How Substance Use Disorder Affects Mood Stability in ADHDÂ
People with ADHD are more likely than average to develop a substance use disorder (SUD), especially involving alcohol, cannabis, nicotine, or stimulants. A 2024 review in Frontiers in Psychiatry found that lifetime rates of substance misuse among people with ADHD may exceed 40%, particularly when ADHD remains undiagnosed or untreated.
ADHD and substance use: a two-way relationship
The connection between ADHD and substance misuse is bidirectional. ADHD-related impulsivity, emotional dysregulation, and reward-seeking behaviour can increase the likelihood of substance use. In turn, chronic use of alcohol or drugs disrupts dopamine regulation, worsening attention, mood control, and emotional stability.
Research published in The Lancet Psychiatry (2025) highlights how dysfunction within the prefrontal–limbic network, a brain system involved in emotion and decision-making — makes people with ADHD and SUD more reactive to stress and less able to self-regulate.
How substance use affects mood
Alcohol, cannabis, and stimulants can temporarily improve mood or focus but are often followed by emotional crashes, agitation, or withdrawal symptoms. Over time, these cycles increase the risk of anxiety, depression, and irritability. People with ADHD and SUD often describe heightened emotional sensitivity, difficulty calming down, and greater relationship stress.
This pattern can reinforce a loop of frustration and low self-esteem, driving further substance use in an attempt to regain balance.
NICE and NHS guidance
The NICE NG87 guideline recommends that clinicians screen for substance misuse during every ADHD assessment. If SUD is present, treatment should begin with stabilising the addiction before prescribing stimulant medication, since stimulants can worsen misuse or emotional volatility.
The NHS also supports an integrated care approach, where ADHD specialists, addiction services, and mental health teams work together to manage both conditions. This joined-up care helps restore emotional stability and supports long-term recovery.
Treatment and recovery strategies
Managing ADHD alongside SUD requires a trauma-informed, holistic approach. Evidence supports using Cognitive Behavioural Therapy (CBT) and Dialectical Behaviour Therapy (DBT) to manage impulsivity, emotional triggers, and stress responses. For people with a history of trauma or Adverse Childhood Experiences (ACEs), trauma-focused therapy is often essential.
Medication can still play a role, especially when carefully prescribed. Non-stimulant medications such as atomoxetine or guanfacine are sometimes preferred because they support focus and emotional regulation with a lower risk of misuse. The Mayo Clinic and Cleveland Clinic both recommend stabilising substance use before introducing stimulant treatment to improve safety and long-term outcomes.
A 2024 Frontiers in Psychiatry study also found that individuals who received coordinated ADHD and addiction treatment achieved a 32% greater improvement in emotional regulation than those receiving standard addiction therapy alone.
Takeaway
Substance use disorder can significantly destabilise mood in ADHD by disrupting dopamine balance, increasing impulsivity, and impairing emotional regulation. This creates a feedback loop where ADHD symptoms drive substance use, and substance use worsens emotional instability.
According to NICE and the NHS, the most effective pathway involves integrated, multidisciplinary care that treats both ADHD and addiction simultaneously. Combining therapy (CBT, DBT, or trauma-informed care) with thoughtful medication management can help individuals rebuild emotional resilience and achieve lasting recovery.
