ADHD and substance misuse: what to know

Alcohol, cannabis, nicotine, sedatives and stimulants may be used to cope with restlessness, distress or sleep problems, but they can also worsen judgement, mood and daily functioning. Using a substance does not establish the cause of attention symptoms, and an assessment should examine the timing of both.

ADHD may involve impulsive decisions, reward-seeking and trouble maintaining routines. Intoxication, withdrawal and disrupted sleep can produce or intensify similar difficulties. A clinician therefore asks which symptoms began in childhood, which occur while sober, and how substance use changes them.

Substances can also alter the effects and safety of prescribed medicines. Sharing medication, taking extra doses, or combining a prescription stimulant with other stimulants can cause harm. Give the prescriber an accurate account of everything used, including non-prescribed tablets and supplements.

Arrange a combined review of ADHD symptoms, substance pattern, mood, sleep and physical health. Note what is used, when, how much, what triggers it and whether stopping causes symptoms. Keep medicines secured and take them only as prescribed.

Treatment may combine psychological support, help with cravings or withdrawal, ADHD-focused strategies and carefully monitored medication. Do not stop alcohol, sedatives or other regularly used substances suddenly without clinical advice, because withdrawal from some substances can be dangerous.

Call local emergency services for collapse, seizure, severe breathing difficulty, chest pain, extreme agitation, confusion, suspected overdose, or inability to wake someone. Seek immediate help as well if there are thoughts of suicide, a plan to self-harm, or a risk of harming another person.

Prompt medical review is warranted when use is escalating, obligations are being missed, withdrawal symptoms appear, or prescribed medication is being taken differently from the instructions.

Ask how substance use may affect the accuracy of an ADHD assessment, whether withdrawal needs medical supervision, which treatment setting fits your needs, and how medicines will be dispensed and monitored. Also discuss a written crisis plan and who to contact if cravings or unsafe use return.