By Martha McLaughlin

There is a strong relationship between addiction and attention deficit hyperactivity disorder (ADHD). An article in the journal Alcohol and Alcoholism notes that studies have found the lifetime risk of addictive illness among ADHD patients to be double that of those without the condition.1

Although the correlation is clear, the reasons for it are less so. There are a number of theories and possibilities, which may vary with patient characteristics. Possible reasons for the increased risk of addiction among ADHD patients include the following:

    • Impulsivity — a primary ADHD symptom — may lead to increased experimentation with addictive substances. Alcohol and Alcoholism notes that it is “fairly evident” that ADHD patients are more reckless with drugs and alcohol than others are, which explains their greater consumption of drugs considered high-risk.

      The study found that, among people suffering from drug addiction, those with ADHD start using substances earlier and experiment more freely than individuals without the ADHD component. The tendency to make quick decisions without fully considering possible consequences may be a contributing factor.

 

    • Drugs used to treat ADHD may prime the brain for abuse of other substances. Animal studies have shown that use of the ADHD drug Ritalin can lead to an increase in drug-seeking behavior. The fact that most drugs used to treat ADHD are stimulants and controlled substances is reason for many to approach ADHD medications with caution.

      Proponents of treating ADHD with stimulant medications note that animal studies often use much higher doses of the medication than is used for treating ADHD in humans. Some human studies have found an increased risk of substance abuse in patients who were treated with ADHD drugs, and others have found the opposite – that early ADHD treatment reduces the risk of later substance abuse.

      WebMD notes that one of the longest-term studies, which spanned 10 years and followed 100 boys with ADHD, found the risk for substance abuse in boys who took stimulant drugs was no greater than for those who didn’t take the medications.2 Although stimulant ADHD drugs continue to be the most prescribed, non-stimulant medications are also available.

 

    • People with undiagnosed, untreated or ineffectively treated ADHD may use drugs and alcohol to self-medicate. Although the causes of ADHD are not fully understood, it appears that the neurotransmitter dopamine is involved. Healthline reported on studies finding a higher density of dopamine transporters in people with ADHD, which leads to a dampening of dopamine’s effects.3

      Low dopamine levels are associated with ADHD symptoms, and most drugs of abuse directly or indirectly raise dopamine levels. An article in ADDitude magazine notes that students with ADHD who respond well to their medication have a lower risk of substance abuse than those who respond poorly, bolstering the hypothesis that substance abuse in many cases may be an attempt to manage ADHD symptoms.4

 

    • Drug abuse itself can lead to an ADHD-like condition. Drugs of abuse initially raise the amount of usable dopamine, but in an attempt to maintain balance, the body adapts. And if drug use continues, dopamine levels fall below normal. The manifestations of the imbalance may include ADHD-type symptoms.

 

  • The same issues may underlie both ADHD and addiction. These may include both biological and environmental causes. Healthline notes that various lifestyle and behavioral factors may contribute to ADHD, including neglect or abuse, which are also associated with addiction.3

    Common genetic factors are also beginning to be identified. A gene called LPHN3 has been found to play a role in both conditions. Although much remains to be understood, the gene appears to affect serotonin and dopamine receptors, among its other effects.

For people dealing with both ADHD and addiction, treating both conditions, preferably in an integrated way, is the best option. Because of the potential problems with stimulant drugs, practitioners may prefer to try non-stimulant ADHD medications first. If they decide a stimulant is best, one that comes in an extended-release formula is often the best choice.

Some addiction treatment professionals require their patients to be abstinent from all potentially addictive substances for a period of time before prescribing ADHD medication. They may also propose non-drug treatment approaches. A comprehensive addiction treatment program will work individually with all patients to tailor programs to their unique characteristics and will continue to monitor and adapt treatment as necessary for the best possible outcomes.


Sources:

1 Ohlmeier, Martin D., et al. “Comorbidity of alcohol and substance dependence with attention-deficit/hyperactivity disorder (ADHD).” Alcohol and Alcoholism, March 7, 2008.

2ADHD and Substance Abuse.” WebMD, Accessed October 8, 2017.

3Attention Deficit Hyperactivity Disorder (ADHD): The Role of Dopamine.” Healthline, Accessed October 8, 2017.

4  Wilens, Timothy. “Does Stimulant Medication Cause Addiction?ADDitude, Accessed October 8, 2017.