ADHD & Substance Use: Understanding the Connection

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects millions of individuals worldwide. It is primarily characterized by persistent patterns of inattention, hyperactivity, and impulsivity. These characteristics vary from person to person, but they often create challenges in both personal and professional life. Here’s a breakdown of each: 

• Inattention: Difficulty focusing on tasks requiring sustained mental effort. People often get easily distracted, struggle with organization, lose important items, or make careless mistakes. 

• Hyperactivity: Excessive movement and inability to remain still. This may involve fidgeting, talking excessively, or feeling restless during tasks that require prolonged sitting or concentration. 

• Impulsivity: Acting quickly without considering consequences. People with impulsivity may blurt out thoughts, interrupt conversations, or make hasty decisions that provide immediate satisfaction but could cause long-term problems. 

The Link Between ADHD and Substance Use 

Research consistently shows that individuals with ADHD are at a higher risk of substance use than neurotypical individuals. Several factors contribute to this elevated risk:  

•  Impulsivity and Risk-Taking Behavior: The impulsivity that accompanies ADHD is often associated with risk taking behavior. Individuals may have trouble recognizing the long-term consequences of substance use. Impulsive behavior is often driven by a need to feel pleasure and can feel uncontrollable. This impulsivity increases the likelihood of experimenting with substances, especially during adolescence. 

• Self-Medication: Individuals with ADHD may turn to substances like alcohol, cannabis, or stimulants to self-medicate. These substances can temporarily ease restlessness or enhance focus, but they can also worsen ADHD symptoms over time. For example, alcohol may seem to calm hyperactivity, while stimulants like cocaine may appear to help with concentration. However, the long-term impact is often harmful. 

• Dopamine Irregularities: ADHD is linked to irregularities in the brain’s dopamine system, which is responsible for pleasure and reward. It also plays a role in mood, attention, motivation and movement. In short, dopamine irregularities can lead to difficulty experiencing pleasure or feeling motivated without external stimuli. Many substances trigger an increase in dopamine release causing the individual to have temporary relief and gratification and finally ‘’feel normal’’. 

The Coexistence of ADHD with Other Mental Health Conditions 

Individuals with ADHD can face difficulties in their everyday life that make it more challenging to function effectively in social or occupational contexts. Whether it be academically, professionally or socially, these struggles can lead to low self-esteem and a sense of failure. These feelings of inadequacy tend to push the individual to want to numb their pain with substances. The use of substances makes them feel more in control and more normal. 

ADHD often coexists with other mental conditions such as anxiety, depression and oppositional defiant disorder, to name a few. The combination of ADHD with other mental health challenges can lead to feelings of inadequacy and a strong drive to self-medicate. The combination of these conditions heightens the risk of turning to substances to cope: 

• Depression and Substance Use: People with ADHD and depression may use alcohol or drugs to numb emotional pain. 

• Anxiety and Substance Use: Those with anxiety may turn to substances to ease feelings of tension or unease. 

The Importance of Early Intervention and Treatment 

Treating ADHD at a younger age can significantly reduce the risk of developing a substance use disorder. Early intervention may delay the onset of substance use and improve overall outcomes. Here are some critical steps to consider: 

• Medication Management: The medications most widely prescribed for ADHD are controlled substances such as Ritalin and other stimilants. Simply put, this means that they have the potential to lead to abuse and addiction when not taken as prescribed.  

• Behavioral Therapy: Cognitive Behavioral Therapy (CBT) is an essential tool in managing impulsivity and developing healthier coping mechanisms. It helps individuals recognize negative thought patterns and teaches strategies to manage impulsive behaviors. 

Some people assume that it’s risky to take medications. In truth, it’s the opposite; : people with ADHD who take medications as prescribed are less likely than their untreated counterparts to drink or misuse drugs. Studies have shown that individuals who are treated with stimulant medications during childhood and adolescent are less likely to engage in substance use compared to those who do not receive treatment. Put another way, treating ADHD effectively is powerful protection against substance misuse. 

Building a Healthy Lifestyle 

Treating co-existing mental health disorders is essential. This can help reduce the overall risk of substance use by addressing the underlying emotional distress that may drive individuals to develop self-medicating behaviors. Building a healthy lifestyle can significantly reduce the risk of substance use by addressing core symptoms: 

• Physical Activity: Exercise helps improve attention and reduce hyperactivity by providing an outlet for excess energy. 

• Nutrition: A balanced diet rich in whole grains, lean proteins, fruits, and vegetables supports brain function and mood regulation. Reducing sugar and processed food can also improve focus and emotional stability. 

• Adequate Sleep: ADHD symptoms, such as impulsivity and emotional dysregulation, can worsen without proper rest. Prioritizing quality sleep helps with emotional well-being and mental clarity. 

ADHD symptoms may also improve with simple activities such as deep breathing and meditation. These tools tend to help with stress management and focus. 

Having a strong support system is vital. For individuals with ADHD, having caring people to help monitor for signs of trouble can be very helpful. This support can come from family members, friends, professionals and community or online support groups. A strong support system provides emotional stability, guidance and even accountability. It can offer positive reinforcement and encourage healthy coping strategies. 

Mindfulness and Cognitive Behavioral Therapy (CBT) for ADHD 

CBT and mindfulness practices can help provide skills to manage ADHD symptoms. CBT can help individuals control impulsive behavior by teaching them to address and manage their thoughts in a healthy way. Here is how: 

• CBT: This therapeutic approach teaches individuals to challenge and change their thought patterns. For those with ADHD, CBT helps control impulsive actions and foster a healthier perspective. By learning to develop healthier thoughts and beliefs, people can better manage stress and anxiety. 

• Mindfulness Meditation: By focusing on the present moment, mindfulness can help individuals with ADHD regulate emotions, reduce impulsivity, and stay grounded. 

Education and Awareness: Key to Prevention 

Education and awareness on ADHD in general can be a powerful ally in the fight against substance misuse. Understanding symptoms will help individuals recognize and manage symptoms as they arise, thus reducing the likelihood of reaching for substances to cope. Education reduces the stigma around ADHD, encouraging individuals to seek help without fear of judgement.  

Being informed empowers individuals to advocate for themselves and seek appropriate accommodations to help them succeed and be less tempted to numb their emotions with external stimuli. It also provides knowledge to make healthier personal choices and helps prevent individuals from getting into high-risk situations. 

Individuals with ADHD should be aware of environments or social groups where substance use is prevalent and avoid them when possible. Educating people to build strong decision-making skills, learn to say no to peer pressure, and practice assertiveness makes it less likely they will be caught off guard.  

While individuals with ADHD present a higher risk for substance use, it does not mean that they will misuse substances. With the right approach, people with ADHD can lead fulfilling lives free from substance misuse. The best way to achieve this outcome is with a comprehensive plan that includes combination of medication, behavioral interventions, therapy, and a healthy lifestyle.   

ALAViDA helps individuals change their relationship with any substance through confidential, on-demand resources & coaching. Our TRAiL Pathway provides a comprehensive and supportive journey to quit smoking or using substances. From evidence-based strategies and interactive activities to a personalized care team, we’re here to help every step of the way. 

For more information, you can access it on the TRAiL. 

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About the author: 

Julie Perkins is a trained nurse and virtual coach and substance disorder subject matter expert at Alavida, a product of Lifespeak Inc. She has experience in a wide range of hospital settings, including emergency care, pediatrics and trauma. She has worked as a nurse with the Correctional Service of Canada since 2010, where she specializes in the care of federally incarcerated individuals experiencing mental health and substance abuse issues. She is currently the nurse responsible for ADHD screening and monitoring in the establishment. In her role, she implemented the Smart Inside Out program, a CBT-based program for substance use disorders in correctional settings, and leads weekly meetings for prisoners on issues related to addictions