Intoxicants are risky business if you have attention deficit disorder (ADHD). A recent survey found that more than 15 percent of adults with the disorder had abused or were dependent upon alcohol or drugs during the previous year. That's nearly triple the rate for adults without ADHD. Alcohol and marijuana were the substances most commonly abused.
“Abuse isn't about how much you're doing or how often it happens. It's about how your use affects your relationships, health, work, school, and your standing with the law,” says Wendy Richardson, a marriage and family therapist and certified addiction specialist in Soquel, California. “If you have difficulties in these areas and you keep on using, you definitely have a problem.”
Why is substance abuse such an issue for adults with ADHD?
“In our study of young adults, only 30 percent said they used substances to get high,” says Timothy Wilens, M.D., associate professor of psychiatry at Harvard Medical School in Boston. “Seventy percent are doing it to improve their mood, to sleep better, or for other reasons.” This kind of “self-medication” seems especially common among individuals whose ADHD remains undiagnosed, or who have been diagnosed but have never gotten treatment. “When people with ADHD get older, the hyperactive component often diminishes,” says William Dodson, M.D., an ADHD specialist in Denver. “But inside, they’re just as hyper as ever. They need something to calm their brain enough to be productive.”
That was the case for Beth, 27, a special education teacher in Ft. Wayne, Indiana. In college, she recalls, “My mind was so out of control, and drinking would make that go away. I didn’t drink to get smashed, but to concentrate and get my homework done.” Drink eased other ADHD miseries, too. Says Beth, “The boredom was impossible. I could be sitting in an interesting lecture and be totally bored. When I drank, I didn’t care that I was bored.”
The impulsivity, poor judgment, and social awkwardness that often come with ADHD pave the way to overindulgence, regardless of the consequences. Jennifer, 29, of Fayetteville, Arkansas, felt that having ADHD made it hard for her to fit in — except with the crowd that smoked marijuana. “They accepted me,” she says. “I used to think, ‘They don’t care if I’m a little crazy, if I don’t finish sentences, and walk out of the room while they’re talking.’”
There are other ADHD-related factors that can raise the risk for substance-abuse problems. Compared to people without the disorder, those with ADHD are often less successful academically. Fewer graduate from high school and college, and they earn less money.
Biology is another factor. “There’s an increased rate of substance-use disorders in close relatives of people with ADHD,” says Dr. Wilens. Genes associated with risk-taking and novelty-seeking behavior may predispose an individual to both ADHD and substance abuse.
Whatever the explanation, trouble usually starts in adolescence; until age 15, ADHDers are generally no more likely than non-ADHDers to experiment with drugs. From this age on, rates of abuse and dependency skyrocket. Half of all adults with untreated ADHD will develop a substance use disorder at some point in their lives.
In adulthood, any major life change can mean increased risk. “Starting a new job, or having a child may activate a genetic vulnerability,” says Richardson.
Preventing the Problem
The medications most widely prescribed for ADHD, methylphenidate and amphetamine, are controlled substances — meaning they have the potential to lead to abuse and addiction. Because of this, some people assume that it’s risky to take these drugs. In truth, it’s the opposite: ADHDers who take these medications as prescribed are less likely than untreated ADHDers to drink or abuse drugs. Put another way, treating ADHD effectively is powerful protection against substance abuse.