ADHD and addiction: a connection worth knowing about

“A glass of wine in the evening wasn’t fun. It was the only moment in the day when my head went quiet.”

Plenty of people could say that sentence. Someone who spends the whole day running between tasks they never finish, who cannot settle in the evening, and who has discovered somewhere along the way that a glass, a cigarette, a joint or an hour of gaming on the phone gives them, for a while, what they cannot get any other way: quiet. It is not about getting intoxicated. It is about relief.

ADHD and addiction meet more often than you might expect, and there are well-understood reasons for this connection. In this post I will try to explain why that is, what research tells us, what it means for medication, and why one or the other difficulty is so often overlooked in treatment. One thing before I begin: I do not make diagnoses. ADHD is assessed by a psychiatrist or clinical psychologist, and addiction by a doctor. This post is meant to help you understand, not to assess yourself.

A connection that is rarely talked about

When people think about addiction, they rarely think of ADHD. And when they think about ADHD, they rarely think of addiction. Yet research has long shown that the two are closely linked.

A meta-analysis published in 2012 by a Dutch group led by Katelijne van Emmerik-van Oortmerssen pooled studies of people in treatment for alcohol or drug addiction. Around 23 per cent met the criteria for ADHD — almost one in four. That is several times higher than how common ADHD is among adults in general.

The connection runs the other way too. A 2011 meta-analysis by Steve Lee and colleagues pooled studies that followed children with and without ADHD into adolescence and adulthood. Those with ADHD more often went on to develop problems with nicotine, alcohol, cannabis and other drugs. This does not mean that every child with ADHD will become addicted — the vast majority will not. But it does mean the risk is higher and worth knowing about.

Why does this matter? Because in both directions it opens a question that otherwise nobody asks. If someone has tried unsuccessfully for years to stop drinking, there may be something underneath that has never been recognised. And if someone has an ADHD diagnosis, it makes sense for them and the people close to them to know about one of the traps that may lie ahead.

Why they meet: four routes

No single cause explains the link between ADHD and addiction. Researchers describe several routes, which can intertwine in any one person.

Reward now. In ADHD, the brain’s reward system is tuned differently. A study published in 2009 in JAMA by Nora Volkow’s group found changes in adults with ADHD in the dopamine pathways linked to reward and motivation. In everyday life this shows up as difficulty waiting: a reward that comes in a month barely counts, while a reward that comes now pulls with full force. Substances and certain behaviours offer exactly that — fast, reliable, immediate. You can read more about how the reward system works in addiction in Addiction is not weak will: what happens to the reward system and under dopamine in the knowledge base.

Impulsivity. A person with ADHD often tries things sooner, says “yes” more easily and finds it harder to say “enough”. This is not only about the first cigarette in the teenage years. It is also about the third glass when the plan was one.

Self-medication. In 1985 the psychiatrist Edward Khantzian described the hypothesis that people often do not choose substances at random, but according to what those substances help them bear. More on this route in the next section.

Family and genes. ADHD is largely heritable, and the risk of addiction is partly passed on too. At the same time, a child who grows up with a parent with unrecognised ADHD or an addiction grows up in an environment that leaves its mark. Genes and environment are hard to separate here.

Self-medication: what the substance does for you

Khantzian’s self-medication hypothesis is simple and, at the same time, deeply human: people do not reach for substances because they are seeking pleasure, but because the substance, for a while, eases something that is otherwise too hard. In ADHD this is often inner restlessness, thoughts that won’t let up, sleeplessness, and feelings that arrive too strongly and too fast. I have written about how emotions in ADHD sometimes catch fire faster than a person can catch them in Emotional dysregulation in ADHD: when a feeling arrives too fast.

With different substances this logic has different faces:

• Nicotine and caffeine can briefly improve focus — which is why many people with ADHD find that they “can’t even start without coffee and a cigarette”. Smokers are noticeably more common among people with ADHD than in the general population. More in Caffeine, nicotine and energy drinks: the small addictions we do not count.
• Alcohol quietens thoughts in the evening and helps you fall asleep — at least at first. In the long run it worsens sleep, which means a worse next day and more reasons for the next glass.
• Cannabis feels to many like a way to “switch the head off”. For some, though, it worsens exactly what is already vulnerable in ADHD: motivation, memory and organisation.
• Stimulants without a prescription — from illegal drugs to someone else’s pills — are a special case. People with unrecognised ADHD sometimes describe them as the first thing that made them “clear-headed” rather than high. That is exactly what can make them dangerous, because such an effect sets off no alarm.

The self-medication hypothesis does not mean that using substances is a sensible choice or that it is harmless. It does mean that it has a purpose worth understanding. If you take a substance away without understanding what it was giving you, a gap remains — and something else will quickly try to fill it.

Not only substances: screens, games and shopping

The same mechanisms that draw people with ADHD towards substances also operate in behaviours that offer quick rewards. A phone with endless scrolling, video games with constant small wins, online shopping with next-day delivery, betting on the phone during every match. All of this is built to reward instantly and unpredictably — which is especially attractive to a brain that finds waiting harder.

Care is needed here. Not every long gaming session is an addiction, and not every purchase is an escape. People with ADHD can become absorbed in something because it genuinely interests them, and that is not an illness. The question is whether you can stop when you want to, and whether the behaviour is harming your life. For a closer look, read Phone and screen addiction: habit or problem? and Gambling: the addiction with no smell that stays invisible.

Does ADHD medication lead to addiction?

This is one of the most common questions parents and adults have when they are considering treatment. Stimulants are, after all, related to substances that are misused. Isn’t there a danger that a child or adult gets “used to” them and then reaches for something else?

Research does not support this fear. A meta-analysis by Kathryn Humphreys and colleagues, published in 2013 in JAMA Psychiatry, pooled studies that followed children with ADHD into adulthood. Stimulant treatment in childhood was not associated with a higher risk of later addiction — nor with a lower one. A Swedish register study by Zheng Chang and colleagues from 2014 even found that taking ADHD medication was associated with a lower risk of substance misuse later on.

Important precautions remain, though. Prescribed stimulants can be misused, sold or shared, so it matters that you take them exactly as your doctor has instructed and do not give them to anyone else. For people already in treatment for addiction, the psychiatrist weighs the risks especially carefully when choosing a medication — sometimes choosing a different type of medicine or more frequent monitoring. These are a doctor’s decisions, not yours and not mine. I have written about what ADHD medication does and what it doesn’t in ADHD medication: what it does and what it doesn’t. And as always: do not stop or change your medication on your own.

Stimulants taken without a diagnosis, to keep up with the pace at work or at university, are a separate story. That is not ADHD treatment but a risk, which I write about in Alcohol and stimulants in demanding professions: quiet self-help.

Why one difficulty is often overlooked

When someone comes into addiction treatment, attention is understandably focused on the substance. ADHD can go unnoticed because its signs overlap with the signs of substance use or withdrawal: restlessness, sleeplessness, distractibility, irritability. At the same time, in someone who is actively using substances, ADHD really is hard to assess reliably.

An international consensus statement published in 2018 by a group of addiction and ADHD experts led by Cleo Crunelle therefore recommends screening people in addiction treatment for ADHD, while making the diagnosis carefully and with a detailed life history — including information about childhood, before substance use even began. It also recommends that both difficulties be treated in a coordinated way, rather than one after the other indefinitely.

The reverse is also true. A person with an ADHD diagnosis who seeks help with organisation or relationships may not mention their drinking or cannabis use on their own. Not because they are hiding it, but because it does not seem connected. That is why it makes sense to ask about it — without judgement, as one of the ways a person copes.

Family, shame and relationships

In relational family therapy, which I am training in, we are interested in how such patterns are passed down the generations. With ADHD and addiction this transmission is often twofold. A child inherits some predisposition, and at the same time grows up with a parent who may drink to quieten their own restlessness, which nobody ever named. What looks to a child like “that’s just how Dad is” is sometimes unrecognised ADHD hiding behind alcohol.

Imagine a conversation like this between a mother and her adult son, who has just been diagnosed with ADHD (a composite, not a real person):

“The psychiatrist asked me whether anyone in the family had similar difficulties.”
“And what did you say?”
“That I didn’t know. Then I thought of Dad. How he could never sit still. How he started everything and finished nothing. How he drank.”
His mother is silent for a long time. “I always thought he drank because of me.”
“Maybe he drank because of himself. Because of something nobody knew how to name.”

A conversation like this excuses nothing that happened. But it can lift some of the guilt that family members have carried for years. And it can open a question that matters for the next generation: what will we do differently?

Shame is strongly present in all of this. Shame about ADHD — “you never finished anything” — and shame about addiction — “you can’t control yourself”. When the two meet, they amplify each other. And shame is one of the main reasons people do not seek help, or give it up at the first slip. That is why it matters to know that a relapse is not a defeat, but part of the road, something it is possible to learn from.

Exercise: what does this give me?

This exercise is not a test for addiction. It is a way to understand better what role a substance or behaviour you keep returning to plays in your life. It takes twenty minutes and a sheet of paper.

1. Choose one thing you use more often than you would like — a glass in the evening, a cigarette, your phone before bed, betting, shopping.
2. Write down when you most often reach for it. At what time, in what mood, after what kind of event? Be as precise as you can.
3. Write down what it gives you in that moment. Not what it should give you, but what it really does. Quiet in your head? Focus? A sense of being rewarded? The end of the day?
4. For each answer, consider whether you could meet that need, at least partly, in another way. Not as a replacement, just as one more option — movement, a conversation, a different evening ritual.
5. Write down what worries you about it. If the answer is “quite a lot”, the next step is a conversation with your GP or a professional, not stricter self-control.

If you would like to think more carefully about where the line between habit and problem lies, Am I an addict? Questions that say more than quantity may help.

Where this connection does not apply

Because the link between ADHD and addiction is strong, it is easy to overgeneralise. So, a few limits.

Most people with ADHD do not develop an addiction. A higher risk is not destiny. Many people with ADHD have a perfectly ordinary relationship with substances, or do not use them at all.

Not every addiction is hidden ADHD. Behind an addiction there may be trauma, depression, anxiety, loneliness, social pressure, or simply long exposure to a substance. ADHD is one possible explanation, not the only one. This post is no reason to start looking for ADHD behind every glass, in yourself or in someone close to you.

Substances themselves mimic ADHD. Long-term use of alcohol or cannabis, and withdrawal too, can cause distractibility, restlessness and poor organisation. That is why assessment during active use is difficult and must be done by a professional who knows both fields.

ADHD does not remove responsibility. Understanding why you are more vulnerable does not mean the consequences of your actions are not yours. It does mean you can carry them without the shame that so often pushes you back into the same cycle.

Where to find help

If you recognise yourself in this post — or recognise someone close to you —, a good first step is a conversation with your GP. They can judge whether a referral to a psychiatrist is needed, who can assess both ADHD and addiction. If you already take medication, tell your doctor about any substances you use as well — this matters for your safety, not for judgement.

Psychotherapy can be an important part of the road, but it does not replace medical care. When substance use is severe or there is a risk of serious withdrawal, a doctor is the first port of call. Therapy, though, is a space for what I described above: for understanding what the substance was for, how patterns were passed on in the family, and how to build other routes to relief. If you do not want, or are not yet able, to stop completely, the perspective described in Harm reduction: an approach that does not demand immediate abstinence may also be useful. I also work with English-speaking clients in person in Ljubljana.

If you feel you can’t cope any more, or have thoughts of harming yourself, don’t wait. Call the crisis line Klic v duševni stiski on 01 520 99 00 in Slovenia (every day from 7 pm to 7 am), the Samarijan helpline on 116 123 in Slovenia (24 hours) or, in an emergency, 112. You can find more about the concept itself in the knowledge base under addiction.

What to remember

• ADHD and addiction often meet: among people in treatment for addiction, almost one in four has ADHD.
• The link is explained by the reward system, impulsivity, self-medication and family influences — often all together.
• Research does not show that treating ADHD with prescribed medication increases the risk of later addiction. A doctor always decides about medication.
• One difficulty often hides the other; it works best when both are treated in a coordinated way.
• The question “what does this give me?” often tells you more than the question “how much?”.