Understanding The Link of ADHD & Addiction

There is no evidence that ADHD and addiction are linked. Research suggests that people with ADHD may be more susceptible to developing addictive behaviors. Some reasons for the connection include poor impulse control and seeking stimulation to alleviate boredom. People with ADHD may turn to substances or other addictive behaviors as a way to self-medicate and manage their symptoms.  

While having ADHD does not cause addiction and substance use, research studies show that 50 percent of adults with ADHD also have a history of dealing with addiction and substance use in their lifetime. In contrast, the lifetime occurrence of substance use among adults in the general population is approximately 25 percent [1].  No evidence suggests any genetic link between ADHD and addiction. However, what makes them more prone to addiction is a combination of psychological, environmental, and biological factors. Several symptoms of ADHD can increase the likelihood of addiction. These include anxiousness, impulsivity, poor emotion regulation, low frustration tolerance, reward-seeking. Let’s break that down even further. 

ADHD is characterized by hyperactivity, poor impulse control, and difficulty paying attention. These symptoms can all lead to impulsive decision-making, seeking more rapid rewards, and difficulty pausing and considering the long-term consequences of choices. The impulsive nature may increase the likelihood of engaging in risky behaviors including substance use/abuse and other addictive behaviors. Environmental factors such as family history of addiction childhood experiences, and social pressures can also contribute to the increased risk of addiction in people with ADHD. Additionally, people with ADHD often face challenges in areas of life such as the occupational and academic arenas, societal stigma, and low self-esteem, which all can increase the vulnerability to using substances as a way to cope. ADHD is believed to have a genetic component, meaning it can be passed down in your DNA in your family of origin. Some studies have shown that certain genes associated with ADHD are linked to an increased risk for addiction. People with ADHD may also have differences in the brain’s reward pathways and neurotransmitter systems, making them more susceptible to the euphoric and pleasurable effects of substances. 

One of the most significant differences between an ADHD brain and a non-ADHD brain is the level of norepinephrine (a neurotransmitter) which is synthesized from dopamine. Since the two go hand-in-hand, experts believe that lower levels of dopamine and norepinephrine are both linked to ADHD.[2] An imbalance in the transmission of dopamine in the brain may be associated with symptoms of ADHD, including inattention and impulsivity. This disruption may also interfere with the dopamine reward pathway, changing how the ADHD brain perceives reward and pleasure.[3]   Dopamine-seeking behavior is seeking out anything that makes you feel good. Dopamine motivates us and creates a sense of satisfaction when we meet goals, or pleasure when we're positively stimulated or rewarded. Since the ADHD brain has less dopamine, people will often seek out activities and behaviors that give them a burst of this “feel good” neurotransmitter. The role that dopamine plays in the brain's reward system is the link to addiction. While dopamine addiction is not possible, what a person does get addicted to is doing things that make you feel that rush of pleasure. Dopamine does play a role in addiction, but this relationship is complex. Researchers are still trying to understand the many complex factors that influence addictions to substances and behaviors.

The signs of addiction can vary and depend upon the substance or behavior involved and what stage of the addiction the person is in. Here are some symptoms and behaviors commonly associated with addiction: needing the substance or engaging in the behavior daily, developing a tolerance to the substance or needing to engage more frequently in behaviors, needing to take more of a substance over time to achieve the same effect, losing control over the use of the substance or behavior and being unable to stop using it, experiencing withdrawal symptoms when not using or engaging in a behavior, spending a lot of time procuring, using, and recovering from use, using the substance in risky settings, taking risks to engage in behaviors, absence from school or work, poor work or educational performance, avoidance of recreational and social activities, continuing to use the substance or engage in the behavior despite negative consequences to one’s relationships, obligations, and health, making excuses to use, the use of the substance in solitude and being secretive about behaviors, resorting to secretive behaviors to hide one’s use of the substance, becoming hostile when confronted with one’s substance use or behavior, and neglecting personal care or poor personal hygiene. According to the DSM 5, there is a time frame of identified criteria being met for one year. According to the DSM-5, there is a set of 11 criteria, of which two must be met, over 12 months to qualify as a substance use disorder.   

Signs of addiction include:

• The loss of control of choice around use or repeatedly failing to limit or control engaging in a behavior despite efforts to limit or cut back. For example, when someone promises not to drink too much but ends up drunk when they do drink.  
• Preoccupation with or constantly thinking about the substance or behavior makes it difficult to focus on other aspects of life that are important. An example is when extra effort goes into making sure there is alcohol to drink by going out of their way to buy and take bottles of liquor to the family gathering, just in case there isn’t any, or enough. 
• Tolerance - needing increased amounts of the substance or behavior to achieve the same desired results. For example, needing only three drinks to get buzzed has increased to six to achieve the same effect.  
• Withdrawal - experiencing emotional or physical symptoms when use ceases. Symptoms of withdrawal may include anxiety, irritability, agitation, depression, and/or physical discomfort. 
• Neglecting obligations to responsibilities such as work, school, relationships, and health. Some who are struggling with an addiction will often be late to work or school, call out sick regularly, and not show up for engagements they committed to that are important such as weddings or anniversaries. Physical appearance may be neglected such as wearing uncleaned clothing or perhaps presenting malodorous.  
• Loss of interest or a decline in participating in activities that are not related to the addiction.  For example, someone who is active in their addiction may stop attending regular family gatherings or stop attending a book club or gym classes. 
• Engaging in risk-taking behaviors such as driving under the influence, using dirty needles, or engaging in unsafe sex.  It is not uncommon for individuals with alcohol addiction to think they are safe to drive and justify driving when drinking by saying it’s only 1 mile down the road, I am fine to drive when they aren’t. The person addicted to IV heroin will use a dirty needle if there isn’t a clean one so “they can get well.”
• Financial struggles from spending excessive amounts of money on a substance(s) or behavior, lead to financial stress. Someone may ask to borrow money when they never have before, even though they are employed, or not paying bills when due. 
• Continued use despite negative consequences whether they are social, physical, psychological, physical, or financial consequences. Some individuals with an addiction will lose friends, family, marriages, jobs, businesses, homes, and health. They will be sick with diabetes, heart problems, or major depression as a result of an addiction and they will continue to use it though their family and doctor tell them they need to stop. [4]

People with ADHD are at higher risk than those who do not have ADHD for developing substance use disorders and addiction.[5]  According to the International Collaboration on ADHD and Substance Abuse, approximately one out of six adults with a substance use disorder has ADHD.[6]  Females and males with ADHD had comparable risks of addiction, although females had a higher risk of some addiction than males. Females with ADHD may be perceived as less impaired than males, but they are at an equally increased risk of addiction.[7]  Nobody starts using any substance to become addicted. Many people think it could never happen to them or that they will be able to control how much and what they use. Substance addictions develop over time and through a variety of factors that contribute to the development and progression of addictive behaviors. Some of these factors are biological (genetic predisposition to addiction), environmental, psychological, and social factors. There isn’t evidence to suggest that people with ADHD prefer one drug significantly more than any other. Several studies have shown a strong connection between ADHD, drug abuse, and alcoholism. ADHD is five to 10 times more common among adult alcoholics than it is in people without the condition. Among adults being treated for alcohol and substance abuse, the rate of ADHD is about 25%.  What's more, people with ADHD typically start having problems with drugs and alcohol at an earlier age than people without the condition.[8]

Some people with ADHD may be more drawn to stimulants because they target the neurotransmitters norepinephrine and dopamine, both of which are believed to be linked to be linked to ADHD.[10] Stimulant use turns into an addiction when someone is taking more than prescribed to get high. Common addictive substances people with ADHD use include caffeine (coffee, tea, and colas), nicotine (cigarettes), and pseudoephedrine (over-the-counter decongestants). The most commonly abused illegal stimulants include cocaine, crack cocaine, crystal methamphetamine, and ecstasy.[11] 

People with ADHD may be drawn to alcohol as a form of relief from the negative emotional experiences they have as a result of the disorder such as anger, frustration, irritability, or over-excitement. [12]. Alcohol is known to increase some symptoms of ADHD. Impulsivity, proper decision-making, and lack of attention are increased due to the symptoms of ADHD and the effects of alcohol.[13] Alcohol use turns into alcoholism when a person exhibits an inability to stop, the need for an increased amount to achieve the same effect, and may be physically dependent on the substance so when a person doesn’t have it, the body begins to go into physical withdrawal. 

People with ADHD may be drawn to marijuana as a form of relief from the symptoms of ADHD. A 2022 study found that people with ADHD who used cannabis self-reported benefits like symptom improvement, improvement in medication side effects, and calmness and relaxation.[14] Marijuana use turns into a marijuana addiction when substance use begins to interfere with a person’s day-to-day functioning.

There is no direct genetic link between addictive behaviors and ADHD Addictive disorders are complex and often caused by behavioral, emotional, and life factors. Thrill-seeking behaviors, the need for immediate gratification, and a search for novel pleasure-seeking experiences are more common for many people with ADHD. Life stressors, such as job loss and financial difficulties, are more frequent with ADHD and are also risk factors for substance use and other addictive behaviors.[15]

Common behavioral addictions for ADHD individuals include: 

• Gambling & ADHD: Gambling addictions are among the most powerful and destructive behaviors. Whether this involves sports gambling, casino gambling, or other forms of gambling, they cause disruptions in people’s lives. Financial and relationship problems follow in their wake.
• Sex Addictions & ADHD: By definition, a sexual addiction involves a loss of control over one’s sexual behavior. For some people, this involves having “serial affairs,” whether or not the person is engaged in a committed relationship. For some, it involves soliciting sexual partners online or turning to prostitutes. The most common form of sexual addiction is pornography addiction. 
• Food Addiction & ADHD: Food addictions are considered to be both physical and behavioral addictions. They are so common that many don’t regard them as addiction, but rather as regular eating habits. Unfortunately, the foods that are most addictive are the foods that are the most unhealthy. A steady diet of them not only increases the risk for obesity and physical illnesses, such as diabetes but also wreaks havoc with mood regulation and cognitive functioning as blood sugar levels take a roller-coaster ride. Highly processed foods, such as cookies and cakes, are addictive for the same reason that addictive drugs are addictive: They deliver a high dose (in this case, of sugar) and have a rapid rate of absorption. That “sugar high” you feel after a bowl of ice cream is an actual high. That “carbohydrate craving” you feel for a bag of chips is a real craving for carbs. Strong cravings are a symptom of addiction.
• Internet Addiction & ADHD: The Internet is designed to be distracting and addictive. It gives immediate gratification. There is an endless variety of entertainment, information, and social connections. “Hello, there,” says the ADHD brain, “where have you been all my life?” Internet addictions include excessive use of online media, including social media, message boards, and innumerable websites. But most people will say, you just described modern life! Actually, no. What makes an addiction is excessive use. If time spent on the Internet makes you fail to get work done or ignore or hurt the people you love, then it must be acknowledged that you have a problem with the Internet.

Shopping Addictions For many people, with or without ADHD, shopping provides instant gratification and a temporary mood boost. People with ADHD are at high risk for overspending and for shopping addictions for two major reasons: Naturally impulsive people are impulsive shoppers and not keeping track of finances makes it easy to lose track of how much money a person is spending.

Many studies support no connection between taking ADHD medications to addiction later in life. A study in 2013 found that for kids with ADHD, taking stimulant medication as children neither increases nor decreases their risk of becoming addicted later. The study analyzed 15 long-term studies following thousands of children from a mean age of 8 to 20. “We found the children were neither more likely nor less likely to develop alcohol and substance use disorders as a result of being treated with stimulant medication,” said the lead author of the study. “We found no association between the use of medication such as Ritalin and future abuse of alcohol, nicotine, marijuana, and cocaine.[16]  This same study also found that on average, taking Adderall did not lead to an increased risk of becoming addicted to other stimulants later in life. When used to treat ADHD, stimulant medications aren’t considered to be habit-forming. Additionally, there isn’t any evidence that using them will lead to substance use disorders. Nevertheless, there’s a potential for improper use and substance use disorders with any stimulant medication, especially if you have a history of a substance use disorder. However, recent research states that medically treated people with ADHD had a lower rate of substance use disorders than if they weren’t treated.[17]

Treatment for someone who has ADHD and addiction will encompass BOTH treating ADHD as well as the addiction and this is commonly referred to as Co-Occurring Disorders. Depending upon several factors, you may need inpatient care to monitor your symptoms more closely and manage detox and withdrawal. Upon discharge, you will be referred to outpatient care. Your treatment plan, regardless of whether inpatient or outpatient will likely consist of the following or a combination of medication management, individual talk therapy, group therapy, family therapy, and 12-step recovery programs. It is important to treat both disorders in conjunction as they are connected - people will have most assuredly used to medicate symptoms of ADHD. 

Treatment options for ADHD and addiction include:

• Rehabilitation: This is inpatient treatment, in a contained medical setting, that takes place for a total of anywhere from 5 days to 38 days. This consists of a combination of therapies such as group, family, and individual, medication management, and addiction-focused treatment.  
• Medication: medication is the first line of treatment for ADHD and can be prescribed by a physical, psychiatrist, psychiatric nurse practitioner, or physician assistant and used to help relieve symptoms of withdrawal and help lessen cravings. Medications are prescribed specifically for each individual, often relative to what the addiction was to, and monitored on a regular and consistent basis. 
• Behavioral Therapy: There are many modalities of therapies used that successfully treat addiction including CBT (cognitive behavioral therapy) which is a form of psychological treatment that has been demonstrated to be effective for a range of problems including depression, anxiety disorders, alcohol and drug use problems, and, DBT (dialectical behavior therapy) which teaches people how to live in the moment, develop healthy ways to cope with stress, regulate their emotions, and improve their relationships with others. 
• 12-Step Meetings: a plan to treat and overcome addictions where people can help one another achieve and maintain abstinence from substances of abuse, but that healing cannot come about unless people with addictions surrender to a higher power.

Although it's most often treated in childhood, adult ADHD is increasingly being diagnosed among adults. Fortunately, resources for adults with ADHD are plentiful from a compilation of national support organizations, YouTube channels, websites, social media profiles, therapist directories, and more that focus on neurodiversity affirmation and community. Having ADHD does not mean you will become addicted to the prescribed medications or that they will lead you to take other drugs and become an addict. NOT treating the symptoms of ADHD will cause you more harm than getting help. Not all help is in the form of a pill - there are ways to learn to manage the symptoms without medications. I have found that there is no one solution for managing almost any disorder or mental health struggle or diagnosis. It is a combination of things that are done in conjunction that leads to healing and wholeness. You’re struggles do not define you, they are only part of your life. You are more than the sum of your experiences.