By Mary Fetzer
When people who have ADHD are treated with stimulant medications, are they more likely to abuse substances later in life? The short answer is “no.” In fact, studies show that individuals with ADHD who are not treated are more likely to develop substance abuse disorder.
Research has shown that having ADHD — as a child, adolescent or adult — is associated with higher rates of substance abuse. One large meta-analysis of previous studies found that about one in every four young adults who sought treatment for substance abuse also had ADHD. Another study found that of more than 3,500 adults from 10 countries who had sought treatment for substance abuse issues, 41% of them had ADHD.
And studies show that children and adolescents with ADHD experiment with substances at a younger age than kids who do not have ADHD.
“Children and teens with ADHD are more likely than their peers without ADHD to smoke tobacco, drink alcohol and use drugs, ” says Pierrette Mimi Poinsett, a pediatrician and consultant for the Mom Loves Best parenting blog. “They are at a higher risk for substance use disorder.”
But, Poinsett says, this higher risk does not come from taking prescribed stimulant medication. In fact, various studies have shown the opposite is true: children and adults diagnosed with mental health disorders who get medication as treatment are less likely to abuse other drugs later.
The Link Between ADHD and Substance Abuse
According to Johns Hopkins Medicine, substance use disorder is caused by genetic vulnerability, environmental stressors, social pressures, individual personality characteristics and psychiatric problems. And, experts say, ADHD can be a contributor.
“The impulsive behaviors and risk-taking tendencies associated with ADHD can make a person vulnerable to substance abuse problems,” says Holly Sargent, a mental health professional from the BrainCode Neurofeedback Center in Denver, Colo.
“The brains of people with ADHD often feel like they cannot ‘switch off,'” Brown says. “They may engage with dopamine substances — like nicotine or cocaine — to cause ‘paradoxical calming’ or use intoxicants that can temporarily relieve internal hyperactivity and repetitive thought patterns that can be distressing.”
Stimulant Medications for ADHD Appear to Decrease Risk of Substance Abuse
ADHD symptoms include difficulty paying attention, hyperactivity and inability to focus. Prescription stimulants have a calming and focusing effect on people with ADHD, according to the National Institute on Drug Abuse.
“Stimulant medications — methylphenidates, such as Ritalin, and amphetamines, such as Adderall — are commonly prescribed to manage the symptoms of ADHD,” says clinical psychologist Devishi Mittal. “These medications work by increasing certain neurotransmitters’ activity in the brain to improve focus, attention and impulse control.”
When people with ADHD get stimulant treatment, there appear to be fewer reasons to self-medicate — which can lead to substance abuse. One study found that the longer the duration of ADHD medication, the lower the rate of substance abuse.
“This is because stimulant medication can help individuals with ADHD better manage their symptoms, which may reduce the risk of self-medicating with drugs or alcohol,” says Mittal.
Additionally, individuals with ADHD who are treated with medication may be more likely to receive appropriate support and resources to help them manage their symptoms and avoid substance abuse, according to Poinsett.
“Research shows that individuals with ADHD who are being treated with medication are less likely to abuse drugs or alcohol compared to those who are not receiving treatment,” says Lester Morse, director of East Coast Recovery in Lowestoft, England. “ADHD diagnosis and access to treatment are essential to battling substance abuse in those with ADHD.”
Sumeet Kumar, a genetics scientist and founder of the genetic informational website GenesWellness, agrees.
“The real concern emerges when ADHD is left untreated,” he says.
Caution With Stimulant Medications Is Warranted
Still, none of this means that people with ADHD shouldn’t be careful about how they use stimulant medications. Stimulant medications are classified as Schedule II medications by the U.S. Drug Enforcement Administration, which means they require stricter control. While they do not directly lead to substance abuse, their use for treating ADHD should be managed carefully.
“We’re not saying that there’s absolutely no risk with prescribed stimulants,” Kumar says. “Some people might misuse their ADHD medication, taking higher doses than prescribed or using it in ways not intended by their physicians.”
Poinsett adds that stimulant medication — especially short-acting stimulants like Ritalin and Adderall — can be shared and misused. Parents and educators of children with ADHD and families and friends of adults with ADHD, along with health care providers, should be vigilant for signs of medication misuse.