Recovery When ADHD Is Also Present

You are trying to stay off a drug while a prescribed stimulant is still in the bottle, and you do not know which problem the program will take seriously. Attention-deficit/hyperactivity disorder is one diagnosis. A substance use disorder is another. They can be present in the same person, and treating only the one that showed up first leaves the other in the room. What follows is that overlap. It is not a rating scale, not a stimulant schedule, and not permission to share a prescription. Integrated care for mental disorders and substance use disorders as a group is the dual-diagnosis guide.

If someone has chest pain, a seizure, or trouble breathing, call 911. For a mental health crisis, call or text 988.

What the diagnosis is, and what it is not

CDC says ADHD is one of the most common neurodevelopmental disorders of childhood. It is usually first diagnosed in childhood and often lasts into adulthood. Children may have trouble paying attention, may act without thinking about the result, or may be overly active. CDC describes three presentations, depending on which symptoms are strongest at diagnosis: predominantly inattentive, predominantly hyperactive-impulsive, and combined. Symptoms can change as daily demands change. Trouble focusing once in a while is ordinary. CDC says that for children with ADHD the symptoms continue, can be severe, and can cause difficulty at school, at home, or with friends.

There is no single test. CDC says a mental health professional or a primary care clinician can make the diagnosis, and that anxiety, depression, sleep problems, and some learning disabilities can look similar. If the question is about a child, CDC says to talk with a health care provider first. A listing does not diagnose adults or children.

NIDA's research report on common comorbidities says substance use disorders occur at high prevalence with ADHD, alongside depression, bipolar disorder, psychotic illness, and personality disorders. Its public page on co-occurring conditions says adolescents who have substance use disorders have especially high rates of mood and anxiety disorders, conduct disorder, and ADHD. Family-based treatment for teens is the guide for teens and young adults. A high rate in a survey is not a label for one teenager.

Risk, medicine, and a research limit

NIDA's report says numerous studies have documented an increased risk for substance use disorders in youth with untreated ADHD, although some studies suggest that only those who also have a conduct disorder have greater odds of later developing a substance use disorder. The report says treatment of childhood ADHD with stimulant medications such as methylphenidate or amphetamine reduces the impulsive behavior, fidgeting, and inability to concentrate that characterize ADHD. It also says effective treatment often involves prescribing stimulants that have addictive potential, that the research is not yet conclusive, and that many studies suggest ADHD medications do not increase the risk of a substance use disorder among children with ADHD. It says stimulant medication should be combined with family and child education and behavioral interventions, including counseling on the chronic nature of ADHD and on substance use risk.

That paragraph is about research, mostly in children. It is not an order to start a stimulant in residential care, and it is not an order to stop one. CDC says that in most cases ADHD is best treated with behavior therapy and medication together, and that for preschool-aged children ages 4 to 5, behavior therapy, particularly parent training, is recommended before medication is tried. Effective plans include monitoring and changes along the way. What works depends on the person and the family. A program brochure that says "we are drug-free, so leave your prescriptions at home" is not CDC's sentence. Ask the prescriber and ask the program. Bringing a list or the bottles, and not stopping a benzodiazepine or an opioid medicine alone, is the medications-to-rehab guide. The same caution applies to hiding an ADHD medicine.

Nonmedical use is a different subject. NIDA's definition of prescription misuse, on the misuse guide, is a wrong dose, someone else's medicine, or taking it to get high. Taking a prescribed medicine as directed is not that definition. Sharing a pill is. The crash and the emergency signs are the stimulant withdrawal guide and the overdose guide. Chest pain, a seizure, or trouble breathing needs the emergency help already named above, not another chapter.

Alcohol, cravings, and treating both

NIAAA's harmful-interactions pamphlet, published in 2003 and still posted by the institute, lists medicines used for ADHD. It says alcohol combined with methylphenidate or dexmethylphenidate can be tied to dizziness, drowsiness, and impaired concentration, and that amphetamine, dextroamphetamine, and lisdexamfetamine carry a possible increased risk of heart problems. It says the pamphlet is not a complete list of medicines or ingredients, and that a pharmacist or other clinician can help. Brand names on a 2003 table are not a current formulary. Do not drink to test the warning, and do not stop the medicine because the table exists.

NIDA says research suggests ADHD is associated with the same brain changes associated with drug cravings, which may explain why people with both a substance use disorder and ADHD often report greater cravings. The verb is "may." It is a reason to tell a clinician about both problems. It is not a measure of anyone's willpower.

NIDA's broader point, which the dual-diagnosis page develops, is that co-occurring conditions are usually better treated together than separately, and that overlapping symptoms make the diagnosis harder. People with both often have symptoms that last longer and resist treatment more than either condition alone. Screening for only one of them is how the other gets missed. SAMHSA's co-occurring page is the federal treatment overview. A referral conversation does not perform that screening.

CDC's funded ADHD line, 1-866-200-8098, answers questions about ADHD. SAMHSA's National Helpline is 1-800-662-HELP (4357). SmarterRecovery is a referral helpline. SMART Recovery is a separate mutual-help program. Call or text (800) 653-9376 if you want help finding a program that can talk about both a substance use disorder and ADHD. Say which medicines are already prescribed.

Additional Resources

Sources cited on this page:

• CDC: About ADHD
• NIDA: Co-occurring disorders and health conditions
• NIDA: Common Comorbidities with Substance Use Disorders Research Report
• NIAAA: Harmful interactions, mixing alcohol with medicines
• SAMHSA: Co-occurring disorders
• SAMHSA National Helpline
• 988 Suicide & Crisis Lifeline

Common Questions