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Why do adults with ADHD often have histories of substance use disorders? 

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Updated
ByMy Patient Advice
Author: Victoria Rowe, MSc | Reviewed by: Dr. Rebecca Fernandez, MBBS

It is common for adults diagnosed with ADHD to have a past or present history of alcohol or drug misuse. According to NHS England, ADHD “rarely presents in isolation,” and is frequently linked to mental health and substance use disorders. This connection is not about weakness or willpower; it is about how ADHD affects the brain and behaviour. 

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Why substance use is more common in ADHD 

Studies consistently show that adults with ADHD are two to three times more likely to have experienced a substance use disorder (SUD) compared with adults without ADHD. Reviews published estimate lifetime rates as high as 43% (PubMed, 2025). 

The reason lies partly in brain chemistry. ADHD involves differences in dopamine regulation and reward sensitivity, meaning people may feel chronically under-stimulated or restless. Substances such as alcohol, cannabis, or stimulants can temporarily relieve this, creating a short-term sense of calm or focus. According to NICE NG87 guidance, impulsivity and emotional dysregulation further increase the likelihood of early experimentation and repeated use. 

When ADHD goes untreated 

Untreated ADHD often leads to self-medication, using alcohol or drugs to manage anxiety, low mood, or racing thoughts. NICE and the Royal College of Psychiatrists both recognise this as a major reason ADHD is underdiagnosed in adults seeking addiction treatment. The Office for Health Improvement and Disparities reports that neurodevelopmental conditions like ADHD are strongly overrepresented in UK addiction services. 

Untreated ADHD can also worsen relapse risk. Evidence from BMJ research shows that ADHD medication significantly reduces the likelihood of substance misuse, suicide, and criminality, whereas untreated symptoms increase vulnerability. 

What NICE and NHS recommend 

NICE NG87 and NG135 recommend that screening for ADHD should be part of all addiction assessments, and that treatment should be integrated, combining ADHD management, substance misuse therapy, and emotional support. 

According to NHS guidance, medication and structured therapy can reduce impulsivity and improve emotional control, making recovery from addiction more achievable. For behavioural and psychological support, programmes like Theara Change offer evidence-based coaching and therapy for ADHD, complementing clinical care. 

Takeaway 

Adults with ADHD face higher risks of substance misuse, not because they are reckless, but because their brains seek balance in ways that can backfire. Early diagnosis, joined-up care, and effective ADHD treatment can reduce these risks and support lasting recovery. 

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. 

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