Understanding the connection between ADHD and substance use disorder

Throughout his 43 years as a pediatrician and 17 years as an addiction specialist, Jan Widerman, DO, has come across many patients who might have avoided developing a substance use disorder (SUD) had they been diagnosed and treated for attention deficit/hyperactivity disorder (ADHD) as children. As a mostly genetic disorder, ADHD is typically diagnosed before the patient is 12 years old and affects around 5-12% of the population.

“Seventy to 80% of these patients do not outgrow the diagnosis,” said Dr. Widerman. “If untreated, it can lead to higher rates of SUD, as well as accidents and problems in work, relationships and life.”

Dr. Widerman recently spoke at OMED 2024 about the correlation between ADHD and SUD. He shared information to help DOs feel better-equipped to diagnose ADHD in adults, understand how ADHD affects patients’ lives, differentiate ADHD from other comorbidities and determine proper dosing of medications to treat ADHD.

The correlation between ADHD and SUD

Dr. Widerman notes that many patients with ADHD report having tried stimulants previously. A stimulant, often taken for ADHD, blocks reuptake and increases release of norepinephrine and dopamine in the nervous system.

“A major risk for future SUD is childhood/adolescent trauma, and it’s majorly genetic,” said Dr. Widerman. He’s made it his goal to fully understand where substance use disorder comes from, in case it can be prevented when his patients are still children, which is why he often looks to see if the parent also has SUD or untreated ADHD.

“Untreated ADHD is a major factor in children for future drug use,” Dr. Widerman continues. He notes that the program PreVenture found four symptoms in particular that are 90% predictive of future drug use when combined—anxiety, impulsiveness, thrill-seeking and hopelessness. Around 25% of patients who do have SUD have also been found to be ADHD patients, with common ADHD symptoms in adults being depression and anxiety.

Treating one to help the other

“Commonly, I have seen this many times,” said Dr. Widerman. “Treating for ADHD helps a patient with SUD get better. Their goals are met, it’s easier to control their impulsiveness and it’s very important for their success, which spurs recovery and changes lives.”

There are stimulant and non-stimulant medication options for adults. Studies have shown that because of the benefits of stimulants with patients who have ADHD and SUD, divergence, or giving the medication to others to take recreationally, is low. Common self-medications that patients have tried for treatment have included caffeine, nicotine, cocaine and methamphetamine.

“In treatment, we start with a low dose and work it up,” said Dr. Widerman. “Long-acting meds are preferred. Proper dosing is imperative because too low a dose will cause many unwanted side effects and can make matters worse.”

He describes how typically, he likes a patient to call and check in after three days of trying the new meds—he can usually tell by their response whether the low dose is right for them or if it immediately needs to be increased.

“Get the feedback from the patient and design (the meds) to fit their needs,” he advised.

Dr. Widerman says he has found the underdiagnosis and undertreatment of ADHD to be a major deficit in our approach to successful treatment for SUD.

“I found the reluctance to use stimulants to treat ADHD patients with SUD does not take into account the altered brain chemicals and brain function of those patients, and thus does not address the impulsiveness and lack of success in life, thus perpetuating a life of substance abuse,” he said.

Dr. Widerman’s full talk is now available on the OMED24 platform, where participants can also access virtual educational content from 20 medical specialties through Dec. 31 and obtain up to 50 hours of CME credit.

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