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Co-Occurring ADHD & Substance Use Disorder

Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with daily functioning.1, Substance use disorders (SUD) often co-occur in people with ADHD.2 Past studies have estimated that as many as 23% of adults who misuse substance have ADHD.2 Understanding the complex relationship between ADHD and addiction, how co-occurring disorder or dual diagnosis treatment can help, and where to find treatment for ADHD and addiction can be important for achieving recovery.

What is Attention Deficit Hyperactivity Disorder (ADHD)?

ADHD is characterized by a chronic inability to control or sustain attention, hyperactivity, or both.2 While often diagnosed in childhood, ADHD symptoms can continue into adulthood.2 Currently, the overall prevalence rate of adults with ADHD is about 2.5%.2 Further, a lifetime prevalence rate of ADHD in people between the ages of 18 and 44 is about 8.1%.2

What are the Different Types of ADHD?

There are 3 different diagnostic subtypes of ADHD. These include:2

  • Predominantly inattentive: This type includes symptoms such as, having a hard time organizing or finishing tasks, a hard time paying attention to details, a hard time following instructions, being easily distracted, or constantly forgetting details of a daily routine.3
  • Predominantly hyperactive-impulsive: This type includes symptoms such as fidgeting and talking a lot, having a hard time sitting still for long, being restless or impulsive, interrupting others, grabbing things from people, speaking at inappropriate times, having a hard time taking turns or listening to directions, and having more accidents or injuries than others.3
  • Combined type: The last type of ADHD shows an equal presentation of both inattentive and hyperactive-impulsive symptoms.3

The Relationship Between ADHD and Addiction

Substance use disorder and ADHD are commonly seen together, representing what are known as co-occurring disorders.2 Some studies have suggested that relatively early substance use is more likely to escalate more quickly in adolescents with ADHD.2 Some children with ADHD may be more likely to develop conduct disorder in adolescence and antisocial personality disorder in adulthood, which could additionally increase the likelihood of substance use disorders in those who do.1Those that show more hyperactivity-impulsivity symptoms seemed to have a higher risk of substance misuse and substance use disorder than those with only inattention symptoms.2

It has been found that substance misuse is about 6 times more likely in those with ADHD.4 It’s hypothesized that mental health issues such as ADHD and substance use disorders prevalently co-occur for several reasons, such as:5

  • Common genetic factors and shared environmental risks predisposing for both issues.
  • Mental health issues increasing the likelihood of substance use initiation as a means of self-medication, as well as mental health disorder-related brain changes increasing the rewarding effects of substances.
  • Substance use-triggered functional and structural brain changes that make mental disorder development more likely.

Symptoms of Co-Occurring ADHD and Addiction

Symptoms of ADHD include inattention symptoms and hyperactivity-impulsivity symptoms.1

Inattention symptoms include:1

  • Failing to pay close attention to details or making careless mistakes.
  • Having a hard time sustaining attention.
  • Being easily distracted.
  • Not seeming to listen when spoken to directly.
  • Not following through on instructions and failing to finish schoolwork, chores, or duties.
  • Having a hard time organizing tasks and activities.
  • Avoiding or being reluctant to engage in tasks that require sustained mental effort.
  • Losing things that are necessary for tasks or activities.
  • Being forgetful in daily activities.

Hyperactivity and impulsivity symptoms include:1

  • Fidgeting with or tapping hands or feet.
  • Squirming in their seats.
  • Leaving their seat in situations where they are expected to stay seated.
  • Running about or climbing in situations where it is inappropriate.
  • Being unable to play or engage in leisure activities quietly.
  • Always “on the go.”
  • Talking excessively.
  • Blurting out answers before a question has been completed.
  • Having difficulty waiting for their turn.
  • Interrupting or intruding on others.

The signs and symptoms used as diagnostic criteria for substance use disorder include:1

  • Drinking and/or using a drug in larger amounts or over a longer period of time then intended.
  • A persistent desire or unsuccessful efforts to cut down or regulate substance use.
  • Spending a great deal of time getting, using, or recovering from the substance.
  • Strong urges to use or cravings for drugs or alcohol.
  • Failing to fulfill obligations at work, school, or home as a result of substance use.
  • Continuing to use the substance even when having persistent social or interpersonal problems that are caused or increased by the effects of the substance.
  • Giving up social, occupational, or recreational activities due to drug or alcohol use.
  • Continuing to use the substance in situations where it is physically dangerous.
  • Continuing to use even with the knowledge of having a physical or psychological problem that is caused or increased by using the substance.
  • Developing tolerance to the substance.
  • Experiencing withdrawal symptoms when stopping the substance.

How To Treat Co-Occurring ADHD and Substance Use Disorder

Treatment for co-occurring ADHD and substance use disorder may provide some additional challenges to managing either condition on its own.2 People with ADHD and a substance use disorder may have difficulty engaging in treatment and learning coping skills.2 A co-occurring ADHD and substance use disorder diagnosis may also have a greater risk for relapse and poorer substance use treatment outcomes.2

Despite the aforementioned challenges, integrated treatment strategies can be used to effectively manage co-occurring disorders. The most effective treatment may be a combination of psychoeducation, medication, individual or group cognitive-behavioral therapy, and peer support.2 A combination of therapy, counseling, and medications for addiction treatment can lead to positive treatment outcomes, especially if both conditions are treated simultaneously.

Does Insurance Cover Co-Occurring ADHD and Addiction Treatment?

The Affordable Care Act (ACA) mandates that all health insurance plans must provide some degree of coverages for the medically necessary treatment of mental health disorders.6 This means that treatment for ADHD and addiction may be covered in part or completely by your health insurance. However, coverage may vary, and one may want to check with their insurance provide to determine coverage before committing to treatment.

Your specific benefits may depend on your state and the health insurance plan that you chose.6 American Addiction Centers can help you verify your insurance benefits online through their helpful tool. Additionally, you can reach out to the admissions navigators at to discuss treatment options, insurance benefits, and cost.

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