"People with ADHD may be self-medicating with drugs or alcohol to keep their depression under control, and of course, that is a recipe for disaster," said study author Esme Fuller-Thomson. She is a professor of social work, medicine and nursing at the University of Toronto's Factor-Inwentash Faculty of Social Work, and director of the Institute for Life Course and Aging in Toronto.
The findings "underline the need for effective interventions to address substance use disorders among those with ADHD," she added.
The new study included close to 6,900 Canadians aged 20 to 39 with and without ADHD, a disorder marked by trouble concentrating, sitting still and/or controlling impulsive behaviors.
People with ADHD were significantly more likely to have a substance abuse disorder than their counterparts without ADHD. Alcohol use disorders were the most common in the new study, followed by marijuana. And more than 1 in 6 young adults with ADHD had an issue with illicit drugs such as cocaine, LSD or heroin, the study found.
The study didn't look at how ADHD treatment affects risk for substance abuse. But cognitive therapy "has been shown to have a very positive effect on ADHD symptoms, substance abuse problems, and depression and anxiety," Fuller-Thomson said.
Therapy often comprises sessions focused on developing coping skills and preventing relapse for substance abuse while also cultivating planning and problem-solving skills to help manage ADHD symptoms.
The study is published in the August issue of Alcohol and Alcoholism.
Substance abuse treatment programs can be trickier for people with ADHD, said psychologist Ari Tuckman, from Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD).
"When ADHD is untreated, it can be harder for folks with ADHD to get to meetings on time, commit to getting to bed earlier, eating a healthier diet, and reaching out for support in advance, not during a crisis," said Tuckman, who was not involved with the new research.
It may also be harder for people with ADHD to stay the course. "Given the lack of impulse control, people with ADHD may be more likely to break sobriety in the moment," he said.
This is why getting a better handle on substance abuse begins with effectively treating the ADHD. "This is the first domino," Tuckman said. ADHD treatment typically involves medication, counseling and behavioral therapy.
Dr. Scott Krakower, an attending psychiatrist with Zucker Hillside Hospital in Glen Oaks, N.Y., also looked over the study and agreed. "Treating the ADHD and any underlying mental health issues such as depression and anxiety will likely help with substance abuse as well," he said.
Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) offers more information on substance abuse and ADHD.
SOURCES: Esme Fuller-Thomson, PhD, professor, social work, medicine and nursing, University of Toronto, Factor-Inwentash Faculty of Social Work, and director, Institute for Life Course and Aging, Toronto; Ari Tuckman, PsyD, MBA, clinical psychologist, West Chester, Pa.; and CHADD expert; Scott Krakower, DO, attending psychiatrist, Zucker Hillside Hospital, Glen Oaks, N.Y.; Alcohol and Alcoholism, Aug. 3, 2021