Why ADHD and Substance Use Disorders Often Travel Together — and What We Can Do About It
- Lauren Grawert, MD
- 2 days ago
- 3 min read
June 8, 2026
Lauren Grawert, MD, FASAM, Author and Chief Medical Officer at Aware Recovery Care
Tom O'Connor, Publisher
Attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs) frequently occur together. We know that the overlap is not a coincidence —there's growing evidence of shared biology, shared risk, and clear implications for how we treat people who struggle with both conditions.
What the Evidence Shows
Extensive genetic and epidemiologic studies now show a measurable genetic correlation between ADHD and multiple types of substance use disorders — alcohol, nicotine, opioids, and stimulants. Recent genomic analyses characterize pleiotropic (shared) genetic influences, meaning that a single gene can influence multiple traits or conditions, and find higher polygenic risk scores for some SUDs associated with ADHD, and vice versa. These data support the idea that part of the reason these disorders co-occur is overlapping genetic liability, not only environment or self-medication.
Clinical and population studies also consistently show that childhood ADHD substantially increases the risk of later substance use and SUD in adolescence and adulthood, and that ongoing untreated or under-treated ADHD tends to raise that risk further. Meta-analyses and extensive cohort studies have repeatedly documented this elevated vulnerability.
Notably, a large and growing body of research suggests that appropriate ADHD treatment — including pharmacotherapy when indicated — is not associated with higher long-term rates of substance misuse; on the contrary, several recent studies report reduced rates of substance-related problems and other harms among those who receive ADHD treatment.
These real-world studies are reassuring and clinically meaningful.
What Major Clinical Bodies Recommend
Contemporary addiction medicine guidance recognizes co-occurring psychiatric disorders as common and clinically significant. The American Society of Addiction Medicine (ASAM) and the American Academy of Addiction Psychiatry (AAAP) recommend assessing for and treating co-occurring psychiatric disorders alongside substance use disorders. Recent ASAM/AAAP clinical guidance on stimulant use disorder explicitly supports coordinated, concurrent treatment of SUD and co-occurring psychiatric illnesses rather than sequential care, which means treating one condition after the other. In practice, that means we should not 'wait' to treat ADHD until SUD is in remission — we plan care for both.
Treatment Implications for ADHD and Substance Use Disorder
How should this information inform everyday clinical decision-making? Here are a few tips:
Screen routinely: anyone presenting for SUD care should be screened for ADHD (and vice versa). Missing ADHD can leave a major driver of impulsivity, poor adherence, and increased vulnerability for a recurrence, comprehensive care, and better outcomes.
When ADHD and collaboratively coexist, it's crucial to coordinate care among addiction specialists, psychiatrists, and primary care providers. This collaborative approach, which includes behavioral therapies and medication management, can provide comprehensive support and improve patient outcomes. ASAM guidance strongly supports this coordinated approach, reinforcing the sense of teamwork in the healthcare community.
Be pragmatic about medications: stimulant medications are evidence-based for ADHD; when SUD involves stimulants or active misuse, treatment choice and monitoring require extra caution, such as utilizing long-acting stimulant formulations, frequent follow-ups, smaller dispensing amounts, and urine drug screen monitoring. Non-stimulant options like atomoxetine, certain antidepressants, and alpha-2 agonists can be valuable tools when stimulants are contraindicated, providing a sense of security in the face of complex treatment decisions.
Understanding the biological and clinical link between ADHD and Substance Use Disorder reduces stigma and improves care: these co-occurring conditions are treatable. Treating both together gives people the best shot at recovery and functional gains. If you or a loved one is navigating either ADHD or substance use, ask your clinician about integrated care and a coordinated treatment plan. This approach is supported by the evidence and by the American Society of Addiction Medicine (ASAM). And it gives you the best chances of meaningful, long-term recovery.
Read Lauen's bio by clicking her icon at the start of this article.
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