the world around them, these adults are at greater risk for developing substance abuse problems.
ADHD is 5-10 times more common among those who struggle with alcohol use disorder than the general population, suggesting that many people begin to self-medicate their ADHD symptoms along with mood disorders like bipolar disorder, anxiety, and depression, which are common secondary mental health conditions that are triggered by untreated ADHD in adults. By 15 years old, about 40 percent of adolescents with ADHD have started abusing alcohol. Substance abuse will continue into adulthood and may get worse. People who struggle with untreated ADHD are more likely to develop chronic health problems and life-threatening disorders due to substance abuse. These include:
- Cardiovascular damage
- Stroke, pulmonary embolism, blood clots, or heart attack
- Infectious diseases like pneumonia, tuberculosis, HIV, and hepatitis B or C
- Lung damage and disorders
- Kidney and liver failure
- Gastrointestinal damage like ulcers or heart burn
- Brain damage, especially damage to memory and cognition
Treating Comorbid Substance Abuse and ADHD
Due to the prevalence of untreated ADHD among those struggling with alcohol use disorder and other substance abuse problems, it is important for rehabilitation programs to have appropriate psychologists and psychiatrists on staff to diagnose this condition as a potentially underlying cause of the substance use disorder. They can then prescribe psychostimulants in small doses and get the individual appropriate therapy for both substance abuse and ADHD.
Cognitive Behavioral Therapy works well for both conditions. Psychiatrists can monitor the individual for signs of prescription drug abuse, but if ADHD symptoms are being successfully alleviated with prescription substances, it is unlikely that the individual will relapse into drug-seeking behaviors. Medications alone are not enough, however; help through a rehabilitation program and consistent sessions with a therapist are the primary forms of treatment for both drug addiction and ADHD.