1

Introduction

ADHD is one of the most common neurodevelopmental disorders of childhood (Center

for Disease Control and Prevention). The DSM-5 requires children/adolescents, up to the age of

16, to present with six or more symptoms of inattention and/or hyperactivity and impulsivity for

an ADHD diagnosis, while adults are only required to present with five or more symptoms.

ADHD presents itself in people in three different ways: Predominantly Inattentive,

Predominantly Hyperactive-Impulsive, and Combined Presentation.

An adult with ADHD, diagnosed in childhood or adolescence, is more likely to struggle

with substance use and develop a substance use disorder. According to the Institute of Mental

Health, a substance use disorder (SUD) is a mental disorder that affects a person’s brain and

behavior, leading to an inability to control the use of substances.

While many researchers have outlined the comorbidity between ADHD in

childhood/adolescence and substance use/abuse in adulthood, not many studies have been

conducted to determine how the age of an ADHD diagnosis can lead to substance use disorders

in later life. In determining the correlation between age of ADHD diagnosis and SUD in

adulthood, we can shift the increase of comorbid diagnoses to a decrease.

Various research studies have determined that substance use disorders (SUD) have one of

the highest prevalence rates in adults and is typically seen comorbidly with childhood onset of

ADHD. According to Kronenberg et al. (2014), about 50% of individuals with mental disorders

are comorbidly affected by substance use disorders, with 23% of all individuals with SUD to

meet criteria for ADHD. Additionally, ADHD is an independent risk factor for SUD in

adulthood, making children and adolescents with ADHD at an increased risk of developing

substance use disorders in adulthood. Many researchers studied the relationship between females
 2

and males, determining that females with ADHD were 38 times higher and males six times

higher at risk for substance use disorders than the general population (Dalsgaard et al., 2014).

As the rates of children and adults being diagnosed with ADHD increase, the potential

for developing SUD in adulthood also increases. Individuals diagnosed with ADHD in childhood

are treated with pharmacological treatment; and the research outlining the effects of stimulant

treatment on the risk of developing SUD varies (Dalsgaard et al., 2014). This study also reported

that for every year older at the start of stimulants, the risk of SUD in adulthood increased by a

factor of 1.46, while other studies reported either no relationship or a decrease in risk of SUD.

While the relationship between childhood/adolescence diagnosed ADHD and adulthood

SUD has been greatly studied, little is known about adult ADHD and its potential risk on

substance use disorders. With the presence of both diagnoses, individuals have a more serious

course of addiction, a worse therapy outcome, and an increased risk for further mental disorders

(Dirks et al., 2017). Faraone et al. (2007) reported that adults with comorbid ADHD and SUD

have an earlier onset of substance abuse compared to adults without ADHD. To provide proper

treatment and prevention techniques for adults with a comorbid diagnosis of substance use

disorder and ADHD, it is important to understand how they both impact an individual and what

the risk factors are.

Like previously stated, adults with ADHD and SUD have a greater severity of SUD, a

worse therapy outcome and an increased risk for further mental disorders (Dirks et al., 2017;

Faraone et al., 2007). For adults who don’t receive treatment, they tend to have disorganized

thoughts and emotions, decreased structure, and an increase in impulsivity (Kronenberg et al.,

2014). In the long run, substance use disorders can increase ADHD symptoms and interfere with

self-management and maintaining structure, which in turn stimulates agitation causing an

increase in substance use and a further decrease of structure. Additionally, untreated symptoms

can interfere with everyday tasks, like work, hygiene, and social relationships, causing adults to

become isolated or unstructured, which could also increase substance use. Adults with comorbid

SUD and ADHD get caught in a vicious cycle of symptoms and substance use (Kronenberg et

al., 2014).

The purpose of our research is to answer questions about predictors of an undesirable

consequence. More specifically, the goal of this research is to answer if and how a diagnosis of

ADHD in childhood or adolescence increases the likelihood of SUD in adulthood. Further

research on this topic is needed to gain a better understanding of how the comorbidity of ADHD

and substance use forms so that professionals and families can be properly informed of this trend

and work to decrease the likelihood of this outcome on children and adolescents with an ADHD

diagnosis. It can also be helpful in providing better guidelines for the diagnosis of ADHD in

children and adolescents by understanding more clearly how the diagnosis, treatment and

medication can, and often does, lead to an increase in risky behavior surrounding substances

and/or substance abuse in adulthood.

This research is especially important to social workers because they are in unique

positions to interact with individuals and families who may be struggling with ADHD, substance

use disorders, or the comorbidity of them both. Professionals must be aware of the relationship

between ADHD and substance usage in order to not only provide effective care for clients

already struggling with the comorbidity, but also so that they can inform the clients and families

that are at greatest risk. The profession of social work has long been committed to diminishing

negative health and psychological impacts on not only clients, but communities as a whole; and

knowing more about the relationship between ADHD and substance use disorder would help
 4

reduce the burdens of substance use long term. Having the knowledge that ADHD diagnoses are

often a predictor of later substance use means that social workers can use early intervention

techniques to educate their clients so that they are aware of their elevated risk. On the other end,

this information can help determine the treatment of someone who is already struggling with

substance use if they were diagnosed with ADHD in their childhood or adolescent years.

Oftentimes, when people are made aware of a trend, and know that they are not alone and that

other people are going through the same thing, it can help the client’s self-motivation by

removing some of the guilt about their substance use. Ultimately, this research will allow social

workers to interact with and provide interventions for clients that consider both disorders, ADHD

and substance use disorders, at the same time. Acknowledging that ADHD in childhood and

adolescence puts individuals at a greater risk of substance use disorder later in life is the first

step, but knowing how and why this happens over time is essential in order to meet the full needs

of individuals with comorbid ADHD and substance use disorder.

References

Dirks, H., Scherbaum , N., Kis, B., & Mette, C. (2017). ADHD in Adults and Comorbid

Substance Use Disorder: Prevalence, Clinical Diagnostics and Integrated Therapy.

Advances in Neurology , 85(06), 336–344. https://doi.org/10.1055/s-0043-100763

Faraone, S. V., Wilens, T. E., Petty, C., Antshel, K., Spencer, T., & Biederman, J. (2007).

Substance use among ADHD adults: Implications of late onset and subthreshold

diagnoses. American Journal on Addictions, 16(s1), 24–34.

https://doi.org/10.1080/10550490601082767

Kronenberg, L. M., Slager-Visscher, K., Goossens, P. J. J., van den Brink, W., & van

Achterberg, T. (2014, September 19). Everyday life consequences of substance use in

adult patients with a substance use disorder (SUD) and co-occurring attention

deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD): A patient's

perspective - BMC psychiatry. SpringerLink. Retrieved February 15, 2023, from

https://link.springer.com/article/10.1186/s12888-014-0264-1

“Substance Use and Co-Occurring Mental Disorders.” National Institute of Mental Health, U.S.

Department of Health and Human Services,

https://www.nimh.nih.gov/health/topics/substance-use-and-mental-health#:~:text=A

%20substance%20use%20disorder%20(SUD,most%20severe%20form%20of%20SUDs.
 6

“Symptoms and Diagnosis of ADHD.” Centers for Disease Control and Prevention,

Centers for Disease Control and Prevention, 9 Aug. 2022,

https://www.cdc.gov/ncbddd/adhd/diagnosis.html.

“What Is ADHD?” Centers for Disease Control and Prevention, Centers for Disease

Control and Prevention, 9 Aug. 2022,

https://www.cdc.gov/ncbddd/adhd/facts.html#:~:text=ADHD%20is%20one%20of

%20the,)%2C%20or%20be%20overly%20active.