ADHD and addiction: How they’re linked and how to treat both

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Attention deficit hyperactivity disorder (ADHD) and addiction often occur together. Adults with ADHD are more likely than others to develop problems with alcohol and drugs. Roughly one in four people in addiction treatment meets the criteria for ADHD.

The traits that define ADHD, such as impulsivity and difficulty regulating attention and emotion, also make substance use harder to control. Many people also find that alcohol or drugs temporarily dull symptoms they’ve struggled with since childhood.

This article covers how common the combination is and why ADHD raises the risk of addiction. The article also explains:

Which substances are most often involved
Whether ADHD medication leads to drug use
Why ADHD is hard to diagnose during active substance use
What effective treatment looks like, and how families can help

How common is ADHD among people with addiction?

ADHD is far more common among people with substance use problems than in the general population. A meta-analysis of 29 studies looked at people being treated for a substance use disorder. Of those, 23.1% met the diagnostic criteria for ADHD, or almost one in four.

The link starts early. A review of long-term studies followed children with and without ADHD into adolescence and adulthood. The children with ADHD were significantly more likely to develop dependence on drugs, alcohol, or nicotine later in life. The raised risk held regardless of sex, age, or ethnicity.

Many adults with ADHD were never diagnosed as children. For some, an addiction assessment is the first time anyone has considered ADHD as an explanation for lifelong difficulties.

Why ADHD raises the risk of addiction

ADHD raises the risk of addiction in several ways, and no single reason applies to everyone. The condition’s core traits play a part, as does the way substances temporarily relieve its symptoms. Untreated ADHD also tends to create life problems that make substances more appealing.

Impulsivity and reward-seeking

Impulsivity is one of the defining features of ADHD. People with ADHD are more likely to act before thinking through consequences. They’re also more likely to choose an immediate reward over a delayed one. Those tendencies make substance use easier to start and harder to stop once a pattern begins.

Using substances to manage symptoms

Many people with ADHD describe drinking or using drugs to calm a racing mind or to fall asleep. Others use stimulants such as cocaine or tik to focus, often without realising they’re treating an underlying condition. Substances offer short-term relief, but they don’t treat ADHD. Dependence then adds a second set of problems to the first.

The knock-on effects of untreated ADHD

Untreated ADHD often brings struggles at school, at work, and in relationships. Years of being called lazy or careless can also wear down self-esteem. Each of those pressures adds to the pull of substances as a way to cope.

Which substances are most common with ADHD?

People with ADHD can develop problems with any substance. The long-term studies of children with ADHD found raised rates of dependence in later life on:

Nicotine
Alcohol
Cannabis
Cocaine

Illegal stimulants carry a particular risk for people who use them to focus. The doses are uncontrolled, and dependence can develop quickly. Our articles on cocaine addiction and crystal meth explain those risks in more detail.

Does ADHD medication lead to addiction?

Many families worry that stimulant medication for ADHD will lead to drug use later on. The best available evidence suggests the opposite. A study of nearly three million ADHD patients compared the same people during months on and off their medication. On medication, men had 35% lower odds of an emergency department visit related to substance use, and women had 31% lower odds.

ADHD medication can still be misused, and some people take or sell prescribed stimulants for their effects. An international consensus statement covers people with both ADHD and a substance use disorder. The statement recommends long-acting formulations, which are harder to misuse, alongside careful monitoring.

South African ADHD medicines include the following, according to SAHPRA’s medicine schedules:

Methylphenidate: Sold as Ritalin and Concerta, among other brands, and listed in Schedule 6
Lisdexamfetamine: Sold as Vyvanse and also listed in Schedule 6
Atomoxetine: A non-stimulant option, listed in Schedule 5

Decisions about which medicine to use, if any, belong with a psychiatrist who knows the person’s full history.

Why ADHD is hard to diagnose during active addiction

Alcohol, drugs, and withdrawal can all produce symptoms that look like ADHD, such as poor concentration and restlessness. A reliable ADHD diagnosis therefore usually has to wait until a person has stopped using and withdrawal has settled. Our article on dual diagnosis explains this in more detail.

A clinician will also look for evidence that symptoms began in childhood, before any substance use. School reports and conversations with parents or siblings can help fill in that history.

The international consensus statement recommends that addiction services screen every patient for ADHD. Anyone who screens positive should have a full diagnostic assessment as soon as possible. The statement links unrecognised ADHD with earlier, more severe substance problems and lower treatment success.

Treatment for ADHD and addiction

The most effective approach treats ADHD and addiction at the same time, within one coordinated plan. The international consensus statement recommends exactly that, combining medication where appropriate with psychological therapy.

Detox and stabilisation

Treatment usually begins with stopping substance use safely. Withdrawal from alcohol, benzodiazepines, and opioids can be dangerous without medical supervision. At Houghton House, patients spend their first three days in our medical detox unit under round-the-clock nursing care.

Psychiatric assessment and medication

Houghton House is licensed as both a rehabilitation centre and a private psychiatric hospital. An in-house psychiatrist assesses every patient on admission. The psychiatrist prescribes medication where needed and adjusts it as treatment progresses. For a patient with ADHD, that may mean starting or reviewing ADHD medication once withdrawal has settled, under supervision.

Therapy and skills

Medication on its own doesn’t teach the skills that ADHD makes harder, such as planning and managing frustration without reaching for a substance. Our rehab programme includes:

Cognitive behavioural therapy (CBT), which helps people notice the thoughts behind impulsive decisions
Dialectical behaviour therapy (DBT), which builds skills for tolerating distress and regulating emotion
Mindfulness
Individual and group counselling

Some people with ADHD also find a full daily programme, with clear structure and routine, easier to manage than unscheduled time.

Aftercare

Many of the challenges ADHD creates show up after discharge, when daily structure falls away. Our aftercare programme continues therapy and accountability during that transition. Ongoing psychiatric follow-up helps keep ADHD treatment on track.

How families can help

Living with someone who has ADHD and an addiction can be exhausting, and family members often carry years of frustration. A few steps make a difference:

Learn about ADHD, which can help separate the condition’s symptoms from deliberate behaviour
Encourage an assessment that covers both conditions, rather than the addiction alone
Set clear boundaries around substance use, money, and behaviour you won’t accept
Look after your own support needs as well

Our family support programme runs weekly meetings for anyone affected by a loved one’s addiction, whether or not that person is in treatment.

Medical aid cover for ADHD and addiction treatment

Substance use disorders are prescribed minimum benefits (PMBs) in South Africa. All registered medical aids must therefore cover addiction treatment. Houghton House is also a licensed psychiatric hospital. Patients can claim for additional mental health services where a co-occurring condition qualifies under psychiatric PMBs.

Our admissions team checks your benefits and handles pre-authorisation for you. Visit our medical aid cover page, or contact our admissions team to find out what your scheme covers.

Frequently asked questions about ADHD and addiction

Is ADHD a risk factor for addiction?

Yes. Children with ADHD are significantly more likely than other children to develop a substance use disorder later in life. About one in four adults in addiction treatment has ADHD. Our article on addiction risk factors covers other influences that raise the likelihood of addiction.

Can you take ADHD medication in rehab?

In many cases, yes. Whether ADHD medication is appropriate depends on the substance involved, the stage of treatment, and the person’s history. At Houghton House, the psychiatrist makes that decision with the patient and the treatment team. Staff supervise any medication given during an admission.

Why do people with ADHD self-medicate?

Many people with ADHD use alcohol or drugs to calm restlessness, help with sleep, or improve focus. Substances may relieve those symptoms for a while, but they worsen them over time and add the risk of dependence. Treating ADHD directly, with therapy and where appropriate medication, offers more lasting relief.

Where can I get help for ADHD and addiction in South Africa?

Houghton House in Johannesburg treats addiction alongside co-occurring mental health conditions, including ADHD. Call our admissions team on +27 11 787 9142 for a free, no-obligation telephonic evaluation, or contact us online.

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