ADHD and addiction: Knowledge is power

You may have read or heard that kids with ADHD are at a higher risk for addiction. Is this true? If so, why? And what can we, as parents and caregivers, do about it?

In this episode of In It, hosts Gretchen Vierstra and Rachel Bozek talk with Dr. Roberto Olivardia. Roberto is a Massachusetts-based clinical psychologist. He has spent years evaluating people for learning and thinking differences including ADHD. And he was diagnosed with ADHD as an adult. 

He shares helpful information to help families understand the relationship between the risk of addiction and ADHD.

We love hearing from our listeners. Email us at init@understood.org.

Related resources

• Substance Abuse and Mental Health Services Administration

• Suicide and Crisis Hotline

• 5 common concerns parents have about ADHD medications for kids

• Study finds that ADHD medication reduces risk of drug abuse for people with ADHD

• ADHD medication misuse, sharing, and abuse: What you need to know

Timestamps

(02:01) Chemistry of ADHD

(02:40) Helpful statistics about risk and ADHD

(06:15) Self-medication studies

(13:28) Risk of addiction

(15:34) Talking to younger kids 

(21:22) The importance of communication

(22:16) Assertiveness skills for kids

Episode transcript

Gretchen: Hello and welcome to "In It," a podcast for families with kids who learn and think differently.

Rachel: Here you'll find advice, camaraderie, stories of successes and yes, sometimes failures, from experts and from parents and caregivers like you.

Gretchen: I'm Gretchen Vierstra, a former classroom teacher and an editor here at Understood.org.

Rachel: And I'm Rachel Bozek, a writer, editor, and mom who has definitely been in it. Today we're getting into some hard but important truths around ADHD, substance use, and addiction.

Gretchen: For this conversation, we're bringing back Roberto Olivardia, a Massachusetts-based clinical psychologist with more than 20 years of experience evaluating people for things like ADHD. He's also someone who himself was diagnosed with ADHD as an adult.

Rachel: A quick note before we get started. This is a serious topic and may hit close to home for some. If you or someone you're caring for is struggling with substance use or addiction, there are excellent resources available on the government website for the Substance Abuse and Mental Health Services Administration. Go to SAMHSA.gov/find-help. And as always, if you or someone you know is in crisis, you can reach a reliable crisis helpline by dialing or texting 988. OK, now let's get into it.

Gretchen: Roberto, welcome back to "In It."

Roberto: I'm glad to be here. Thank you for having me again.

Gretchen: We are so excited to have you here today. And as you know, we're talking today about the risks of substance use for kids with ADHD.

Roberto: Yes.

Gretchen: And I'm thinking maybe we should dive right into the deep end and talk about addiction. Are our kids with ADHD at a higher risk for addiction, and if so, why? Is there a biological reason for that? Something to do with their brains? What's going on?

(2:01) Chemistry of ADHD

Roberto: Yeah. So, I think it's really important to understand the chemistry of ADHD, that in general, when an ADHD brain gets rewarded, it wants a lot more of that reward. I mean, certainly, for anybody, when it gets rewarded, we sort of might lean towards that thing. But with ADHD, because the brain is always craving stimulation when we like something — and I say we, I have ADHD — but when we are stimulated or rewarded by something, we run the risk of liking it too much without sort of proper boundaries.

Gretchen: So, how different is this predisposition for someone with ADHD as compared to the general population?

(02:40) Helpful statistics about risk and ADHD

Roberto: So, to give you some just quick stats, people with ADHD are 2 to 3 times more likely to have a substance abuse or dependency issue. Having ADHD doubles the risk of nicotine dependence. It could triple the risk of alcohol dependence across all substances. Studies that look at various substance-dependent populations find about 20% have ADHD.

Gretchen: Wow.

Now that's where it's identified and diagnosed. ADHD, despite people thinking it's overdiagnosed, studies show that it's still vastly underdiagnosed, particularly in older people. Because of just the identification and what we knew about ADHD years ago, you know, versus now. So, there is there is definitely a higher risk.

And I think it's always important for parents who have kids with ADHD to one, know that, and then two, we can start to talk to our kids, you know, when they're young and it doesn't have to be about drugs or alcohol, because I should also say that it's a much higher risk of any addictive behavior.

So, we might be talking about substances, but we run a higher risk of binge eating disorder, of gambling addiction, of, I work with a lot of young men with ADHD who are addicted to pornography, to impulsive spending. So, all of these things that have what we call a dopaminergic effect, which is that it's increasing levels of dopamine in the brain.

Gretchen: I can imagine some parents or caregivers listening right now wishing they could unhear everything you're saying. Like, "I don't really want to know this about my child's brain chemistry."

Roberto: So, it does start with sort of a neurochemical basis and why it's so important to understand that is just generally and culturally we tend to moralize addiction in this country, which is so not right and appropriate. And we often associate this with an aspect of willpower. And the truth is, not all brains are designed the same. I intimately understand how easy it could be to fall into something that on one level, you know, is not good, but your brain is somehow getting rewarded by that.

Gretchen: Yeah.

Roberto: Not everybody has that predisposition or that tendency. So, that's great. If you don't have that tendency, life is a lot easier on at least on that level. But, we want to take that sort of moral piece away and just look at this as like a chemical issue. So, the ADHD brain, in a nutshell, has deficits in dopamine regulation and processing for the, in simple terms, they're kind of lower available dopamine. So, it's, the ADHD brain is at baseline a bored brain.

So, what a lot of substances do like cannabis which is one of the most abused substances that I see amongst people with ADHD is it elevates levels of dopamine. You have impulse control issues for people with ADHD. So, where someone without ADHD might want to engage in something, but they pause because they can see the consequences that can come from that, for someone with ADHD, they might not be as aware in that moment of those consequences.

An ADHD brain is always sensation-seeking. But also from a psychological level, people with ADHD often can struggle with self-esteem issues. And sometimes substance use is a way of self-medicating that.

(06:15) Self-medication studies

Now what's interesting, a colleague at Mass General Hospital, his name is Timothy Wilens, W-I-L-E-N-S, doctor Wilens has done a lot of research in the ADHD community looking specifically at ADHD and substance use.

And through his studies have found that about 30% of people with ADHD report using drugs and alcohol to get a high, whereas 70% actually report using it to self-medicate ADHD symptoms. So, my patients who have ADHD who are using substances will say "Alcohol helps me get to sleep. This substance helps me focus. I am just riddled with all these negative thoughts of thinking how stupid I am that the drugs sort of numb me out."

So, what we're learning is that from a psychological level, in addition to all the physiological levels, that people with ADHD are more likely at risk to use these substances to self-medicate the ADHD. And also, aside from the higher predisposition, and this is also really, really important, is the bridge between experimentation and abuse or dependence is much shorter for people with ADHD.

And I say this to young people I work with. I have two children, a 19 and 17-year-old who both have ADHD. You know, I said, "The fact is, like your peers are going to be engaging in this and a lot of them won't develop a problem with it. And I'm, you know, certainly not advocating the use of it, but they're not going to have an issue with it. Just know that we run a higher risk of having an issue with it. That's something that's just an innocent sort of experimentation could turn into a very bad habit very, very quickly with ADHD. And that's just the reality of it."

Gretchen: When people with ADHD understand all this about their brains and their chemistry, do you find that it affects how they think and feel about themselves?

Roberto: Definitely. Because even with, you know, patients of mine who have ADHD, who and again, going back to understanding that this is, could broaden to a lot of addictive behaviors, it's not uncommon. And I've seen this particularly with adults who were undiagnosed ADHD or where their ADHD was not really properly treated, who might have had, let's say, a drug or alcohol problem achieve sobriety, which is an enormous feat and accomplishment.

And then developed a binge eating disorder, then developed a gambling addiction, and then maybe worked through that and then developed another issue and leaving them feeling "What is wrong with me?" And either feeling broken or feeling like they lack any sense of will as opposed to understanding "No, this is the same kind of animal here. It's just manifesting in different ways."

And to know that that same sort of part of us, like I, I often think of these things like a coin, you know, the heads and the tails. The same part of us that can have us run the risk of getting addicted to certain things, I feel is also responsible for the things that we can feel like super passionately about, and have a zest for. That same kind of quality and flavor of when we hook into something like, if you get me started to talk about music, we can be here all day.

Because it is, I mean, there's no question if you hook my brain up when I'm at a show, you know, at a concert, which I go to as often as I can, or even listening to music, you're going to see a lot of dopaminergic activity. So, it's understanding that it's not like we, even when people achieve sobriety, that they're kind of different people. That way of about you is there.

Gretchen: Right.

Roberto: It's just being very careful to making sure you're funneling that into things that are healthy, things that are appropriate, you know, things that aren't going to get you into any trouble.

Rachel: So, I feel like this question might be kind of complicated, but I'm going to keep it as simple as possible. When someone is self-medicating with something that we wouldn't ordinarily think that people should, quote, should take, and it's making them feel better, in that case, is it a bad thing?

Roberto: It's a great question. So, this is why, even in approaching this, whether you're a parent, a clinician, we don't want to demonize the person for having, you know, the problem. Because the first question to ask is, "What is this doing for you?" Because they're, even if they know they're engaging in something that they probably shouldn't be, it's hearing, "OK. It's it's rewarding you."

And to understand and this is specifically an issue when it comes to cannabis because you have now cannabis, which is legalized in many states, and not only as a substance that is seen as not harmful, which is not true. It's neurologically very harmful, to especially a developing brain. But it's being marketed as being medicinal.

Rachel: Right.

Roberto: It's being marketed as being actually helpful. And I'll have a lot of young people I work with who's like, "Oh, isn't this a treatment? Like this would be better than amphetamines, which people can get hooked on," which isn't true. The risk of addiction for someone with ADHD for stimulant medication is very, very low. And, my great friend and colleague and ADHD expert, Ari Tuckman says it best when he said "If It were, if stimulant medication was that addictive, people with ADHD would never forget ever taking their medication."

Rachel: Right.

Gretchen: Good point.

Roberto: And would never forget making sure their prescription is filled and working with the psychiatrist to do that. And, but it's delivered just differently in the ADHD brain. So, what we know about cannabis and particularly is yes, it's doing all of those things.

And we want to validate to the person, "Yes, it may be helping you sleep and it may be calming you down. It might make your thoughts sort of more linear. And what we also know is that it's eroding those executive centers in the brain that it's only working to exacerbate those ADHD symptoms in the long term. So, in the moment, yes, it's doing those things. And it doesn't mean it's good for you."

Rachel: Right.

Gretchen: So, do ADHD medications make addiction less likely?

Roberto: You know, even when talking about this and what I get so frustrated by is still this kind of, all these cultural misperceptions about what ADHD is. So, even in sobriety circles, there are some rehabilitation programs that count stimulant use for someone with ADHD, even when prescribed as a violation of sobriety, which is so offensive to people with ADHD.

(13:28) Risk of addiction

What we know, and this is empirical research — again, a lot of credit to Dr. Wilens for doing these studies — studies show for people with ADHD, the use of stimulant treatment reduces the risk of relapse, even with young children and teens who have ADHD, that when they do longitudinal studies following them over the years, find that those who are taking medication are less likely to develop a substance use problem and issue.

Gretchen: Right.

Roberto: And it makes sense because again, if you are getting properly treated and so much, what's feeding into the substance use disorder, are these ADHD symptoms, impulse control, you know, just even proper, you know, focus and concentration, the need for stimulation, if you just overall feel more grounded, which is what proper treatment, pharmacological treatment of ADHD would achieve, there's less of sort of the need for that, you know, in that way.

So, yes, and I get it. For parents, you know, we, you hear these concerns about Adderall and a lot of these medications, keeping in mind that people who don't have ADHD, these drugs are very addictive because it does a very different thing in the brain. If you're using it as prescribed, the risk is very, very low.

I can honestly tell you, and I've seen lots of patients with ADHD. I know lots of people in my life with ADHD. I've only come across maybe one client who abused their stimulant medication. So, it wasn't taking it as prescribed, but they were abusing it. I never see it and it's because it's delivered differently in the brain.

Rachel: So, when should you start talking to your kid with ADHD about the dangers of substance use for them, and how should parents talk about it?

(15:34) Talking to younger kids

Roberto: Yeah, I think it's so important, just even at young ages before substance is even in the vocabulary of just, you know, educating about ADHD. And part of that is, you know, we might have a hard time, you know, regulating although that word might be is too big of a word when they're young. But when we like something, it's hard to stop, you know, something that we really like. And when we don't like something, it's really hard to start, you know, and want to, you know, do that thing.

And kind of, start to create a space of not only then, but share, you know, whether you have ADHD or not of yeah, like, for example, you know, when like, I, I love food and, you know, "Daddy loves pizza." And sometimes if there's more slices to be had, I have to say, "Oh, like, I could, I, like, I could eat a large pizza easily. But how I'm going to feel afterwards might not be good."

And you sort of give, you know, drop those examples.

Rachel: Yeah.

Roberto: Because it's also helpful when kids know that this isn't something just about them. You know, when Mom or Dad or caregiver is talking about this, "Oh, OK." Well, you know, they look up to their, you know, caregiver. And it could be, you know, "Oh, we love watching TV. We love playing video games. And it is hard to stop because we like it so much. And but we kind of have to because we have to go to bed and we have to do these things."

And so, you start to introduce that idea. And then again, I'm all about this sort of strength-based model of that same thing means like when you're connected to something that you love, like I, what my kids heard growing up is like, "I love what I do. Like, I don't call this a job because it's almost seems like, is it a job? Like, I love it, like I love what I do, and I can work long days and I'm not, I don't leave the office at the end of the day being like, 'Oh, what a long day.' I'm just, I'm energized by it."

You know, so you want to sort of have them see sort of the full picture of it. And then as they get older and, you know, depending on who your kid is, like, I was, you know, the kind of kid I learned a lot, too young. I had a lot of friends in the neighborhood who were older. And, you know, I grew up at a time where you weren't as supervised as, you know, I think now that you are. So, there was exposure there to me at a very young age, like, much younger than, you know, my parents would have thought.

And the truth is now, like cannabis, for example, is, I mean, I'm working with 11 and 12-year-olds who are engaging in the use of cannabis, who know lots of their peers who are using weed. So, to not assume that at 13, they're not seeing that kind of, you know, exposure. So, then it starts to be like, "You know, as you get older, you're going to see lots of different things. And, some of those are, you know, alcohol and drugs."

And, and I think to approach it one as, again, not moralizing it because I think a lot of times we're like, "Oh, only bad people, the bad kids, you know, or, you know, the kids whose parents aren't supervising them are doing drugs." And that's not true. Like, there are really good people who get themselves wrapped into these, you know, things. And so, it is this balance of saying, you know, one of the things we know about ADHD is there is a higher risk for these kinds of problems.

Now, I also say the majority of people with ADHD do not have a drug or alcohol problem. However, if you take a sample of people with drug and alcohol problems, you're going to see a higher-than-normal rate of people with ADHD. And so, it's just to let them know like that you're going to be confronted with these kinds of things. And I want to be clear about that these things aren't helpful.

And not just because they're wrong, and the, you know, I'm thinking for those of you who are South Park fans, like, you know, Mr. Mackey would be like, "Drugs are bad, you know, drugs are bad." And it's like, because as a kid, as an ADHD kid, sometimes the things that I was told not to do were more attractive. Like, those were the things that were sort of more appealing.

So, the thing that I hear most from young people I work with that prevents them from really engaging in those conversations is if they feel there's judgment made against peers who, because a lot of my patients, even the ones that are not using drugs or alcohol, have friends who are using drugs and alcohol. And if they fear that if their parents, either will look down upon their friends or by association, start to look down on their child for having association with those people.

Rachel: Yeah. In talking about all this, is the message that they should never, ever touch any kind of, you know, drugs and alcohol, like, you know, even when they're of age because of this potential tendency or not?

Roberto: So, I mean, we wouldn't have a blanket statement to say, "Oh, you should never, ever, ever do it." But, I mean, I can tell you as a parent, I strongly, strongly, promoted total sobriety because there is addiction on both sides of my kid's family. My maternal grandfather and maternal uncle died of alcoholism. And I know myself and, you know, situations in my life and just how I'm wired. And I told them, like," I will never, ever think of you less or..."

You know, that's an, and it goes with, as parents, it will go without saying, but your kid might not know. They might think, you know, they're going to vastly disappoint you.

(21:22) The importance of communication

And I always want my kid to know "At the end of the day, if you make a certain choice and decision, you always can call me. Always, always, always, always, always call me I. The first question is not going to be what, what? Why did you do that?"

Gretchen: Right.

You know, and that sort of thing. And what I would promote is "If you engage in it, you, you know, want to be safe, but really be honest and pay attention, because in some ways, if it makes you feel so good, we want to really be cautious of that. Let's find a way to talk about that."And I won't be like, "Oh my gosh, why did, you know, you do that?"

And so, it's balancing that and yeah, like I, I wouldn't say never from the perspective of because then if your child does engage in the use, they don't want to feel like, like I would never say to my kids like "Don't ever drink, you know, don't ever do that."

(22:16) Assertiveness skills for kids

But I worked as a parent in with my clients in building assertiveness skills, how to, you know, be in a situation where you can still be, you know, with those kids if they're funny and they're like, because a lot of my friends engaged in that and I didn't have to. And at the same time, I liked them because they were funny and they had a lot of. So, how do you build assertiveness skills to be able to say, "Oh, you know, no, thank you."

And, you know, we, I can appreciate other aspects here of the relationship and the friendship. So, that's how I would do it. So, how do you build assertivenes? And I think again, what I hear from a lot of the young people is, even with peers, a lot of times even when like with peer pressure and things like that, it's often around the judgment.

Like if you come across like, "I'm not judging you for if you like to drink and whatnot, I mean, I might have concerns secretly, and I did. I had friends who struggled with this that, but I'm not thinking of you as a less less of a person or anything like that." A lot of times peers sort of lay off, you know, it's I think when they start to feel judged by somebody who makes the decision to be sober, you know, to not engage.

Gretchen: Yeah. Can you give an example, what, like if I were to talk to my kid about "OK, you know, here are the words you should use when you're trying to not engage, but you don't want to offend your friends." Like what might, what are some, like, sentence starters or, like, conversation ideas you can give your kids?

Roberto: Yeah, I mean, sometimes, you know, my kids are very open. You know, they say "We have a pretty high risk of addiction, like in my family. And it's something I just want to be careful about." For some people might not feel as comfortable saying that. And so, they might say, "Oh, you know, I don't like the feeling of being out of control."

Gretchen: Right.

Roberto: Or I have a client who, he said, and he actually does get motion sick very easily, like on boats and stuff like that, and he says, he really doesn't want to drink, and he uses that. He says, "You know, I get motion sick" and he makes it, he's very funny. He's like, "It'll be like a vomitorium, you know, here in two seconds just by me being dizzy." And it works. And the thing is, it's like people are like "OK, cool."

Gretchen: Yeah.

Rachel: So, in our last minute or two that we have, is there anything we didn't get to that you feel is important to include here?

Roberto: Yeah, I guess I just want to really highlight and underline how important the identification of ADHD when ADHD is in the fold. How important that is to diagnose, how important it is to understand the full range of that. Because a lot of times in other circles when ADHD is talked about is just an issue of attention, just an issue of academics.

And, we know, you know at Understood and places that it is, it can affect every domain and why I'm appreciative of this dialog and this conversation we're having is that when people can get that diagnosis and get treatment and and I've seen it so much like just with people, because sobriety is such, it's so hard. It's so hard. I mean, and it's such an amazing accomplishment when someone can achieve sobriety and when they know that there's this additional tool of treatment for ADHD that can make that process in that road easier for them.

It feels like, you just like you won the lottery, you know, in that way.

Gretchen: Yeah.

Roberto: And that's what I want people to sort of, you know, be aware of. And at the end of the day whatever choices people make, you know around substances, it's of course I want people safe and living long, healthy lives, but even in having these conversations and as a parent, what I try to convey is I want you to just have the facts. Let's just be accurate.

Rachel: Yeah.

Gretchen: Yeah.

Roberto: As much as we can here, because I would be remiss if I didn't share this with you because I work with people who have, you know, who are in recovery. And they said, "I wish somebody told me that having ADHD had even something to do with addiction or a binge eating issue," or, you know, you name it, like sometimes that it's like an epiphany for people where I want that to be common knowledge and not, again, from the perspective of scaring people, but just educating them.

And I think for anybody, whether you have ADHD or not, that's just so important. The more knowledge you have of yourself, the more then at least you're going into decisions with accurate information.

Gretchen: Knowledge is power.

Roberto: Knowledge is power.

Gretchen: Oh well, thank you so much. This has been such a helpful conversation.

Roberto: Oh thank you. I appreciate us having the conversation.

Rachel: Thanks so much for listening today. If you have any thoughts about the episode, we'd love to hear from you. You can email us at init@understood.org.

Gretchen: And check out the show notes for this episode, where we have more resources and links to anything we mentioned.

Rachel: This show is brought to you by Understood.org. Understood is a nonprofit organization dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. Learn more at Understood.org.

Gretchen: "In It" is produced and edited by Julie Subrin, with additional production support from Cody Nelson and Ash Beecher. Justin D. Wright, mixes the show and Mike Errico wrote our theme music. Briana Berry is our production director. Neil Drumming is our editorial director.

Rachel: From Understood.org, our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick. Thanks for listening.

Gretchen: And thanks for always being "in it" with us.