SUD Risk Is Elevated by ADHD
ADHD increases a patient’s risk for substance use disorder; this is well established. However, not enough providers understand both attention deficit and SUD or behavioral compulsions, thus impeding effective treatment.
The ADHD brain exhibits a need for extraordinary stimulation, which heightens the risk for alcohol and substance misuse, especially among people with untreated ADHD.1 Substance use disorder is among the most problematic co-occurring conditions for people with ADHD. Some researchers speculate that up to a quarter of people with addiction issues have undiagnosed ADHD.2
Substance use disorder (SUD) usually begins in adolescence or early adulthood. The overlap between ADHD and SUD, as well as other co-existing conditions (such as depression, anxiety, and post-traumatic stress disorder), is relevant to clinical practice. However, not enough of the providers treating patients for SUD or behavioral compulsions are also experts in ADHD.
Why? Addiction care attracts fewer providers for various reasons, including the lack of educational training around substance abuse and the difficulty in managing people with SUD. Patient care is fragmented, even fractured, as a result. A good search for help starts at the department of psychiatry at a nearby medical school.
The SUD-ADHD Connection
Why is SUD more common among people with ADHD? The link is unclear, though researchers speculate that abnormalities in the limbic/reward systems in ADHD brains may account for the increased risk.
In simple terms, I believe addiction is largely caused by what I call “the itch at the core of ADHD.” What do I mean by this? Many people with ADHD find that reality isn’t stimulating enough to hold their attention. They look for ways to pump up the volume. Some have called this “reward deficiency syndrome,” by which the individual feels compelled to create extraordinary simulation to find ordinary pleasure.
Not too long ago, the best treatment available for SUD was a 12-step rehabilitation program. However, the success rate (if you define success as sober after one year) was only 15%. Today, the success rate has climbed to 70% with the advent of medication-assisted treatments. These include buprenorphine, which can assist in withdrawal from street opiates, and Vivitrol, an injectable form of naltrexone, which blocks opiate receptors to reduce cravings. Also contributing to the higher success rate: harm reduction programs — community initiatives that help users stay safe and sober, and/or reduce substance use in a controlled setting — and treatment with cognitive behavioral therapy.
For people prone to substance misuse, and looking to “scratch that itch,” I recommend finding safe and constructive ways to create stimulation. Some suggestions include starting a business, writing a book, growing a garden, or building a boat.
SUD is one of the cruelest examples of bait-and-switch that life can offer. What begins as a taste of paradise soon turns into a land of torment and sometimes even near death. It’s important for caregivers and adolescents to talk about the dangers of addiction. An ADHD diagnosis coupled with medication taken consistently to treat it, may help protect against SUD.
SUD & ADHD: Next Steps
- Read: The ADHD & Addiction Link
- Q&A: “Is ADHD Medication Safe If You Have a History of Substance Abuse?”
- Free Download: What to Ask Before Starting an ADHD Medicine
Ned Hallowell, M.D., is the founder of the Hallowell Center for Cognitive and Emotional Health. His latest book is ADHD 2.0: New Science and Essential Strategies for Thriving with Distraction — from Childhood Through Adulthood, written with John J. Ratey, M.D.
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1Zulauf, C.A., Sprich, S.E., Safren, S.A., Wilens, T.E. (2014). The Complicated Relationship Between Attention Deficit/Hyperactivity Disorder and Substance Use Disorders. Curr Psychiatry Rep. (3):436. https://doi.org/10.1007/s11920-013-0436-6
2van Emmerik-van Oortmerssen, K., van de Glind, G., van den Brink, W., Smit, F., Crunelle, C.L., Swets, M., Schoevers, R.A. (2011). Prevalence of Attention-Deficit Hyperactivity Disorder in Substance Use Disorder Patients: A Meta-Analysis and Meta-Regression Analysis. Drug Alcohol Depend. 122(1-2):11-9. https:doi.org/10.1016/j.drugalcdep.2011.12.007