ADHD Myths: Medication & Overuse - does it cause addiction?

Newspaper headlines - and lots of social media posts - are full of horrific statistics about ADHD and addiction. If you’re worried that you are doomed to watching your child spiral into substance misuse - or you’re a late diagnosed parent worried about your child - these can cause a lot of stress - and heartache.

The problem is that many people now believe that ADHD medication itself leads to addiction. This can deter people, especially young adults, from seeking effective treatment for ADHD. Let's separate fact from fiction by looking at the scientific evidence.

The myth we're exploring today suggests that taking medication for ADHD, especially the stimulant kind, is a one-way ticket to addiction.

The Neurobiology of ADHD

Before we look at the medication itself, it's important to understand the neurobiology of ADHD. ADHD is now explained to be a group of deficits, or challenges, in our executive functions. These include skills like attention, impulse control, and organization, as well as planning, awareness of time passing and emotional regulation. Neurotransmitters like dopamine and norepinephrine play a crucial role in these functions, as they carry information and signals around the relevant areas of the brain. These are often - but definitely not only - in the front part of our brains, the PFC (pre-frontal cortex). There are many parts of our brain that work together to carry out these functions, so please don’t misunderstand how complicated it is - this is just a really simple generalisation.

The Mechanics Behind ADHD Medication

ADHD medications, primarily stimulants like Adderall and Ritalin, work by increasing the levels of these neurotransmitters in the brain. These medications have been stringently tested and are generally considered safe when used as prescribed. They are designed to help improve focus and reduce impulsivity, which enhances the quality of life for people with ADHD.

The medication stimulates more neurotransmitters while slowing down the receptors - or ‘hoover’ cells.

The current belief - and these things are being updated as more research is done - is that ADHD brains often have too many dopamine transporters. They ‘carry away’ the circulating dopamine too quickly, so by slowing down the ‘hoover’ transporters, as well as stimulating more dopamine production, ADHD brains experience a level of dopamine that allows them to carry out executive functions faster and more efficiently. There are new studies looking at medications that will have the same action for norepinephrine and serotonin at the same time.

Contrary to popular belief, research shows that individuals with ADHD who are treated with medication are not at a higher risk for substance abuse. In fact, untreated ADHD can be a risk factor for developing substance abuse issues later in life. One study showed that treating ADHD with medication reduced the risk of substance abuse by 30% - ONE THIRD - as well as the positive impact on rates of school drop out, teenage pregnancy, traffic accidents etc.

While ADHD medications are generally safe, they should always be used under medical supervision. This ensures that the medication is effective and minimizes the risk of misuse. Regular check-ups can also help in adjusting the dosage or changing the medication if needed.

The other problem young people in particular face is the abuse of these treatments by non-ADHD students who think that they will improve their academic performance or study capacity. Unfortunately, the opposite seems to be true - and non-ADHD people taking stimulants did worse in tasks - although they felt they were doing better.

One aspect of this ‘off licence’ abuse of medication is that I have often wondered - how many of those young people using them are finding they can focus… and are actually undiagnosed ADHD themselves? So far I’ve not found any studies looking specifically at that topic but you can be sure I will keep looking.

It's worth mentioning that medication is often most effective when combined with behavioral therapy and other supports. This ‘three legged stool’ approach to life with ADHD can provide much more effective treatment that improves the noticeable negative impact in most areas of our lives.

Are you more willing to try medication now?

If you’re a parent or a late diagnosed adult with ADHD who has been putting off trying medication because you’re worried about the possible connection with addiction, I hope that this has helped to reverse that idea - proper treatment, along with support, reduces the likelihood of substance abuse and addiction for anyone with ADHD.

ADHD medication does not lead to addiction. If anything, we are less likely to self-medicate as we experience the serious negative impact of ADHD. However, it's essential to consult with your qualified healthcare provider for proper diagnosis and treatment.

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Further reading:

Biederman, J., et al. (1999). "Pharmacotherapy of attention-deficit/hyperactivity disorder reduces risk for substance use disorder." Pediatrics, 104(2), e20-e20.

Wilens, T. E., et al. (2003). "Does stimulant therapy of attention-deficit/hyperactivity disorder beget later substance abuse? A meta-analytic review of the literature." Pediatrics, 111(1), 179-185.

Fabiano, G. A., et al. (2009). "A meta-analysis of behavioral treatments for attention-deficit/hyperactivity disorder." Clinical Psychology Review, 29(2), 129-140.

Chang, Z., Lichtenstein, P., Halldner, L., D’Onofrio, B., Serlachius, E., Fazel, S., Långström, N., Larsson, H. (2014). "Stimulant ADHD medication and risk for substance abuse." Journal of Child Psychology and Psychiatry, 55(8), 878-885. [DOI: 10.1111/jcpp.12164](https://dx.doi.org/10.1111/jcpp.12164)

Eme, R., A.B.P., P. (2017). "ADHD Medication and Substance-Related Problems." Journal of Addiction Medicine, 11(5), 342-347. [DOI: 10.21694/2578-5508.17003](https://dx.doi.org/10.21694/2578-5508.17003)

Blum, K., Modestino, E. J., Gondré-Lewis, M., et al. (2018). "The Benefits of Genetic Addiction Risk Score (GARS™) Testing in Substance Use Disorder (SUD)." International Journal of Genomic Data Mining, 1(1), 1-6. [DOI: 10.29014/IJGD-115.000015](https://dx.doi.org/10.29014/IJGD-115.000015)

Levy, S., Katusic, S., Colligan, R., Weaver, A., Killian, J., Voigt, R., Barbaresi, W. (2014). "Childhood ADHD and Risk for Substance Dependence in Adulthood: A Longitudinal, Population-Based Study." PLOS ONE, 9(8), e105640. [DOI: 10.1371/journal.pone.0105640](https://dx.doi.org/10.1371/journal.pone.0105640)

Caye, A., Swanson, J.M., Coghill, D. et al. Treatment strategies for ADHD: an evidence-based guide to select optimal treatment. Mol Psychiatry 24, 390–408 (2019). https://doi.org/10.1038/s41380-018-0116-3

Liu, H.L.V., Sun, F., Anderson, D.I. et al. The Effect of Physical Activity Intervention on Motor Proficiency in Children and Adolescents with ADHD: A Systematic Review and Meta-analysis. Child Psychiatry Hum Dev (2023). https://doi.org/10.1007/s10578-023-01546-5