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Sorting Out ADHD and Abuse of Drugs

There is a tendency to view attention-deficit hyperactivity disorder (ADHD) as just a childhood disorder. ADHD typically conjures up images of fidgety, hyperactive children who can’t control themselves. In the U.S. alone, 6.1 million children and adolescents have been diagnosed with the disorder. 

ADHD also has an adult face as 30 to 60 percent of people diagnosed in childhood continue to show symptoms into adulthood. The outward display of ADHD hyperactivity as a child morphs into an inner restlessness as an adult. When people diagnosed with ADHD become teens or adults, they increasingly turn to alcohol or drugs to quell the restlessness and edginess that come with the disorder.

Several studies have asserted that there is a strong connection between an ADHD diagnosis and drug and alcohol abuse. There is statistical evidence that bears this out. ADHD is five to 10 times more common among adult alcoholics than for people without the disorder, says WebMD. It is also more common for children with ADHD to begin abusing alcohol in their teenage years.

What’s more, it’s not uncommon for undiagnosed adults to go through their young life engaging in substance abuse, only to be diagnosed with ADHD later in life. Adults like Niall Greene, who was profiled in Vice in October 2015, is one such example.

“This is what ADHD is like,” Greene said. “You wake up, everything’s fine. And by five o’clock your life is upside down…. Once one thing goes wrong, everything goes wrong.”

Greene and many others are also the faces of ADHD, adults who have developed substance abuse issues and need professional treatment.

If you or a loved one fits into this category, read on to learn about the connection between mental health disorders and substance abuse and treatment options. 

Dual Diagnosis: Mental Health Disorders and Substance Abuse

People who engage in substance abuse are very likely to also have a co-occurring mental health disorder. In fact, an estimated 8.1 million adults — that’s 3.3 percent of all adults in the U.S. — had a mental illness and a substance use disorder in the past year, according to the 2015 National Survey on Drug Use and Health.

People with certain psychiatric disorders tend to abuse particular substances. Common pairings include major depression with cocaine addiction and alcohol addiction with panic disorders. Also, people who have schizophrenia tend to abuse alcohol and engage in polydrug addiction. Individuals who struggle with borderline personality disorder tend to participate in episodic polydrug abuse.

Yet, combinations vary greatly and depend on the individual user. However, the common reason people engage in substance abuse is to manage their mental health symptoms, a practice known as self-medicating.

Thus, people who have a substance addiction and ADHD — simultaneously or sequentially — are eligible for dual diagnosis recovery services, that is, treatment that addresses both conditions at the same time. 

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What Is Mental Illness?

The American Psychiatric Association (APA) refers to mental illnesses as health conditions marked by changes in emotion, thinking, behavior, or some combination of those aspects. Mental illnesses are also marked by distress and/or problems with functioning in social, work, or family activities.

People with mental health disorders often struggle in many areas of their lives. Maintaining employment, handling social situations, and even completing menial tasks can be a challenge. Common mental health disorders include:

  • Bipolar disorder
  • Borderline personality disorder
  • Generalized anxiety disorder
  • Depression
  • Obsessive-compulsive disorder (OCD)
  • Panic disorder
  • Eating disorders (anorexia, bulimia, binge eating)
  • Personality disorders
  • Schizophrenia
  • Post-traumatic stress disorder (PTSD)

ADHD is also a common disorder for children as the U.S. Centers for Disease Control and Prevention (CDC) estimated that in 2016, 9.4 percent of children ages 2-17 (6.1 million) had ever been diagnosed with it. 

Signs of Mental Illness

Mental illness affects people from every background, ethnicity, educational level, and socioeconomic status. While it can occur at any age, three-fourths of all mental illness starts at age 24, according to the APA.

What’s more, mental illness can impact people at varying degrees. There are conditions that people have that hardly ever interfere with their daily lives, and then there are others so debilitating that they require hospitalization.

The symptoms common of all mental illness include:

  • Mood swings
  • Irritability
  • Excessive tension or worrying
  • Appetite or weight changes
  • Sharp increases in energy
  • Sleep disorders, such as insomnia
  • Racing thoughts or rapid speech
  • Inability to experience pleasure
  • Strong feelings of guilt or worthlessness
  • Loss of interest in activities
  • Feelings of helplessness
  • Numbness
  • Trouble concentrating
  • Impaired judgment or impulsivity
  • Restlessness

People with ADHD tend to exhibit a few of these symptoms, including impulsivity, trouble concentrating, and restlessness. 

The Reality of ADHD and Substance Abuse

People with ADHD exhibit symptoms of inattention, hyperactivity, and impulsivity. The disorder also co-exists with conditions such as depression, anxiety, learning disabilities, conduct disorder, and oppositional defiant disorder.

What’s more, a 2009 study concluded that ADHD is likely caused by a deficit of dopamine, the neurotransmitter that governs the brain’s pleasure and reward centers. Another study indicated that, rather than a lack of dopamine, people with ADHD had less gray matter in certain areas of the brain. This is why stimulant medications such as Ritalin and Concerta are prescribed to those with ADHD: they boost dopamine and activate focus in a user.

There is also that chemical correlation between Ritalin and cocaine. Both stimulants work to increase dopamine. What’s more, Ritalin has been referred to as the “poor man’s cocaine.”

People have crushed and snorted Ritalin tablets or dissolved the drug in water and taken it intravenously. Studies show that abusing Ritalin can lead to dependence on the drug, states WebMD.

When someone with ADHD becomes an adult, there is a risk that he or she will seek out intoxicants to compensate for the lack of dopamine.

Also, because ADHD tends to produce impulsivity and behavior issues in people, they can become more prone to drug and alcohol abuse. If a child with the disorder has a parent who is an alcoholic, it increases their chances of developing an alcohol problem as well.

Statistics also show that people with ADHD start having drug and alcohol issues at earlier ages than people without the condition.  

Or there are cases like Niall Greene’s: people who have abused substances for the majority of their young life only to find out, as adults, that they had ADHD all along. 

Here’s Vice on Greene’s substance abuse: As a teenager, Greene’s behavior wasn’t flagged as ADHD. “If I’m not getting enough stimuli, I create my own stimuli,” he explained. For him, that came in the form of drink and drugs. From the time he was 15, he’d black out every time he drank; by the time he was in his 20s, he was using cocaine compulsively and would sometimes take five Ecstasy tablets at a time. He’s explicit that he wasn’t doing this for fun—it was out of a sense of desperation.

There is also this 2010 study to consider, which states that 15 to 25 percent of adults with substance abuse disorders (SUDs) also have ADHD.  

Causes of Mental Illness

There is no specific cause of mental illnesses like ADHD, only a combination of factors that can predispose someone to develop the condition. Those factors tend to be genetic, biological, psychological, environmental, or a combination of any of these elements.

Mental illness is common in people who have relatives that also have a mental illness. The disorders that seem to run in families include ADHD, autism, bipolar disorder, schizophrenia, and major depression. The National Institutes of Health (NIH) concluded there was limited evidence of shared genetic risk factors for those five psychiatric disorders.

Mental illness can also occur in persons who have an imbalance of brain chemicals, which are called neurotransmitters. When chemicals are in this state or are not working properly, certain messages may not be communicated in the brain properly, which can lead to mental illness. What’s more, particular infections from brain damage can lead to the development of mental illness or the worsening of symptoms. Brain defects, injury and prenatal damage can also cause mental illness as well as poor nutrition and exposure to toxins such as lead. Long-term substance abuse can also contribute to mental health disorders such as depression, anxiety, and paranoia.

Mental illness can also come from the psychological damages incurred from traumatic childhood events, such as physical, emotional, or sexual abuse. Parental neglect, the early death of a loved one, and a poor ability to relate to other people are also contributing factors.

Environmental stressors can also make someone prone to developing a mental illness, such as family dysfunction, death, divorce, or cultural/societal expectations. Environments that promote feelings of inadequacy, low self-esteem, anger, anxiety or loneliness in someone can make them more prone to developing a mental illness. Frequently jobs or schools can also contribute to the presence of a psychiatric disorder. Another critical environmental factor is substance abuse in the home by a parent.

Woman dealing with mental health issues

When Substance Abuse Is Present

The World Health Organization defines substance abuse as harmful or hazardous use of psychoactive substances such as drugs or alcohol. When someone abuses these substances, they can develop a dependency to the point where they will only feel normal when the substance(s) is present in their bodies.

Addiction is inculcated in a person when they continue to use despite harmful consequences and adverse effects involving health, professional, and/or legal ramifications. The signs of substance abuse and addiction are often revealed through compulsive and destructive behaviors exhibited by a user.

The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) is the principal authority for psychiatric diagnoses as set forth by the APA. The DSM-5 lays out 10 or 11 criteria, depending on the substance, that describes “a problematic pattern of use of an intoxicating substance leading to clinically significant impairment or distress” occurring within a 12-month period. Someone who meets two or three of the following criteria have a “mild” disorder; four or five is considered “moderate,” and six or more rates as “severe.”

The criteria are as follows:

  1. The substance is often taken in larger amounts or over a longer period than was intended.
  2. There is a persistent desire or unsuccessful effort to cut down or control use of the substance.
  3. A great deal of time is spent in activities necessary to obtain the substance, use the substance, or recover from its effects.
  4. Craving, or a strong desire or urge to use the substance, occurs.
  5. Recurrent use of the substance results in a failure to fulfill major role obligations at work, school, or home.
  6. Use of the substance continues despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of its use.
  7. Important social, occupational, or recreational activities are given up or reduced because of use of the substance.
  8. Use of the substance is recurrent in situations in which it is physically hazardous.
  9. Use of the substance is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
  10. Tolerance, as defined by either of the following:

1. A need for markedly increased amounts of the substance to achieve intoxication or desired effect

2. A markedly diminished effect with continued use of the same amount of the substance.

11. Withdrawal, as manifested by either of the following:

  1. The characteristic withdrawal syndrome for that substance (as specified in the DSM-5 for each substance).
  2. The use of a substance (or a closely related substance) to relieve or avoid withdrawal symptoms.

Dual Diagnosis Treatment

If you or a loved one has ADHD and is abusing a substance, there is professional, specialized treatment available that addresses both disorders concurrently. Professional treatment begins with medical detoxification. This is a medically supervised procedure where the substance is removed from your body, and any withdrawal symptoms that arise are managed safely and comfortably.

After detox is done, it is recommended that you enter into a residential program where you will receive ongoing therapy and counseling at a treatment facility. During this phase, you will also have access to cognitive behavioral therapy (CBT) and alternative therapies to treat your mental health condition. 
In addition to help from mental and addiction specialists, you will learn coping skills and mental health education to improve your mental health and maintain your sobriety. Professional treatment also provides access to aftercare via alumni recovery programs. These programs offer the kind of community support that can be a critical hedge against relapse.


U.S. Centers for Disease Control and Prevention. (2019, October 15) Attention-Deficit / Hyperactivity Disorder (ADHD).Data and Statistics About ADHD. Retrieved from

ADDitude. (2020, February 25) ADHD Statistics. Retrieved from

WebMD. ADHD and Substance Abuse. (2018, May 20) ADHD and Substance Abuse. Bhandari, S. MD Retrieved from

Vice. (2015, October 21) The Disturbing Relationship Between Addiction and ADHD. Sottile, L. Retrieved from

American Psychiatric Association. (2018 August) What Is Mental Illness? Parekh, R. MD., MPH Retrieved from

JAMA Network. (2009, September 9) Evaluating Dopamine Reward Pathway in ADHD.Clinical Implications. Retrieved from

Brain. A Journal of Neurology. (2013 November) A positron emission tomography study of nigro-striatal dopaminergic mechanisms underlying attention: implications for ADHD and its treatment. Retrieved from

WebMD. ADHD and Substance Abuse. (2018, May 20) ADHD and Substance Abuse. Bhandari, S. MD Retrieved from

Journal of the American Academy of Child and Adolescent Psychiatry. (2011) A Sobering Fact: ADHD Leads to Substance Abuse. Wilens, T. M.D. Retrieved from

National Institutes of Health. NIH Research Matters. (2013, March 18) Common Genetic Factors Found in 5 Mental Disorders. Retrieved from

The Kim Foundation. (n.d.) What are the Causes of Mental Illness. Retrieved from

World Health Organization. Substance Abuse. Retrieved from

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