The Link Between AD/HD and Substance Use Disorders

ADHD and Substance Abuse

Last Updated (Wednesday, 31 December 1969 15:59) Monday, 08 September 2008 20:35

Attention-deficit/hyperactivity disorder (ADHD) causes difficulties in paying attention, keeping still, and suppressing impulsive behaviors. It can lead to problems in school and on the job and create tensions with family members and other people. In addition, research has shown that children with ADHD have an elevated risk of becoming abusers of drugs and alcohol. Studies that have tracked children to adulthood have found higher rates of transition to abuse among those with ADHD compared to those without the disorder. Conversely, studies with adult substance abusers, particularly cocaine abusers, have found that when they were children a high percentage had ADHD that was undiagnosed and therefore untreated.
There has been wide spread concern that treating children with a stimulant medication would increase the likelihood that they would abuse substance when they became adults.  In generally, studies have consistently found that children who were medicated for their ADHD were less likely to become substance abusers during 4 years of follow-up than were children with ADHD who were not medicated. In addition to helping protect children with ADHD from becoming substance abusers, methylphenidate may also help adult cocaine abusers with ADHD reduce their drug use. In a pilot study, Dr. Frances Levin and researchers at Columbia University in New York City gave methylphenidate for up to 12 weeks to 12 adult cocaine abusers with ADHD. Patients also received individual weekly relapse prevention therapy, which involved identifying situations in which they were likely to return to cocaine use and developing strategies to avoid cocaine use in these situations. Of the 12 patients who entered the study, 7 could be reached for a 3-month assessment. Patients reported a reduction in ADHD symptoms, cocaine use, and craving; urine tests confirmed that their cocaine use had in fact decreased significantly.

Biederman, J., et al. Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder. Pediatrics 104(2):e20, 1999 (www.pediatrics.org).

Gawin, F.; Riordan, C.; and Kleber, H. Methylphenidate treatment of cocaine abusers without attention deficit disorder: A negative report. American Journal of Drug and Alcohol Abuse 11(3-4):193-197, 1985.

Levin, F.R., Evans, S.M.; McDowell, D.M.; and Kleber, H.D. Methylphenidate treatment for cocaine abusers with adult attention-deficit/hyperactivity disorder: A pilot study. Journal of Clinical Psychiatry 59(6):300-305, 1998.

Levin, F.R., and Kleber, H.D. Attention-deficit/hyperactivity disorder and substance abuse: Relationships and implications for treatment. Harvard Review of Psychiatry 2:246-258, 1995.