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Substance use problems

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Summary

  • Childhood ADHD is linked to a higher risk of later substance use disorders involving alcohol, nicotine, and other drugs.
  • Childhood stimulant treatment has not been linked to a higher risk of later substance use disorders.
  • Treatment for ADHD with substance use problems also needs to account for memory and executive function difficulties.

Ever using a substance and developing a disorder are different risks

Research-backed

Studies following children into adolescence or adulthood found that childhood attention-deficit/hyperactivity disorder (ADHD) was linked to higher later risk of substance use disorders involving alcohol, nicotine, and cannabis(Lee et al., 2011).

However, the proportion who had ever drunk alcohol did not differ significantly between groups with and without ADHD. Trying a substance and later developing abuse or dependence need to be considered separately(Lee et al., 2011).

No higher later addiction risk detected with stimulant treatment

Research-backed

A meta-analysis of long-term follow-up studies found no higher risk of later substance use disorders among people with ADHD who received stimulant treatment in childhood(Humphreys et al., 2013).

This does not mean the medication carries no risk of misuse. An expert consensus recommends that clinicians assess medication risks when substance use problems are also present, rather than ruling out effective ADHD treatment across the board(Young et al., 2023).

Treatment needs to consider memory and executive function difficulties

Research-backed

With both ADHD and substance use problems, forgetting appointments or struggling to complete treatment exercises can make continued attendance harder. These difficulties should not automatically be taken as a lack of willingness to change(Young et al., 2023).

An expert consensus recommends adapting treatment: appointment reminders, more concrete explanations, repeated emphasis on key points, and shorter, more frequent sessions when needed. Treatment teams can discuss these adjustments with the person receiving care(Young et al., 2023).

Evidence

References (3)
  1. Meta-analysisProspective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic reviewLee, Humphreys, Flory, Liu, Glass (2011). Clinical Psychology Review
  2. Meta-analysisStimulant Medication and Substance Use OutcomesHumphreys, Eng, Lee (2013). JAMA Psychiatry
  3. ConsensusIdentification and treatment of individuals with attention-deficit/hyperactivity disorder and substance use disorder: An expert consensus statementYoung, Abbasian, Al-Attar, Branney, Colley, Cortese, Cubbin, Deeley, Gudjonsson, Hill, Hollingdale, Jenden, Johnson, Judge, Lewis, Mason, Mukherjee, Nutt, Roberts, Robinson, Woodhouse, Cocallis (2023). World Journal of Psychiatry