Popular opinion often claims that the use of ADHD prescription drugs can lead to a dependency, further habits of drug abuse, or make people more prone to develop addictions later in life. However, that’s wrong.
In fact, recent studies show that medication treatment for ADHD in early life actually decreases the likelihood of developing a substance use disorder.
Nevertheless, people with ADHD are still prone to addictive behaviors. The proportion of ADHDers in treatment for substance abuse or addiction is disproportionally high in comparison to the prevalence in the overall population. Research suggests that this might be due to the neurobiological overlaps of addiction and ADHD.
Clearing up popular misconceptions
“Habit forming” or “hooked” are buzzwords that are often used in discussions of the connection between treating ADHD with prescription drugs, for example stimulants like Adderall or Ritalin, and addiction. While technically medication treatments of ADHD are a form of “drug use”, the important nuance here is drug abuse.
Yes, stimulants and non-stimulants that are used to treat ADHD have the potential of being addictive. But the outcome - developing an addiction or not - depends on the way they're being used.
If taken in prescribed doses and under the supervision of a physician, there’s no evidence to support the claim that stimulants can lead to addiction. In fact, research shows that if ADHD is treated with medication in early years, the likelihood of forming a substance abuse disorder later in life decreases!  , 
Understanding the difference: Dependence and addiction
The difference between dependence and addiction is a little complicated. That is because the terminology has been changing over the years, but also been used interchangeably.
To clarify: Today the term “addiction” has been abandoned in diagnostics. Addiction is now referred to as substance use disorder (SUD).
Substance use disorder can be diagnosed when 2 or more of 11 symptoms are present over a 12-month period. These symptoms can be categorized as follows:
- Loss of control
- Risky use
- Social problems
- Drug effects (withdrawal, tolerance)
Drug or Substance dependence is no longer classified by the DSM-V criteria. However it can be characterized by symptoms of withdrawal and tolerance.
Furthermore, there are two different types of dependence: Psychological dependence and physiological dependence.
Applying these concepts to ADHD medication
Physicians will almost never cut ADHD medication on the spot. Fading them out is common practice. That is, because symptoms of withdrawal are not uncommon.
It is also possible that you build up a tolerance against ADHD medication, in which case the physician might slightly raise the dosage.
So, it's not at all uncommon that people being treated with ADHD medication develop a dependence on the drug. However, that doesn’t mean an addiction or the development of a substance use disorder has to - or will - occur. That happens only if the medication is abused, or taken for recreational / non-medical use, or in higher doses than prescribed.
Important: never change the dose of any medication without consulting your physician, and only use it for the prescribed purposes!
Signs of ADHD medication misuse or abuse
ADHD medication might be misused or abused, if:
- One wants to discontinue the use, but is struggling to.
- The dosage is increased continuously to achieve the same effect.
- Medication is used to achieve a “high”.
- Symptoms of withdrawal appear once the use is discontinued.
- Excessively taking 'medication vacations' for the sole purpose of stocking up on capsules or pills.
Why people with ADHD are more at risk for developing an addiction
Two key facts:
- The prevalence of ADHD in the general population worldwide is roughly estimated at 7%.
- The percentage of people in treatment for substance abuse living with (diagnosed) ADHD is often estimated at 25%.
My point? Think about the gray zones - imagine how many people with diagnosed or undiagnosed ADHD struggle with a substance abuse disorder, but aren’t in treatment.
In fact a 2016 study examined the prevalence of ADHD among patients seeking treatment for cannabis use disorder*. It concluded that between 34% and 46% percent of the patients had ADHD. So -why do so many people with ADHD often develop substance abuse disorders?
*There is controversy about this 'disorder'; this article is not reflective of the author's or company's views on this controversial condition.
Overlapping neurobiology of addiction and ADHD
One study took a look at the overlapping neurobiology of addiction and ADHD. It concluded that both ADHD and addiction affect two areas of the brain that are associated with:
- motivation, incentive salience, and impulsivity
- error detection, executive functions, and maintenance of goal directed behavior
The close proximity of ADHD to addiction can be categorized in three steps that all happen in the same brain regions:
Binge/intoxication and impulsivity
The first step of addiction is the intoxication where a person is looking for a pleasurable experience. With ADHDers, the initial use will most often involve an element of impulsivity.
Withdrawal/negative affect and diminished sensitivity to reward
A person who has been using will often experience withdrawal symptoms or other negative effects when they stop using the substance. This is largely due to the diminished activation of the reward circuits. And people with ADHD naturally have a very low sensitivity to reward in the first place.
Preoccupation/anticipation and impaired control
At this stage, a person begins seeking out the substance - they 'crave' it. This stage is associated with the area of the brain responsible for executive functioning, or the prefrontal cortex. Again, this is an area affected by ADHD and is associated with impulsive and reward-seeking behavior.
In conclusion, the article notes that there are remarkable neurobiological parallels between ADHD and addiction.
Self-medicating ADHD symptoms
Another factor of the elevated risk of ADHDers to develop addiction is the self- medicating effects that the drugs may have on ADHD symptoms.
In a podcast, Dr. David Teplin points out that it's not uncommon for people with ADHD to experiment with substances that initially decrease ADHD symptoms. Also - the flood of dopamine that many substances prompt is very appealing to the ADHD brain.
Furthermore, it isn’t necessarily always substances that ADHDers can grow reliant on, or addicted to. Excessive sports, eating or gambling are just as common.
Too long didn’t read
ADHD medications don’t cause addiction.
If taken in the prescribed doses and under the supervision of a physician a dependency might develop, which is nothing to worry about and not an addiction / substance use disorder.
If ADHD is medicated in early life, the risk of developing a substance use disorder later in life decreases.
Addiction and ADHD share close neurobiological roots and mechanisms, which is one reason why ADHDers are more likely to develop a substance use disorder.
If you take (ADHD) medication, never increase or decrease the dose without consulting your physician, and don’t use it for any non-medical purposes.
Furthermore the use of substances to deal with ADHD symptoms might be appealing, but the dangers of developing an addiction are especially high. Consult a physician about medically safe ways of treating your ADHD!
If you have the suspicion that you might be addicted to or abusing substances you can get help! Some resources for facts and help include: