October is ADHD Awareness Month. So, it’s a good time to talk about a clinically important observation: Attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) frequently occur together.
We know that the overlap is not a coincidence – there’s growing evidence for shared biology, shared risk, and clear implications for how we treat people who struggle with both conditions.
What The Evidence Shows
Large genetic and epidemiologic studies now show a measurable genetic correlation between ADHD and multiple types of substance use disorders — alcohol, nicotine, opioids, and stimulants. Recent genomic analyses characterize pleiotropic (shared) genetic influences and find that higher polygenic risk scores for some SUDs associate with ADHD and vice versa. These data support the idea that part of the reason these disorders co-occur is overlapping genetic liability, not only environment or self-medication.
Clinical and population studies also consistently show that childhood ADHD substantially increases risk of later substance use and SUD in adolescence and adulthood, and that ongoing untreated or under-treated ADHD tends to raise that risk further. Meta-analyses and large cohort studies have repeatedly documented this elevated vulnerability.
What Major Clinical Bodies Recommend
Importantly, a large and growing body of research suggests that appropriate ADHD treatment — including pharmacotherapy when indicated — is not associated with higher long-term rates of substance misuse; on the contrary, several recent studies report reduced rates of substance-related problems and other harms among those who receive ADHD treatment. These real-world studies are reassuring and clinically meaningful.
Contemporary addiction medicine guidance recognizes co-occurring psychiatric disorders as common and clinically important. The American Society of Addiction Medicine (ASAM) and the American Academy of Addiction Psychiatry (AAAP) recommend assessing for and treating co-occurring psychiatric disorders alongside substance use disorders. Recent ASAM/AAAP clinical guidance on stimulant use disorder explicitly supports coordinated, concurrent treatment of SUD and co-occurring psychiatric illnesses rather than sequential care. In practice, that means we should not “wait” to treat ADHD until SUD is in remission — we plan care for both.
Treatment Implications
How should this information inform everyday clinical decision-making? Here are a few tips:
- Screen routinely: anyone presenting for SUD care should be screened for ADHD (and vice versa). Missing ADHD can leave a major driver of impulsivity, poor adherence, and increased vulnerability for a recurrence (relapse).
- Treat concurrently and collaboratively: when ADHD and SUD co-exist, coordinate care among addiction specialists, psychiatrists, and primary care; behavioral therapies and medication management can and often should proceed together. ASAM guidance supports this coordinated approach.
- Be pragmatic about medications: stimulant medications are evidence-based for ADHD; when SUD involves stimulants or active misuse, treatment choice and monitoring require extra caution such as utilizing long-acting stimulant formulations, frequent follow-ups, smaller dispensing amounts, and urine drug screen monitoring. Non-stimulant options like atomoxetine, certain antidepressants, and alpha-2 agonists can be useful tools when stimulants are contraindicated.
A Final Note For ADHD Awareness Month
Understanding the biological and clinical link between ADHD and SUD reduces stigma and improves care: these co-occurring conditions are treatable. Treating both together gives people the best shot at recovery and functional gains. If you or a loved one is navigating either ADHD or substance use, ask your clinician about integrated care and a coordinated treatment plan — this approach is what the evidence and ASAM recommend. And it gives you the best chances of meaningful, long-term recovery.
At Aware Recovery Care, we treat the whole person on the path to recovery from substance use disorder. If ADHD coexists alongside your alcohol or drug dependency, we have the experts and tools to help address both issues—with compassion and understanding. Contact us online by submitting a form here or call 844-292-7372 to learn more about how we can support you on your path to recovery.
Selected sources & further reading
- Koller D. Genetic contribution to the comorbidity between attention-deficit/hyperactivity disorder and substance use disorder (2024).
- Vilar-Ribó L. et al., Genetic overlap and causality between substance use and ADHD (2021).
- Rohner H. et al., Prevalence and course of ADHD and links to SUD (2023).
- Quinn P.D., ADHD medication and substance-related outcomes (review).
- ASAM Clinical Guidelines and ASAM/AAAP guideline on stimulant use disorder (ASAM).
