Why is ADHD underdiagnosed in people with addictions?

PostedNovember 25, 2025

UpdatedNovember 26, 2025

ByMy Patient Advice

Author: Victoria Rowe, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

Many people living with addiction may also have undiagnosed ADHD, yet the connection often goes unnoticed. According to NICE guidance, overlapping symptoms, stigma, and siloed clinical pathways are key reasons why ADHD is frequently missed in those with substance use disorders (SUDs) (NICE NG87).

Overlapping symptoms blur the picture

The signs of ADHD, such as impulsivity, restlessness, and emotional dysregulation, often mirror the effects of substance use or withdrawal. NHS clinicians note that this overlap can make it difficult to tell whether symptoms come from ADHD itself or the consequences of addiction (NHS England ADHD Taskforce, 2025). Peer-reviewed studies show that up to a quarter of adults in addiction treatment may have undiagnosed ADHD, compared with much lower rates in the general population (BMJ, 2025).

Stigma and system barriers add to underdiagnosis

People seeking help with alcohol or drug problems often face stigma, and that can discourage open discussion about attention, focus, or emotional symptoms. At the same time, many addiction services still lack formal ADHD screening pathways. NICE guidance recommends that assessments take coexisting substance use into account and include collateral history from relatives or partners, but these multidisciplinary assessments aren’t always available in frontline addiction care (NICE NG87, 2025 update).

The clinical consequences

When ADHD is missed, individuals may self-medicate with alcohol, stimulants, or cannabis to manage restlessness or low mood. Over time, this can worsen both conditions. Evidence from the PMC (2025) suggests that adults with untreated ADHD are significantly more likely to develop a substance use disorder, and recovery outcomes improve when both ADHD and addiction are addressed together.

What helps?

NICE and NHS guidance emphasise early, integrated assessment. That means screening for ADHD within addiction services, distinguishing between intoxication effects and persistent symptoms, and offering combined treatment plans including medication, psychoeducation, and behavioural support. Private and NHS services such as ADHD Certify provide structured assessments and medication reviews, helping close the gap for those who may otherwise fall through the cracks.

Takeaway

ADHD and addiction often coexist, but without a comprehensive assessment, many people remain undiagnosed. Recognising the overlap and treating both conditions together can improve recovery, reduce relapse risk, and give people the understanding they’ve been missing for years.

Victoria Rowe, MSc

Author

Victoria Rowe is a health psychologist with a Master’s in Health Psychology and a BS in Applied Psychology. She has experience as a school psychologist, conducting behavioural assessments, developing individualized education plans (IEPs), and supporting children’s mental health. Dr. Rowe has contributed to peer-reviewed research on mental health, including studies on anxiety disorders and the impact of COVID-19 on healthcare systems. Skilled in SPSS, Minitab, and academic writing, she is committed to advancing psychological knowledge and promoting well-being through evidence-based practice.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the author's privacy.

Dr. Rebecca Fernandez, MBBS

Reviewer

Dr. Rebecca Fernandez is a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being.

All qualifications and professional experience stated above are authentic and verified by our editorial team. However, pseudonym and image likeness are used to protect the reviewer's privacy.