ADHD and Substance Abuse

We know that one of the long-term effects of ADHD is a heightened risk for substance abuse. In fact,  research has found that kids with ADHD are two to three times more likely to abuse substances than kids in the general population.

This association is not surprising, given that the hallmarks of ADHD include trouble focusing, curbing impulsivity and sitting still, says Jeannette Friedman, LCSW, a therapist who works with families struggling with substance use issues. “So, when kids are introduced to a substance that calms them down, it feels good to them,” she says. “Trying to engage in more productive behaviors to manage their ADHD, such as meditating or going for a walk, becomes much harder because a substance provides such a quick fix. There’s just nothing that can compete.”

And ADHD can make teenagers more vulnerable to addiction, adds Sarper Taskiran, MD, a child and adolescent psychiatrist at the Child Mind Institute. Kids with ADHD tend to experience the effects of all substances more intensely. “Their brains are hungrier for these experiences because of their wiring,” he says. Being prone to impulsivity, they may also progress to addiction faster than neurotypical teens.

Most experts agree that marijuana is the number one substance being used by teens and young adults with ADHD, with alcohol and nicotine just behind it.

Dr. Taskiran notes that kids with ADHD are not so much looking to get high as to self-medicate.

“These kids are more hyperactive, more impulsive, and their minds move at a faster pace, which is sometimes tiring for them,” he says. “They tend to gravitate to substances which decrease the pace of their thoughts. Nicotine, and in some cases cocaine, are appealing because they increase attention in the short term, while marijuana can cause mild sedation and euphoria.”

Research has also shown that kids with ADHD have a higher rate of alcohol abuse.

In addition to being predisposed to substance use because of the symptoms of ADHD itself, teenagers with the disorder have other risk factors when it comes to excessive substance use, including:

• Higher risk of a co-occurring disorder. Kids with ADHD commonly have additional mental health disorders, such as anxiety, depression and oppositional defiant disorder. Having another disorder further increases substance abuse risk, says Dr. Taskiran.
• Environmental factors. It’s common for kids with ADHD to struggle academically or with fitting in, and they may gravitate to other kids (with or without ADHD) who share these struggles. “What happens is they tend to find themselves among the risk takers in the school where substances are more available for experimentation,” says Friedman.

There is a misconception that the stimulant medications used to treat ADHD are “gateway drugs” and can increase the likelihood of substance use, but this is not supported by the data, and in fact the opposite may be true.

A 2013 analysis of 15 long-term studies, which followed more than 2,500 children with ADHD from childhood into adolescence and young adulthood, found that medication neither increased nor reduced the risk of substance abuse. “We found no association between the use of medication such as Ritalin and future abuse of alcohol, nicotine, marijuana and cocaine” the study’s lead author said.

But a more recent study, a 2016 analysis of Medicaid data for 150,000 young people with ADHD, found that those who took medication were 7.3% less likely to develop a substance-use disorder than their peers with ADHD who didn’t take medication. In other words, treating ADHD effectively may help protect against substance abuse.

The most important thing for parents to do is to have their child evaluated — and treated — as soon as possible if they seem unusually restless, distracted and forgetful. Aside from that, parents should make sure to:

Talk to your children about substance use early

Let your child know that having ADHD makes them more vulnerable to addiction than their peers without ADHD, advises Friedman, and make sure your child understands that the best way to avoid trouble is to avoid illicit drugs altogether.

Dr. Taskiran adds that kids with ADHD struggle with planning and organization, so they tend to leave drug-related paraphernalia around more. “They can’t hide it, so their parents find out actually faster than peers who don’t have ADHD,” he says. That often gives parents an opportunity to address the topic with their child. But he urges parents not to come on too strong. “They have to take a nonjudgmental stance because having a positive relationship is even more important than trying to nip it in the bud.”

Don’t over-accommodate

Parents of kids with ADHD who are struggling may try to ease their child’s frustration by making allowances for them, says Friedman. “They’ll say, ‘Poor kid, what can we do for them? How do we rearrange things so that they’re more comfortable?’” This can backfire because it prevents kids from learning to manage their challenges. And if a teen can’t manage their challenges, they may turn to a substance to reduce their anxiety. As some experts say, notes Friedman, don’t rearrange the furniture. Teach them tools to walk around the furniture.

Maintain positive communication

Parents of children with ADHD who are struggling in school may focus so much on academic success, says Friedman, that it creates constant conflict between the parent and the child. And that conflict becomes stressful to the child, who may not have effective skills for handling uncomfortable emotions. “They can’t do conflict monitoring as efficiently as their peers, so they respond to distress with less efficient coping skills,” says Friedman. “They turn to self-medication and they turn to substances because they’re not able to self-regulate.

Friedman urges families to not only seek treatment for a child’s ADHD, but to work on maintaining a positive relationship, which can be difficult. “If they find themselves in constant conflict with their child, they also need to seek out measures to resolve that conflict, whether through family therapy or behavioral treatment strategies,” she recommends. “They need to be really mindful of their relationship with their child.”