ADHD and Substance Abuse in Youth

How to better understand the link, and what to do about it

Author: Isola Chambers

Clinician: Samantha Gibson, New Leaf Therapeutic Services

Children and adolescents with ADHD are estimated to be two to three times more likely to develop substance use disorders than their peers without ADHD. This isn’t a marginal difference. It is a pattern that has appeared across decades of developmental research. 

While this statistic might sound alarming, it’s important to be precise about what the estimate means: ADHD is associated with higher rates of later substance use and earlier nicotine use, particularly during adolescence; and increased risk is not the same as inevitability. Many young people with ADHD never develop problematic relationships with substances. Outcomes vary widely depending on individual traits, co-occurring mental health conditions, family support, peer environment, and access to care. 

Understanding the link begins with understanding ADHD itself.

ADHD isn’t just about attention. It involves differences in reward processing, impulse regulation, emotional intensity, and the brain’s braking system. For some young people, especially those with prominent hyperactive or impulsive symptoms, these differences appear to be more strongly associated with later substance-related problems than in people who present with inattention alone. 

Long-term research following children with ADHD into adolescence and early adulthood suggests that many begin using substances earlier than their peers and may progress more quickly to frequent or heavy use. Earlier exposure matters, and early patterns tend to shape later ones. The earlier the brain learns that a substance can affect mood and comfort, the more likely it is that the same pathway will be reused.

Let's touch on a few key ideas within the research:

→ Social Factors

Biology is only one factor at play, and social experience carries significant weight. Many children with ADHD grow up receiving more negative feedback than positive, or at least (on average) more negative feedback than their neurotypical peers. They might struggle academically despite effort. They might feel out of sync with classmates. Over time, some gravitate toward peers who share similar experiences of marginalization or rule-breaking. Research suggests that youth with ADHD are more likely to affiliate with peer groups where substance use is present, which can accelerate both initiation and escalation. 

ADHD interacting with stressors such as school failure, peer rejection, and limited support predicts earlier and more persistent substance use. The inverse is also true: consistent relationships, felt safety, and accessible support can alter trajectories.

→ Co-occurring Disorders

Layered on top of this is the reality that ADHD rarely travels alone. Anxiety, depression, oppositional defiant disorder, and conduct disorder co-occur frequently. Each additional layer adds strain to a young person’s coping system, and significantly increases the likelihood of substance-related problems. 

→ Beyond Substances

It is also helpful to widen the lens beyond just substances. Adolescents with ADHD show higher rates of behavioral addictions such as problematic gaming, gambling, and compulsive internet use. These patterns point toward shared vulnerabilities around reward sensitivity and self-regulation rather than a single substance-specific problem.

→ Medication

A common fear among parents is that ADHD medication might increase addiction risk. Large-population studies suggest that the opposite is true. Youth who receive appropriate treatment for ADHD, including medication and therapy, tend to show lower rates of later substance misuse. This doesn’t mean medication alone is protective, but it does emphasize the importance of supporting the underlying condition, and how this can affect developmental pathways.

So… What now? 

A lot of this information can feel heavy. But it can also function as a vessel of empowerment. Risk isn’t destiny. Knowledge and awareness can allow for earlier and more considered intervention.

The Child Mind Institute emphasizes the importance of addressing both ADHD itself and the quality of the parent-child relationship. When families are in frequent or constant conflict, they should seek help through family therapy or behavioural supports, and try to stay mindful of the relationship at the centre of it all. 

Therapy can offer a space where young people learn skills for emotional regulation, impulse awareness, and coping with stress. It can help parents and caregivers better understand their child’s nervous system, adjust expectations, and rebuild patterns of connection. When ADHD and substance use concerns overlap, working with a clinician who understands both can make a significant difference.

If you’re navigating questions about ADHD or addiction, it’s important to know that support can come in many different forms. What is most important is starting from a place of understanding and curiosity, and from the belief that change is possible. Reach out.