ADHD and Substance Abuse 5 more Clinical Studies

As a follow up to my last post,

Here are 5 more studies on the well-known (among those familiar with ADHD) links between ADHD and substance abuse.

Or 5 more reasons why governments should start properly diagnosing and treating adults and children with ADHD now, or pay 100 times the price later in addictions and all the associated costs; crime, incarceration, additional health care costs, career costs, family damage, etc. And I’m not even mentioning the links between ADHD and tobacco and marijuana, which are the #1 and #3 most popular drugs for children and adults with Attention Deficit Hyperactivity Disorder to abuse.

You can also look at my check 3 part series of posts on ADHD and Crystal Meth Part One as well as Part Two and Part Three.

1. 35% of Cocaine Abusers had ADHD

Comprehensive Psychiatry. 1993 Mar-Apr;34(2):75-82
35% of 298 treatment-seeking cocaine abusers met DSM-III-R (the previous version of DSM IV)
criteria for childhood ADHD. Those that had ADHD were 78% male, 93% had conduct disorder and 47% had antisocial personality disorder and report a history of conduct disorder in first-degree relatives.

Cocaine abusers with childhood ADHD were younger at presentation for treatment and reported more severe substance use, earlier onset of cocaine abuse, more frequent and intense cocaine use, intranasal rather than freebase or intravenous use of cocaine, higher rates of alcoholism, and more previous treatment. This pattern of cocaine use is consistent with clinical descriptions of self-medication of residual symptoms of ADHD in cocaine abusers. Data from this study suggest that there may be more cocaine abusers with a history of ADHD than previously recognized in clinical samples of cocaine users, and that these individuals may differ in clinically meaningful ways from those without childhood ADHD. Moreover, the poorer outcome of subjects with ADHD in this sample underlines the importance of identifying and treating residual symptoms of ADHD in cocaine abusers.

2. 24% of Psychoactive Substance Abusers had ADHD

J Clin Psychiatry. 2000 Apr;61(4):244-51

Two hundred one participants were selected randomly from 2 chemical dependency treatment centers

Forty-eight (24%) of the participants were found to meet DSM-IV criteria for ADHD. The prevalence of ADHD was 28% in men (30/106) and 19% in women (18/95; NS). Seventy-nine participants (39%) met criteria for conduct disorder, and 34 of these individuals also had ADHD. Overall, individuals with ADHD (compared with those without ADHD) were more likely to have had more motor vehicle accidents. Women with ADHD (in comparison with women without ADHD) had a higher number of treatments for alcohol abuse.

CONCLUSION: A significant overrepresentation of ADHD exists among inpatients with psychoactive substance use disorders. Over two thirds of those with ADHD in this sample also met criteria for conduct disorder. Our sample had a very large overlap between ADHD and conduct disorder, and the major comorbidities identified here were attributable largely to the presence of conduct disorder. Individuals who manifest conduct disorder and/or ADHD represent a significant proportion of those seeking treatment for psychoactive substance use disorders. They appear to have greater comorbidity and may benefit from a treatment approach that addresses these comorbidities specifically through medical and behavioral therapies.

3. 32% of Cocaine Users and Alcoholics had ADHD

American Journal of Drug Alcohol Abuse. 1999 Aug;25(3):441-8

Of 136 inpatients with an SUD (substance use disorder) diagnosis (cocaine vs. alcohol vs. cocaine/alcohol) 32% had ADHD.

There were no significant differences in the percentage of ADHD between the SUD+ groups divided by drug choice…. Patients with cocaine use were more likely to have ADHD in childhood only when compared to the alcohol or cocaine-alcohol groups. The findings of this study indicate that ADHD is prevalent in treatment-seeking substance users without difference in prevalence or subtype by drug choice.

4. 70% of Crystal Meth (Methamphetamine) Inpatients had ADHD

Journal of  Addiction Disorders. 2005;24(3):133-52.

Methamphetamine-dependent inpatients (N = 51) were screened for childhood attention deficit hyperactivity disorder (ADHD) using the Wender Utah Rating Scale upon admission to 30-day inpatient treatment. Baseline assessments included neuropsychological tests of executive function, memory, information processing, verbal fluency, attention, motor skills, and the Brief Symptom Inventory (BSI), a measure of psychiatric symptomatology. The thirty-six participants (70.6%) screening positive for ADHD reported significantly more frequent methamphetamine use prior to baseline. Baseline cognitive functioning was similar between groups, but the presumptive ADHD participants exhibited significantly worse psychiatric symptomatology. At three-week follow- up, 41 participants (80.4%) repeated the neuropsychological battery and BSI. All 10 non-completers screened positive for ADHD. The entire sample improved with abstinence in most neuropsychological domains except memory. The presumptive ADHD group failed to improve on tests of attention. All participants demonstrated significant reductions in psychiatric symptoms with abstinence.

Methamphetamine-dependent individuals with ADHD symptoms are common and pose a significant treatment challenge.

5. 83% of Inhalant Abusers and 55% of Methamphetamine Abusers in Japan had ADHD.

Psychiatry Clinical Neuroscience. 2005 Feb;59(1):102-5.

They examined the childhood histories of 54 methamphetamine users and 12 inhalant abusers in Japan using the Wender Utah Rating Scale.

The inhalant abusers experienced initial drinking at a younger age than methamphetamine abuser…83.3% of inhalant and 55.6% of methamphetamine abusers had higher scores than the cut-off for ADHD. These findings suggest that drug abuse is associated with childhood ADHD, and that inhalant abusers have a higher incidence of childhood ADHD than methamphetamine abusers.

There’s more on the links between ADHD and addictions on this page of my 100+ ADD resource website

21 thoughts on “ADHD and Substance Abuse 5 more Clinical Studies”

  1. One is left to wonder, why is the addictiont treatment community so slow (on the face of it) to realize the correlations and in turn to advise folks in treatment or concerned about their behaviors to get evaluated for ADD/ADHD?

    In retrospect, two of my closest friends who died from drinking – one suicide, one liver failure – demonstrated manifold signs of undiagnosed ADD… I can’t help but believe that things might have been different if that had been recognized far sooner.

  2. Catherine Diana Metzenbaum

    Thank you for posting all this great info! I am a state Vocational Rehabilitation Counselor. My caseload recently shifted and in the past 6 months I have done intakes with at least 30 adult clients who came to our agency with a single diagnosis of either amphetamine dependence or cocaine dependence. I have noticed a [what seemed obvious to me] trend among this group: all of them who seemed to be at or above average IQ exhibited patent Sx of ADD/ADHD. Level II psych evals provided by our agency confirmed the additional Dx of ADD or ADHD plus the IQ scores. I mentioned this to my supervisor and asked if there were a way to start gathering agency-wide statistics on this as a starting place to develop a more appropriate and comprehensive agency approach to this population of client. I’m excited about reading everything on your site- my packed schedule will permit only short bursts of time for this, but I just wanted to you to know I appreciate you providing this venue. If I can be assured of NO SPAM I will provide my state email address.

  3. Hi Catherine, you’re welcome, tell your colleagues:)

    You don’t need to provide any state email address and I don’t spam.

    I would be interested in hearing about any research you do on this matter and or any action that’s taken.

    re: above average IQ and ADHD. You might want to see my MENSA ADHD Special Interest Group post

    There’s lots of research on ADHD and addiction but the media and politicians are ignoring it. I’ve had several ADHD ex addicts who’ve gone through rehab centers and were very angry that no one there ever talked about ADHD to them.

    If you search PUBMED
    for ADHD and addiction you’ll find 217 hits

  4. I was actually very disappointed with this article the site is for add strengths not add’s downfalls. I was diagnosed as a kid and no offense I had the luxury of my parents trying to keep me off the drugs including those that treat adhd. I currently own a management consulting firm and am pursuing my PhD in Finance. Where exactly are stats on people like me with ADHD? Those of us that do succeed and can function through learning to use our strengths. I am going to look at the site a little bit further however I felt this article to be disciminatory implying that the majority of drug addicts have ADHD.

  5. I was addicted to crystal meth for almost twenty years. It made me feel “normal”.I slept every night and ate regular meals and held a job. I had no idea I was self-medicating until 2 years ago.
    It was relieving to know I wasn’t just a “tweaker”

    Now I am clean, but on meds. I often feel depressed because I feel I am just replacing the illegal stuff with legal, prescribed stuff. Like I cheated myself of really quitting.

    I have been searching the internet forever looking for a site like this and want to thank-you. I will bookmark it and refer to it often.

  6. Joshua,

    this blog is for both. I’m no pollyanna on ADHD, there are both negatives and positives on ADHD and I cover them both. It’s important to look at both sides some are in denial of the positives of ADHD and some are in denial of the negatives of ADHD.

    Many drug addicts and alcoholics do have ADHD. I wouldn’t say it’s the majority of them. The ADHD addiction connection which is well known among the small circle of knowledgeable ADHD professionals and very little known in the media, govt, health system, in rehab centers and general public.

    If this information got out there more, and ADHD hate and stigma could be reduced, than more people would seek diagnosis and treatment. Then there would be less people needless suffering from addictions, and less impact on their families, community, less crime, less needless costs to the taxpayer etc.

    Most parents try to keep their kids of drugs, but you were lucky enough to have parents who’s strategy worked, not all do. What if yours didn’t? Wouldn’t you want to read this post?

    ADDers can accomplish great things check out this category on my blog

  7. Lisa

    Some people who use drugs can be functioning members of society. They’re not always totally dysfunctional, there’s a range.

    There’s a big difference between meth and legal adhd meds, no drain cleaner in adhd meds etc. You really did quit, don’t minimize your achievement.

    Glad you liked my website

  8. Beth Randolph

    I am writing a college paper on legalizing drugs to provide better treatment options for addicts the only reason I decided to write about it is that three of my nephews have ADHD and I worry that not only will they become dependent on drugs but that they will be criminalized for something that they were born with. Thank you for the information. I appreciate it.
    Beth R

  9. I appreciate that you take a pretty even handed approach on research submission and citation. Thank you for the links to the above studies on the various addiction sets.
    I wanted to share a link to a article on prenatal alcohol exposures effects on behavioral, cognitive and social development and the link to FASD.
    Was actually poking around here on the blog for any more info you might have with prenatal associated research and ADD too.
    Thanks for you effort

  10. bob creamer

    just a thought along the lines of adhd and addiction. There is
    every possibility that the symptoms seen early in childhood and diagnosed as ADHD may in fact be addiction instead. The
    more we discover about addiction, as a neurometabolic disease, the more we realize that addiction is not about drugs/
    alcohol perse,but instead about a genetic disease process whose symptoms may show up early and may be displayed
    whether there is or ever has been drug/alcohol use

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