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ADHD and Addiction: How They Intersect
Updated: May 21
The connection between ADHD and addiction is significant and too complex to boil down to just one factor. Research has shown that people with ADHD are more likely to develop substance use disorders, as well as compulsive behaviours such as gambling, compulsive sexual behaviour, and compulsive shopping.
One reason for this connection is that people with ADHD may use substances or engage in addictive behaviours as a way to self-medicate. The symptoms of ADHD, such as impulsivity, inattention, and hyperactivity, can be difficult to manage, and people with ADHD may use substances or compulsive behaviour as a way to cope with these symptoms. There is some speculation that people with ADHD are particularly vulnerable to stimulant dependence - which is ironic given that stimulants are one of the main pharmocological treatments for ADHD. Some researchers have gone on to suggest that illicit stimulants provide a similarly soothing or appealing experience for people with ADHD because of differences in brain chemistry.
Brain chemistry may be involved in other aspects of the correlation between ADHD and addiction. ADHD is associated with a dysregulation of dopamine, a neurotransmitter that plays a key role in the reward system of the brain. It is speculated that dopamine dysregulation can make people with ADHD more susceptible to the addictive effects of substances because of the rewarding feeling it produces.
The Dopamine Hypothesis
If you've spent a minute on neurodivergent Tiktok, you've heard the word "dopamine." Although “the Dopamine Hypothesis” is currently unproven, it seems likely that there could be differences in the way the body uses dopamine (and how the mind responds) for people who live with ADHD. Specifically, it has been speculated that there is a deficiency of dopamine in the prefrontal cortex, which is an area of the brain that is involved in executive functions such as attention, planning, and impulse control - leading to some of the differences experienced by people with ADHD.
The link between dopamine and addiction is a bit less widely discussed.The dopamine hypothesis for addiction, suggests that addiction is caused by a problem within the brain's reward system, which involves the release of dopamine. In addiction, the brain's reward system becomes more sensitive to the addictive substance or behaviour, leading to an increase in dopamine release in response to the substance or behaviour. In practice this means that people start to associate a stronger than normal reward feeling with a particular substance or behaviour.
The fact that dopamine is thought to be a contributing factor in both ADHD and addiction underscores the importance of understanding the role of brain chemistry in both of these conditions and the potential for targeted interventions aimed at regulating dopamine levels in the brain. For people living with both ADHD and addiction, treatment may involve a combination of medication, therapy, and lifestyle changes that address both conditions and their underlying biochemical imbalances. At Stillwaters, our counsellors take a bio-psycho-social-spiritual approach to assessment and treatment, which means we will consider your brain chemistry as well as the other important parts of your experience.
ADHD, Addiction, and the Social World
Outside of brain chemistry, the social world also plays an extremely important role in the development of addiction for people with ADHD. A large body of research supports the idea that social exclusion may play a role in the link between ADHD and addiction. Social exclusion is the experience of being rejected, marginalised, or excluded from social relationships or activities, and it can lead to feelings of loneliness, low self-esteem, and depression. One study showed that kids with ADHD hear 20,000 more corrective messages ("no", "stop that", "don't do that", "that's bad") before the age of eight. If we imagine how that impacts self-concept, and how painful it is to live in the world with poor self concept and ongoing experiences of exclusion, it makes sense that people with ADHD may rely on substances to help them cope.
People with ADHD frequently struggle with social interactions and have difficulty making and maintaining friendships. Studies have shown that people with ADHD are at increased risk for social rejection and social isolation, which can exacerbate their symptoms and lead to additional mental and physical health challenges. When the experience of exclusion is combined with a struggle to emotionally self-regulate (a common symptom of ADHD), the link between ADHD and addiction makes a lot of sense.
Research has found that people who experience social exclusion are more likely to engage in risky behaviours and substance use as a way to cope with feelings of loneliness and social isolation. In Bruce Alexander’s famous “Rat Park” experiment, rats who lived in a boring, isolated cage were much more likely to become addicted to narcotics than rats who had an enriching cage and social time with other rats. Clearly, addiction is not just a matter of brain chemistry.
For people with both ADHD and addiction, social exclusion can create a vicious cycle where ADHD symptoms lead to social rejection, which in turn leads to substance use as a way to cope with the emotional distress caused by social exclusion. This cycle can make it difficult to treat addiction and can make it harder to find community and feel well.
It is important to address social exclusion and its potential role in ADHD and addiction treatment. Therapy and connection to community can be helpful for people with ADHD to improve the quality of their social interactions and reduce the pain of social exclusion. Additionally, addiction treatment that addresses the underlying social and emotional factors that contribute to addiction can help people overcome their dependence on substances and improve the quality of their relationships.
Addiction treatment can be tailored to address the unique biological, psychological, and social needs and challenges of individuals with ADHD. People with ADHD may require different approaches in addiction treatment compared to neurotypical people. It is important to understand that individuals with ADHD may be more vulnerable to addiction due to social, emotional, and neurobiological differences. People with ADHD need comprehensive treatment planning that takes into account the complex relationship ADHD symptoms and the addiction, and which is tailored to the needs of the whole person.
Treatment Considerations
Important considerations in treating ADHD and addiction include:
Comprehensive assessment: A comprehensive assessment that takes into account both ADHD and addiction symptoms is important to identify the unique challenges and needs of the individual. The assessment should include biological, psychological, social, and spiritual factors.
Medication management: ADHD medication can be helpful for managing ADHD symptoms and may also reduce the risk of relapse during addiction treatment. Other medications are available to support some substance use disorders.
Cognitive behavioural therapy (CBT): CBT can be helpful for people with ADHD and addiction, as it addresses both the addiction and the underlying ADHD symptoms, including impulsivity and challenges with emotion regulation. It may also help address problems with self-esteem or self-concept, which are common among people with ADHD and contribute to overall vulnerability to addiction.
Motivational interviewing (MI): MI is a counselling approach that can help people with ADHD and addiction to explore motivations, rewards, and costs or drawbacks associated with substance use.
Behavioural interventions: Behavioural interventions, such as contingency management, can be helpful for people with ADHD and addictions, as they provide immediate rewards for achieving goals related to substance use.
Support for co-occurring disorders: People with ADHD and addiction may also have co-occurring mental health conditions that require treatment, such as anxiety or depression. It is important to address these co-occurring disorders in the treatment plan.
Increased social connection: An increasing body of research suggests that social exclusion and dislocation both people vulnerable to addiction. Therapists can help their clients find accepting communities and make supportive connections within those communities.
It is important for people with ADHD to be aware of their increased risk for addiction and to seek appropriate treatment for substance use or addictive behaviour if it becomes problematic. Treatment for ADHD, such as medication and therapy, can help manage symptoms and reduce the risk of developing addiction.
If you are struggling with ADHD and substance use, our counsellors are here to support you. You can book a consultation in our online calendar or get in touch by email - we look forward to hearing from you!