Does Stimulant Use Lead to Addictions?

I am often asked by those newly diagnosed with ADHD and/or those wary of taking medications to treat it, whether using stimulant medications might increase their risk for substance abuse and or addictions. This is an understandable concern – those who believe that ADHD is really a pharmaceutical company conspiracy rigged to sell more drugs have worked hard to scare (or shame) people away from using medications. Alan Schwartz of the New York Times, and author of ADHD Nation in particular has spent a lot of energy seeding the idea that taking stimulants leads to abuse and addiction. Anyone who has encountered his work in the papers or popular press would likely take note and wonder.

So let’s explore that idea for a bit…

There is an overlap between ADHD and substance abuse. According to a 2006 study, about 15% of adults with ADHD have a co-existing alcohol or substance use disorder (1). Lifetime risk for substance abuse among those with ADHD is high (i.e. they have at some point in their lives a substance abuse issue). Estimates range between 21 – 53% of adults with ADHD, depending upon the study and substance. (2)

Based upon their knowledge of ADHD research, Mary Solanto, Ph.D. and Alan Zametkin, M.D. posit that the reasons for this overlap may be due to: neurobiological issues common to both ADHD and substance abuse conditions (one of which might be impulsivity); finding relief from co-occurring conditions such as depression or anxiety; or self-medicating to relieve ADHD symptoms. (3) This last I see with regularity in my own work, as adults with ADHD tell me they use alcohol and marijuana to ‘calm’ their minds.

But stimulant medications aren’t the cause of the substance use. The medical community has (rightly) studied whether there was a possible cause and effect connection and have researched the question. This makes sense – they certainly wouldn’t wish to prescribe stimulants if one side effect of doing so was an increased likelihood of addictions in a population already more prone than average to such issues. But meta-analyses and longitudinal research done between 2003 and 2013 suggests that stimulant use either doesn’t impact addictions or offers a protective effect. And in 2014, a study of 40,000 individuals in Sweden (mostly between the ages of 8 and 25) found a reduction of 31% in severe substance use in those taking medication. The same study also found that the longer the medication use, the lower the likelihood of substance abuse.(3) On the other hand, there is a very large body of research about substance abuse and ADHD in individuals with ADHD that shows that those who are not treated have a significant increase in substance abuse relative to controls.

Let me say it another way. The most likely way to develop a substance abuse problem (i.e. addiction) if you have ADHD is to decide NOT to take medications…just the opposite of what Schwartz and others would have you believe.

This does not mean that you should suddenly start taking medications without a thought to the possibility of addiction. Because ADHD overlaps with substance abuse, part of what is considered ‘best clinical practices’ for prescribing treatment for adults and children with ADHD is to screen for the propensity to abuse drugs. If you have a past addiction issue, make sure to bring it up with your physician so that the proper medication can be chosen for you.