It appears that adults with ADHD have 4-5 times the risk of developing a Substance Use Disorder than those who don’t have ADHD (1, 2). Both our genes and our life experiences probably contribute to this elevated risk. (3-7).
Children and adolescents with ADHD initiate nicotine and cannabis use earlier than their peers without ADHD, and become dependent faster(8). Nicotine and cannabis alter brain development in areas affected by ADHD, so the brain of a child or adolescent with ADHD is more sensitive to the effects of these addictive substances (9, 10). Younger initiation of cannabis use and prescription drug misuse have both been associated with higher rates and faster development of Substance Use Disorders (11). Other factors that further magnify the risk of developing a substance use disorder include:
- high levels of impulsivity
- anxiety, depression and other psychiatric conditions which occur in ~80% of people with ADHD
- peer rejection
- friends who use addictive or illicit substances
- family members with problematic drinking/substance use
- Conduct Disorder or antisocial behavior
Because early experimentation can begin before adolescence, prevention should begin early. Family discussions about avoiding nicotine, cannabis and alcohol should begin by age 9-10, and avoidance/deferral should continue throughout adolescence/young adulthood, when substance misuse becomes most problematic. Teach children/adolescents to take all medications, especially ADHD medications, only as prescribed.
Early medication treatment of ADHD does not increase later risks of developing a Substance Use Disorder. In fact, early and sustained treatment of ADHD may decrease these later risks, and may improve many other outcomes (12-14). It’s also important to treat any co-morbid psychiatric disorders.
If problematic use does develop, treatment programs that address both substance misuse and ADHD/other co-morbid conditions can be very helpful (15-17). The course of Substance Use Disorders in those with ADHD is often longer, more complex, and more likely to reflect misuse of multiple substances(18). Although relapses are common, continued recovery efforts ultimately can be successful.
About the Author
Betsy Busch, M. D., F. A. A. P. is an Associate Clinical Professor of Pediatrics at Tufts University School of Medicine. She is a well-known ADHD specialist and thought leader in the field, and is currently Treasurer of APSARD.
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