by Trey Dyer
About 4.4 percent of American adults — 10 million people — have ADHD. And roughly 8 million children have been diagnosed with the disease, making it one the most commonly occurring mental health disorders in the United States.
The rate of co-occurring substance use disorders is high among those with ADHD. Individuals with this diagnosis are 2.5 times more likely to develop a substance use disorder. A study by researchers at Massachusetts General Hospital found that 15 to 25 percent of adults who have a substance use disorder also have ADHD.
For co-occurring ADHD and substance abuse disorders, the best treatment programs combine medical treatment for ADHD, drug detox and therapy that address both disorders. Additionally, proper ADHD treatment during childhood can prevent further development of the disorder that may lead to a substance use disorder during adulthood.
The risk for substance abuse is often higher for people with ADHD. Compared to the general population, people with ADHD are:
- Three times more likely to develop a nicotine use disorder
- Two times more likely to develop an alcohol use disorder
- Two times more likely to develop a cocaine use disorder
- 5 times more likely to develop a marijuana use disorder
Research shows that those with ADHD may have lower levels of dopamine — the brain chemical responsible for reward-seeking behavior — and turn to substance abuse or other dopamine-releasing behaviors as a result.
Despite the increased risks, those with co-occurring ADHD and substance use disorders are not doomed to struggle with addiction their entire lives. Many rehab centers offer specialized programs for co-occurring disorders that focus on treating the separate disorders concurrently, giving patients a realistic chance of reaching recovery and living a healthy life.
Treatment for Co-Occurring ADHD and Substance Use Disorder
Treatment for co-occurring mental health and substance use disorders is most effective when the disorders are treated simultaneously. Addressing them at the same time is preferred to treating them one at a time, which was the generally held practice in the past.
Medication is the most common form of treatment for ADHD, and with proper use, it can greatly benefit those with co-occurring ADHD and substance use disorders. Stimulant and nonstimulant medications can be effective in treating individuals with ADHD with or without a co-occurring substance use disorder. The most common types of medications used to treat ADHD are stimulants.
A study by researchers at Massachusetts General Hospital examining the results of six long-term studies found that stimulant treatment for ADHD during youth leads to reduced risk of developing a substance use disorder during adolescence and adulthood.
The two most common stimulants used to treat ADHD are methylphenidate and analogs of amphetamine.
Amphetamine medications activate the reward pathway and trigger the release of dopamine in the brain, bringing balance to dopamine levels among those with ADHD. This can help alleviate drug cravings.
According to researchers at Columbia University, clinical trials of Ritalin (methylphenidate) have also been effective in reducing symptoms of ADHD and substance use disorder when combined with relapse prevention therapy. The drug has a relatively low risk of abuse under proper medical supervision.
Methylphenidate has been used for decades to treat ADHD and has shown to be effective for children and adults. Uncontrolled trials of methylphenidate have shown to have a positive impact in reducing symptoms of ADHD and cocaine use disorders, according to researchers at Columbia University.
Some nonstimulant medications can be used to treat ADHD and may present an alternative to stimulants. While stimulants have a higher abuse potential, nonstimulants are often seen as a less effective treatment option.
Atomoxetine is a selective norepinephrine reuptake inhibitor that can be used to treat ADHD. It affects those with ADHD similarly to stimulants, but in a more gradual manner. With no known abuse potential, atomoxetine is an attractive alternative to stimulant medications.
Tricyclic antidepressants have also been used to treat ADHD. However, they are generally less effective than stimulants in treating ADHD.
Problems with Medication Treatment
Research from Massachusetts General Hospital shows medications that are effective in treating adult ADHD may be effective for adults with ADHD and co-occurring substance use disorders, but the medical benefits of the medications are hindered if an individual is actively abusing substances.
Challenges of treating patients with a substance use disorder include:
- Patients may not take medications reliably.
- Patients may require higher doses in order for a medication to be effective.
- The presence of other substances in a patient’s system may make the therapeutic effects of a medication less effective.
Individuals actively engaging in substance abuse are more difficult to treat with medication, with or without a co-occurring disorder.
Alcohol and ADHD Medications
ADHD medications are associated with high risks when used concurrently with alcohol. Adderall is a medication of particular concern because it is commonly abused by college students who participate in binge drinking culture at parties, bars and nightclubs.
Individuals who abuse Adderall and alcohol together find that the depressant alcohol effects are lessened by the stimulant properties of Adderall, allowing them to drink more for longer periods of time.
Abuse of Adderall or other ADHD medications while drinking may cause people to consume hazardous amounts of alcohol. ADHD medications that block the depressant effects of alcohol may cause individuals to ignore signals from their bodies that they have had enough to drink, which can lead to dangerous health concerns such as alcohol poisoning.
It is crucial for people to consult their doctor about alcohol use while taking any type of ADHD medication.
About the Author: Trey Dyer is a writer for DrugRehab.com. Trey is passionate about breaking the stigma associated with drug addiction in the United States. When Trey is not writing, he can be found fly fishing, playing soccer or cooking BBQ.
Adler, L. et al. (2005, March). Long-term, open-label study of the safety and efficacy of atomoxetine in adults with attention-deficit/hyperactivity disorder: an interim analysis. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15766294
Columbia University. (n.d.). Adderall: Health risks when combined with alcohol? Retrieved from http://goaskalice.columbia.edu/answered-questions/adderall-health-risks-when-combined-alcohol
Levin, F. et al. (1998, June). Methylphenidate treatment for cocaine abusers with adult attention-deficit/hyperactivity disorder: a pilot study. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/9671342
Mariani, J. & Levin, F. (2007). Treatment Strategies for Co-Occurring ADHD and Substance Use Disorders. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2676785/
Michelson, D. et al. (2003, January 15). Atomoxetine in adults with ADHD: two randomized, placebo-controlled studies. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12547466
National Institute on Drug Abuse. (2010). Comorbidity: Addiction and Other Mental Illnesses. Retrieved from https://www.drugabuse.gov/sites/default/files/rrcomorbidity.pdf\
Somoza, E. (2004). An open-label pilot study of methylphenidate in the treatment of cocaine dependent patients with adult attention deficit/hyperactivity disorder. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/15077842
Sottile, L. (2015, October 20). The Disturbing Relationship Between Addiction and ADHD. Retrieved from http://www.vice.com/read/the-disturbing-relationship-between-addiction-and-adhd-511
Wilens, T. et al. (2003, January). Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/12509574
“Image courtesy of stock photos/FreeDigtalPhoto.net” Modified on Canva