Attention deficit hyperactivity disorder (ADHD) is one of the most commonly diagnosed developmental disorders in children and adolescents (Drechsler and Brem), with many PubMed journal articles putting the prevalence number between 5% and 8%. While this statistic might seem a bit dry or standalone at face value, let’s take a second to look at what it really means.
It means that roughly 1 in every 16 children or teens that you see has a neurodevelopmental condition with the potential to seriously affect their day-to-day lives. It means they live with a condition that can cause forgetfulness, a lack of impulse control, poor emotional regulation, low self-esteem, feelings of frustration or inadequacy, and put them at greater risk of anxiety and depression. For some, it means being branded lazy, uninspired, or dumb– no matter the effort they put in; and for others, it means an untimely end as ADHD positively correlates with suicidality in all sexes and age groups (Balazs and Kereszteny).
When a child or adolescent is clinically diagnosed with ADHD, their parents, teachers, and broader support network can step in with understanding and accommodations; however, what happens to the millions around the world who never have this opportunity? What happens when an I-don’t-fit-in teen, on-suspension-again teen, or loser-with-no-future teen gets exposed to sex, drugs, and alcohol as they grow up?
The expected happens.
Exploring the Links Between ADHD and Substance Misuse
A 2007 study on treatment strategies for co-occurring ADHD and substance use disorders by Mariani and Levin states that an estimated 60% of childhood cases go on to have clinically significant symptoms of ADHD as adults. It also found that ADHD is a common co-occurring mental disorder among patients receiving treatment for substance use disorders (SUD), with 10.8% of those with a confirmed SUD meeting the criteria for adult ADHD, compared to 3.8% in adults without a history of substance abuse. When looking at patients with diagnosed ADHD, 15.2% of individuals met the criteria for a SUD, compared to 5.6% in individuals without ADHD. Both of these findings reflect a roughly tripled chance of being diagnosed with either ADHD or a SUD if either one of these conditions develop at any point in their lives.
Although we don’t fully understand the exact causes of ADHD, we do understand that it is connected to dopamine. Pharmacotherapy studies have shown that stimulant medications that increase dopamine levels can effectively treat ADHD symptoms, genetic studies have linked dopamine genes to ADHD, and imaging studies have revealed structural abnormalities in regions of the brain with concentrations of dopamine-producing neurons (Mariani and Levin). Since we accept that dopamine regulation plays such an important role in the development of SUDs, there could be common factors contributing to the 3-times higher co-occurrence rate between ADHD and SUDs.
One theory that explores the link between ADHD and substance abuse attributes the increased co-occurrence to narcotics replicating the effect of ADHD medication in the short term. ADHD stimulants work by affecting an underactive cerebral cortex, stimulating it to release neurotransmitters. When an individual with ADHD uses drugs, they might experience clarity in the short term; however, repeated use will negate any positive effects and soon lead to the development of a SUD.
It’s important to remember that ADHD develops at an early age and is generally diagnosed at around the age of 7, while substance abuse often starts developing during adolescence and early adulthood. Mariani and Levin suggest that the increased co-occurrence can be seen as the product of the developmental interaction with ADHD symptoms (such as impulsivity or behaviour dysregulation) and the consequences of ADHD (such as poor academic performance or low self-esteem), creating an ideal environment for a SUD to develop. During these vulnerable years, early identification and treatment for both ADHD and SUD are important to improve long-term outcomes.
Preventing Future Substance Misuse in ADHD Patients
For parents of children with ADHD
Benjamin Franklin said that nothing in life is certain except death and taxes. This rings especially true for something as complex as human behaviour in an unknown future. If you’re reading this as the concerned parent of a child with diagnosed or suspected ADHD, being aware of their condition and the associated risks is half the battle. While this doesn’t bring you any closer to a guaranteed outcome, it puts you in a position where you can best foresee problems, understand how to react, and best support your child with whatever difficulties they face.
From a medical point of view, there is actually some good news. A meta-analytic review of stimulant therapy on youths with diagnosed ADHD shows a near-50% reduction in risk for developing a SUD, as well as reduced odds of developing alcohol or drug dependence (Wilens et al.). In other words, effective early detection of ADHD and stimulant treatment for the symptoms of ADHD are associated with a reduction in risk for substance misuse or alcohol dependency disorders later in life. That being said, medical treatment for the symptoms of ADHD in children typically takes a back seat to behavioural therapy.
Behavioural therapy aims to learn and strengthen positive behaviours while identifying and correcting problematic behaviours, and programmes are available for both children with ADHD and their parents. For the parents, this includes training that focuses on skills and strategies that use positive reinforcement, structure, and consistent discipline to manage their child’s behaviour, while children with ADHD might see a cognitive behaviour expert that helps them change their thoughts and emotions that negatively affect their behaviour. Behavioural interventions in the classroom can also help a developing mind distinguish between right and wrong social behaviours (CDC).
The CDC also recommends that behaviour therapy be the first step in helping a child with ADHD reach their full potential. Not only did they find that parent training in behaviour management works as well as medication for ADHD in young children in helping correct problematic behaviour, but they also found that young children suffer more of the side effects of ADHD medications than older children.
At this point, we can start seeing how correcting and avoiding negative behaviours in children with ADHD can help them avoid many of the consequences of untreated or undiagnosed ADHD. If a young, growing human can avoid feelings of low self-esteem, doesn’t fall behind academically, and doesn’t have feelings of self-doubt or inadequacy, they’ll have a much greater chance of growing up happy and healthy and avoiding the pitfalls of substance abuse and dependencies.
If you would like to join a support group for parents of children with ADHD, please consult the AADD-UK Help and Support page. You will find contact details for various support groups around the country.
For adults living with ADHD
If you are an adult living with ADHD and reading this because you wish to understand your situation a bit better, we’d first like to commend you for taking the time to read this article. The topics discussed in this article aren’t exactly common knowledge, but understanding the links between ADHD and substance misuse allows you to make more well-informed decisions regarding drug and alcohol use, especially when it comes to the potential risks involved.
If you suspect that you are on your way to developing a substance use disorder, routinely drink or take drugs as part of your everyday life, or find yourself increasingly preoccupied with drugs or alcohol, please consider either seeking professional assistance or mutual aid such as support groups. With a 3-times higher chance of developing a SUD, being open and honest about your substance use now could potentially save you from a lifetime of suffering from substance addiction.
The AADD-UK Help and Support page also features contact information for support groups for adults living with ADHD.
Gladstones Clinic Drug and Alcohol Rehab Programmes
At Gladstones Clinic, we understand that everyone in the grip of addiction is fighting their own unique battle. In the context of ADHD and substance misuse, we offer an empathetic and comprehensive approach built around each patient’s unique needs. Our skilled and qualified medical personnel are proficient at diagnosing ADHD in substance abuse patients where it is suspected, ensuring that it is factored into their personalised recovery plan and not overlooked as a contributing factor. We also provide family therapy sessions for adolescent and teenage patients. These sessions help families understand substance abuse and how to deal with it moving forward, as well as provide valuable information on how ADHD fits into the picture.
Gladstones Clinic has been providing high-quality addiction rehab services to patients suffering from a wide range of addictions for more than 20 years. Our residential facilities in London and the Cotswolds are perfectly suited to facilitate the recovery process, with everything you could possibly need to make your stay as comfortable and productive as possible. Our evidence-backed addiction treatments and therapies have been honed over decades, contributing to a long-term success rate that we’re proud of.
If you or your loved one needs professional help or advice in dealing with addiction, we invite you to reach out to us. You can contact us at 0808 258 2350 or directly through our portal. Let us guide you on this journey towards a healthier, addiction-free life.
Learn more about Gladstones Clinic’s Rehab Programmes, Locations, or Treatment Services.
Works Cited
Balazs, J., and A. Kereszteny. “Attention-deficit/hyperactivity disorder and suicide: A systematic review.” World J Psychiatry, vol. 7, no. 1, 2017, pp. 44-59. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5371172/. Accessed 04 07 2023.
Drechsler, R., and S. Brem. “ADHD: Current Concepts and Treatments in Children and Adolescents.” Neuropediatrics, vol. 51, no. 5, 2020, pp. 315-335. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7508636/. Accessed 04 07 2023.
Mariani, John J., and Frances R. Levin. “Treatment strategies for co-occurring ADHD and substance use disorders.” The American Journal on Addictions, vol. 16, 2007, pp. 55-56. National Library of Medicine, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676785/. Accessed 04 07 2023.
“Treatment of ADHD | CDC.” Attention-Deficit / Hyperactivity Disorder (ADHD), Centers for Disease Control and Prevention, https://www.cdc.gov/ncbddd/adhd/treatment.html. Accessed 4 July 2023.
Wilens, TE, et al. “Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature.” Pediatrics, vol. 111, no. 1, 2003, pp. 179-185. National Library of Medicine, https://pubmed.ncbi.nlm.nih.gov/12509574/. Accessed 04 07 2023.
