Attention-deficit hyperactivity disorder, known as ADHD, is a mental health disorder estimated to affect at least 6.1 million children and adolescents in the United States alone. Adults can have it, too, as 30 to 60 percent of people diagnosed during their childhoods must manage it in adulthood.
ADHD typically presents as poor impulse control, trouble focusing or concentrating, and hyperactivity. People who have it may struggle with their academic or work performance and have challenges with interpersonal relationships.
“Adults with ADHD may have poor time management skills and trouble with multitasking, become restless with downtime, and avoid activities that require sustained concentration,” the U.S. Food and Drug Administration (FDA) writes.
While ADHD can’t be cured, it can be treated and managed. An ADHD diagnosis must come from a health care provider, who is required to consult with the American Psychiatric Association’s Diagnostic and Statistical Manual, Fifth Edition (DSM-5). This is done to confirm the symptoms and figure out the best course of action for the person affected.
ADDitude magazine reports that trouble with substance abuse for people with ADHD begins in adolescence. Rates of drug dependence and abuse spike from age 15 on, it reports. Many of the symptoms of ADHD prompt people to seek out mind-altering drugs and alcohol.
In addition to getting users high, these substances also help people cope with their ADHD symptoms. They also help users attempt to balance their brain chemistry, which may be uneven. One study found that ADHD is likely caused by a deficit of dopamine, a chemical that affects the brain’s pleasure and reward centers.
Another study, however, concluded something entirely different. It said having less gray matter in parts of the brain is the reason for the chemical imbalance.
Whether prescribed medications or illegal drugs are used, both kinds boost dopamine and get the person to focus. This is deemed beneficial to a person who struggles to concentrate on the task at hand. People who pick up drugs and alcohol to manage a mental illness are self-medicating. The illicit substances imitate what prescription medications do.
There is a problem with this, however. A person is at risk of developing a tolerance and a hard-to-break addiction while complicating their existing mental health disorder (which they may or may not know they have). This usually leads to more serious problems down the road.
So, what about those people who treat their ADHD with prescription medications that are part of their ADHD treatment? Are they at risk of developing an addiction, too?
Several sources say no, but it is the issue still isn’t as simple as black and white. First, it helps to understand what ADHD treatment is and what medications do.
Standard ADHD treatment can involve a combination of behavior therapy and medications. Behavior therapy teaches and reinforces positive behaviors to eliminate problem behaviors. Not everyone will receive behavior therapy; they may use medications only.
Medications are employed to help children and adults manage their symptoms. These include fidgeting, interrupting, and not completing tasks, among many others.
Several factors related to ADHD, not the treatment for it, can make someone more likely to develop a substance use disorder. These include environment and biology.
According to the Attention Deficit Disorder Association (ADDA), a genetic link for ADHD exists. When a close relative is diagnosed with the disorder, the risk factor for also struggling with it is between 40 and 60 percent.
The publication also says, “Half of all adults with untreated ADHD will develop a substance use disorder at some point in their lives,” ADDitude reported.
Now, let’s take a look at what kinds of medications are used to treat ADHD.
The FDA has approved several kinds of medications to treat ADHD in children as young as age 6. The drugs fall into two groups—stimulants and nonstimulants.
Stimulants, which speeds up the central nervous system, are the most widely used. WebMD explains that the medications boost the levels of certain brain chemicals, such as dopamine and norepinephrine, so nerve signals can communicate with one another.
“If you take them for ADHD, you’ll get slow and steady doses, just like your brain would create them naturally. That helps boost your energy, helps you pay better attention, and keeps you alert,” it writes.
According to the CDC, “Between 70-80 percent of children with ADHD have fewer ADHD symptoms when they take these fast-acting medications.”
Stimulant medications are categorized by how long they stay in the body. They can be short-acting, intermediate-acting, and long-acting.
Nonstimulants, the second group of drugs, were first approved for ADHD treatment in 2003. These medications do not work as quickly as stimulants do, but they last longer, up to 24 hours. They also are an alternative for children who can’t handle stimulants.
Three FDA-approved non stimulants are Strattera (atomoxetine), Intuniv (guanfacine), and Kapvay (clonidine). Bupropion is not an FDA-approved medication, but it has been studied for use during ADHD treatment, according to HealthyChildren.org. Its use, however, is not widespread, it says.
Possible side effects can accompany non stimulant use. A person using these meds may experience irritability, decreased appetite, and insomnia, among others. HealthyChildren.org says that at higher doses, bupropion may make some people more prone to seizures and hallucinations.
When it comes to whether taking ADHD medications can lead to addiction, observers have weighed in to offer their view. First, it must be noted that many people with the disorder benefit from taking medications appropriately. The drugs boost performance and give users what they need to manage their everyday lives.
Some studies, according to this New York Times article, suggest that treating ADHD with stimulant medications may actually cut the risk of developing a substance addiction.
WebMD writes that there is no evidence that taking ADHD drugs leads to such abuse, especially if the stimulants are taken in the doses that have been prescribed.
“In fact, studies have shown that people with ADHD who are treated with medication have lower rates of substance abuse than people with ADHD who are not treated,” it says.
“ADHD medication is not a gateway drug,” ADDitude writes in its medically reviewed article. “In fact, teens and adults who seek treatment for their ADHD symptoms are much less likely to abuse drugs and alcohol than are their undiagnosed, untreated counterparts.”
That doesn’t mean, however, that these drugs can’t be abused or that someone won’t abuse them. Two ADHD stimulant drugs, in particular, Adderall and Ritalin, are habit-forming and extremely addictive when used in ways that do not match what they were created to do.
They are popular among college students who use regard them as “smart drugs” or “study drugs” because they believe the drugs help them improve their academic performance. Recreational users may crush up or chew these drugs to get high. They may even pair the drugs with alcohol, a deadly combo.
Despite the perception that they are harmless, the reverse is true. Non-prescribed use puts people at risk of taking the medications in higher doses than they should. This can lead to overdose and death.
If you or a loved one has ADHD and a substance use disorder, this means you likely have a co-occurring mental health disorder. It is very common for people to have both. An estimated 8.1 million adults — or 3.3 percent of all U.S. adults — had a mental illness and a substance use disorder in the past year, says the 2015 National Survey on Drug Use and Health.
It is highly important that you find a professional and specialized treatment program that addresses your ADHD and substance use disorder (SUD). This is highly recommended as it’s important to treat both at the same time. This gives dually diagnosed people the best chance at recovery.
Should you choose to get professional treatment, you will start with medical detoxification. This medically monitored procedure ensures that all addictive substances and toxins are removed from your system. If any complications arise during your withdrawal, medical professionals will be there to help you manage them safely and comfortably 24/7. Medical detox also helps reduce the risk of relapse and overdose. Many people want to stop using, but the unbearable cravings keep them in a deadly cycle.
When detox is done, a program is chosen to help you start recovery. You may enroll in a residential program which will provide you with ongoing therapy and counseling at a treatment facility. During your time at the facility, you can attend therapies that can help you get your mental and emotional health in check.
You will work with mental and addiction specialists, who will teach you coping skills and mental health education that supports your sobriety. You also will have access to aftercare services, including a program for graduates who have completed treatment. These programs connect you with a supportive community that understands recovery and what it means to stay true to one’s goal of full-time sobriety.
(September, 2018). Attention-Deficit / Hyperactivity Disorder (ADHD). Centers for Disease Control and Prevention. from https://www.cdc.gov/ncbddd/adhd/data.html
Board, ADHD Editorial. “ADHD Statistics.” ADDitude, ADDitude, 13 Aug. 2019. from https://www.additudemag.com/statistics-of-adhd/
(February/March 2007). The Truth About ADHD and Addiction. ADDitude. from https://www.additudemag.com/the-truth-about-adhd-and-addiction/
(2018). ADHD the Facts. ADDA. from https://add.org/adhd-facts/
Commissioner, Office of the. “Dealing with ADHD: What You Need to Know.” U.S. Food and Drug Administration, FDA. from https://www.fda.gov/consumers/consumer-updates/dealing-adhd-what-you-need-know
Volkow, Nora D. “Evaluating Dopamine Reward Pathway in ADHD.” JAMA, American Medical Association, 9 Sept. 2009. from https://jamanetwork.com/journals/jama/fullarticle/184547
Campo, et al. “Positron Emission Tomography Study of Nigro-Striatal Dopaminergic Mechanisms Underlying Attention: Implications for ADHD and Its Treatment.” OUP Academic, Oxford University Press, 25 Oct. 2013. from https://academic.oup.com/brain/article/136/11/3252/325092
“Fewer Prescriptions for A.D.H.D., Less Drug Abuse?” The New York Times. from https://www.nytimes.com/roomfordebate/2012/06/09/fewer-prescriptions-for-adhd-less-drug-abuse/adhd-medications-are-not-gateway-drugs
Johns Hopkins University. (Feb. 16, 2016). “Adderall Abuse on the Rise Among Young Adults, Johns Hopkins Study Suggests.” from https://hub.jhu.edu/2016/02/16/adderall-abuse-rising-young-adults/
“Non-Stimulant Medications Available for ADHD Treatment.” HealthyChildren.org. from https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/Non-Stimulant-Medications-Available-for-ADHD-Treatment.aspx.