When people think about ADHD, they might picture forgetfulness, trouble focusing or being constantly “on the go.” But ADHD doesn’t just show up in the classroom or workplace. For many teens and adults, ADHD can also affect relationships, decision-making and risk-taking behaviors. One area that doesn’t get talked about enough is the connection between ADHD and substance use.

Let’s start with the basics. Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental condition that affects how your brain manages things like attention, impulse control and emotional regulation. It’s not about “not being able to focus,” but rather about a brain that processes information and stimuli differently. For many people, this can create a constant state of overwhelm, restlessness and a desperate search for a way to feel “normal.”

Now, enter substance use. For a person with ADHD, using substances can feel like finding the missing piece of the puzzle. Maybe a stimulant helps quiet the racing thoughts. Or perhaps a depressant calms the constant fidgeting and anxiety. When these are taken without a prescription, this is what’s known as self-medication. While it can offer temporary relief, it’s a risky game. It’s like trying to fix a leaky faucet with duct tape: It might work for a bit, but it will eventually fail and make a bigger mess.

Research shows that ADHD and substance use disorder (SUD) often co-occur, and the challenges of having both can make life feel overwhelming. But here’s the good news: Dual diagnosis treatment, care that addresses both ADHD and SUD at the same time, can make a real difference.

In this article, we’ll break down what ADHD and comorbid substance use disorder looks like, why it happens, and how clinical teams support recovery with an integrated, compassionate approach.

ADHD and substance use: Why the connection is strong

It’s not just a coincidence that ADHD and substance use disorder often show up together. Studies have found that people with ADHD are at a higher risk of experimenting with alcohol or drugs earlier, using them more often and developing stronger dependencies than those without ADHD.

Why? There are a few reasons:

• Impulsivity — People with ADHD are more likely to make quick decisions without fully thinking through consequences. That can include trying substances at a younger age.
• Self-medication — Some people with ADHD use substances to manage restlessness, anxiety or trouble focusing.
• Reward system differences — The ADHD brain processes dopamine differently, making the instant “reward” of substances more appealing.

Unfortunately, this combination can mean more severe cases of both ADHD and SUD, higher hospitalization rates, and lower chances of sticking with treatment when one condition is treated alone.

The takeaway? Treating both together is key.

Spotting ADHD and substance use disorder early

Here’s something surprising: Screening for substance use in kids with ADHD should start around age 12. That might sound early, but prevention works best before habits set in. Tools like the NIAAA Youth Alcohol Screening Tool or Screening to Brief Intervention (S2BI) can help spot risky behavior.

A good clinical assessment goes deeper than just “Are you using substances?” It includes:

• Looking at overall mental health and family history
• Checking for medication misuse (like taking too many ADHD meds or sharing them)
• Asking about school, work and relationships
• Ongoing monitoring to catch changes early

Think of it as a full health check, but with extra attention to how ADHD and substance use may overlap.

Treatment options: What works best

So what happens when someone has ADHD and comorbid substance use disorder? Treatment has to be tailored to both — ignoring one can make recovery harder.

1. Medications (with safeguards)

Extended-release stimulants are often the first choice for ADHD, even when SUD is present. Why? They’re harder to misuse compared to immediate-release versions.

Clinicians also use safeguards such as:

• Prescription monitoring
• Pill counts
• Observed dosing

If stimulants aren’t safe or effective, nonstimulants like atomoxetine can be considered. They may not be as strong for ADHD symptoms, but they avoid some of the risks.

People with a history of stimulant use disorder sometimes need higher doses of prescribed ADHD medication due to tolerance. But this is always approached cautiously, with close monitoring.

2. Therapy and behavioral support

Medication is important, but it’s not the whole picture. Integrated therapy approaches can help manage both ADHD and substance use:

• Cognitive behavioral therapy (CBT)

This type of therapy helps you identify and change unhelpful thoughts and behaviors. It’s about building a toolkit to navigate challenging situations without turning to substances.

• Motivational Interviewing 

This approach is designed to help you explore and resolve your feelings about making changes. It’s a collaborative process that helps you find your own motivation to move forward.

• Psychoeducation 

Knowledge is power. Understanding how your ADHD affects your brain and your behavior is a crucial step in taking back control. This involves educating you and your family about the conditions and the treatment plan

Research suggests a phased, personalized approach works best, with ADHD and SUD specialists collaborating closely.

3. Family involvement

Having a strong support system is vital. Educating your family about the risks of medication misuse and the importance of adherence is key. For adolescents, supervised medication administration and family counseling can make a huge difference in reducing risk and improving engagement with the treatment plan.

An effective dual diagnosis treatment plan requires coordination between all members of your care team — your primary care doctor, your therapist and your addiction specialists. It’s a group effort, and everyone is on your side.

The gaps we’re still learning about

Here’s the tricky part: Even though we know ADHD and substance use disorder are linked, research is still catching up on the best ways to treat them together. Most studies focus on short-term outcomes, and there’s limited evidence on long-term integrated care, especially for adolescents.

That’s why ongoing monitoring, flexible treatment plans and continued research are so important.

A mix of serious and lighthearted truths

Sometimes conversations about dual diagnosis can feel heavy. But it’s also OK to keep things real and even a little funny. After all, humor is a survival skill.

• Serious truth — ADHD and substance use disorder are more common together than most people realize, and early treatment is crucial.
• Funny-but-true note — ADHD brains can be so focused on finding dopamine that a “quick snack” becomes a three-hour kitchen experiment. Swap substances for sourdough starter, and you might just become the neighborhood baker.
• Serious truth — Treating ADHD and comorbid substance use disorder at the same time can give people a better chance at recovery.
• Funny-but-true note — People with ADHD are often labeled as “bad at sticking to routines.” But if you’ve ever seen someone hyperfocus on organizing their Amazon music playlists or binge-watching a show, you know commitment isn’t the issue, it’s direction.

The mix of challenges and strengths is exactly why a respectful, tailored treatment plan matters.

How clinical teams support dual diagnosis

When treating ADHD and substance use disorder, a multimodal, integrated approach works best. That means:

• Early screening and routine check-ins to spot problems before they escalate
• Safe, evidence-based medication management that reduces risks of misuse
• Therapies that combine ADHD and addiction strategies, rather than treating them separately
• Family and individual education to build understanding and trust
• Collaboration across providers, psychiatrists, therapists, primary care and addiction specialists all working together

This isn’t a one-size-fits-all approach. It’s about building a care plan that meets the unique needs of the person sitting across from us.

Look ahead and find your way home with ReKlame Health

It can feel overwhelming to manage ADHD and substance use disorder at the same time. That’s why our clinical team at ReKlame offers modern, compassionate and culturally competent care that meets you where you are.

Here’s what sets us apart:

• Fast access to care — Initial consultations are available within 48 hours of referral or first contact.
• Young, modern clinicians — We are a team that understands today’s challenges and how to navigate them.
• Integrated care coordination — We work with your other healthcare providers to ensure seamless, effective treatment.
• Evidence-based approaches — From medication management to therapy, we use strategies backed by science.
• Tailored support — Care plans are designed to fit your needs, values, and goals.

ADHD and comorbid substance use disorder may feel like a heavy combination, but with the right support, recovery and stability are absolutely possible. You don’t have to face it alone; treatment can help you take back control of your life.

Give our care team a call today for more information, check your eligibility for free online or book an initial appointment online.