Does stimulant medication increase risk for substance use disorder and developing an addiction?

The question is valid. People with ADHD are at greater risk, after all, for using substances and for developing dependence. And stimulant medication — the first-line treatment for ADHD — is classified by the FDA as a Schedule II controlled substances due to its high potential for misuse, abuse, and dependence. So it’s not surprising that some people worry stimulant medications may inadvertently increases risk for addiction in ADHD brains.

But mounting research shared during the July 2026 ADDitude webinar “ADHD Treatment and Substance Use Problems: The Latest Research on Stimulants & SUD” paints a reassuring picture.

“We’re not showing, on average, that stimulants increase risk for substance use disorder,” said Brooke Molina, Ph.D., Professor of Psychiatry, Psychology, Pediatrics, and Clinical and Translational Science at the University of Pittsburgh, during her joint webinar with Brian D’Onofrio, Ph.D.

Here are their webinar’s main takeaways on ADHD, substance use, and the impact of ADHD medication treatment on substance use-related outcomes.

The Factors That Link ADHD to Substance Use

From inherited family risk and symptom severity to altered reward processing, multiple factors help explain why people with ADHD face an elevated risk for substance use and substance use disorders.

[Overview: Substance Use Disorders — Signs, Symptoms, and Links to ADHD]

“There’s variation in the way that people with ADHD respond to drugs and things that are potentially rewarding,” Molina said. “This does go back to the dopamine differences in the brain.”

Difficulty translating knowledge into action — a common challenge associated with ADHD — is another factor. In this case, awareness of negative effects does not always translate to reduced substance use.

“This is really important for clinicians to be aware of,” Molina said regarding the treatment of people with ADHD and active substance use issues. “You can’t just take a standard treatment developed for something like substance use disorder and drop it on a person with ADHD. [The treatment plan] needs to consider the particular issues that go along with ADHD.”

Stimulants Do Not Increase Risk for Later Substance Use

Multiple long-scale and longitudinal studies show that stimulant treatment in childhood does not increase risk for harmful substance use later on.

One study that looked at onset and duration of stimulant treatment for ADHD found that people who started treatment before the age of 9 or who were receiving treatment for longer (i.e., six or more years compared to less than one year) were less likely to use substances.

[Read: Treating a Child with ADHD Medication Diminishes Future Risk of Substance Abuse]

Stimulants Protect Against Adverse Outcomes

It’s widely recognized that stimulants don’t increase risk for substance use, however some studies have found that stimulant medication actually protects against serious outcomes, like hospitalization, crime, and even substance-related death in patients with ADHD, regardless of age. “There is a roughly 30% reduction in the risk for these serious outcomes,” said D’Onofrio, the Sharon Stephens Brehm Endowed Professor in the Department of Psychological and Brain Sciences at Indiana University.

Even among people with ADHD and a history of substance use, initiating ADHD medication treatment reduces risk for these events, D’Onofrio said.

ADHD and SUD: Implications

Well-respected research overwhelmingly shows that stimulants do not increase risk for substance problems. Still, many people with ADHD, and many clinicians, are slow to accept the evidence.

“We have an enormous number of practitioners out there who just really are very uncomfortable treating ADHD, and they’re scared of dealing with stimulant medications,” said Molina, who noted that upcoming U.S. Guidelines for the Diagnosis and Treatment of ADHD in Adulthood will aim to help clinicians become more familiar with treating complex ADHD.

D’Onofrio added other treatment options exist if stimulant abuse is a concern. “There are extended-release rather than short-acting [meds], and then there are specific types of stimulant medications, different formulations that are harder to abuse,” he said, adding that therapy and other approaches can also help.

Researchers also need to further understand why many youth with ADHD stop taking medication and what effects this trend may have on health outcomes, he said.

For more insights on ADHD, stimulants, substance use-related outcomes, and the studies highlighted during the webinar, watch the replay.

SUD and ADHD Treatment: Next Steps

• Read: SUD Risk Is Elevated by ADHD
• Study: Prescription Stimulants Do Not Increase the Risk of Illicit Drug Use in Adolescents
• Read: No, Stimulants Don’t Cause Brain Damage

ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

Sports betting, now legal in most states, is ensnaring more young men every day.

As ads for FanDuel, DraftKings, and their competitors bombard the nation’s airwaves, frantic calls to gambling addiction hotlines continue to rise – and counselors say young men and their family members account for a majority of those calls.

Studies show that people diagnosed with gambling disorder who also demonstrate symptoms of ADHD are more likely to experience that addiction with greater severity.^{1, 2}

“It’s ubiquitous,” says Tamara Rosier, Ph.D., past president of the ADHD Coaches Organization. “You can gamble on your phone. The ads are all over Instagram. It’s everywhere and it takes effort to get away from it. And when you combine the instant dopamine rush with sports, it’s different. There’s something about sports that make people feel like Gladiators.”

Easy access to sports betting sites and apps is inviting severe personal and financial consequences. In Ohio, calls into helplines have risen more than 300 percent in recent years, mainly from men aged 18 to 32.

Stephen Wu, Ph.D., a researcher at Hamilton College in New York, measured the mental wellbeing among different demographics in states before and after gambling was legalized. “When you look at adult males in their early 30s, you see that the legalization of gambling is related to worse mental health,” he told NPR.

Todd Love, Psy.D., a licensed professional counselor, recommends these steps if you feel trapped in a behavioral addiction that is interfering with your life:

• Treat your ADHD, as treatment stabilizes dopamine signaling and supports recovery.
• Create no-tech zones to begin to break behavioral patterns (e.g., disable notifications, turn off WiFi after a certain time).
• Join a 12-step program like Internet and Technology Addicts Anonymous
• Feed your ADHD brain through movement, learning, creativity, and other healthy ways. Prioritize routines around exercise, sleep, and nutrition.

Gambling and Sports Betting Addiction: Resources

• Understand: When Dopamine Is a Drug – the ADHD-Behavioral Addictions Link
• Take This Self-Test: Are You Showing Signs of Screen Addiction?
• Read: “Is My Grandson Addicted to Gaming?”

ADDITUDE IS HUMAN
Artificial intelligence does not create or edit any written content published by ADDitude. Our editorial team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

Sources

¹Fatseas, M., Alexandre, J., Venisse, J., Romo, L., Valleur, M., Magalon, D., Chéreau-Boudet, I., Luquiens, A., Guilleux, A., Jeu, G., Challet-Bouju, G., & Grall-Bronnec, M. (2016). Gambling behaviors and psychopathology related to Attention-Deficit/Hyperactivity Disorder (ADHD) in problem and non-problem adult gamblers.. Psychiatry research, 239, 232-8 . https://doi.org/10.1016/j.psychres.2016.03.028.

²Breyer, J. L., Botzet, A. M., Winters, K. C., Stinchfield, R. D., August, G., & Realmuto, G. (2009). Young adult gambling behaviors and their relationship with the persistence of ADHD. Journal of gambling studies, 25(2), 227–238. https://doi.org/10.1007/s10899-009-9126-z

May 21, 2026

Adults with ADHD and a coexisting substance use disorder (SUD) are nearly twice as likely to discontinue treatment with medication compared to their peers with ADHD only, according to a new study published in BMJ Mental Health.¹

The Swedish cohort study found that almost half (44%) of adults with ADHD and substance use disorder stopped medication within one year of diagnosis or first SUD-related event, compared to 25% in the ADHD-only group. (The study defined medication discontinuation as a treatment gap of 90 days or more without medication, calculated based on the estimated duration of the previous prescription.) Individuals with a history of abuse of stimulants, cannabis, and/or multiple SUDs experienced significantly higher risks for treatment discontinuation.

Though many patients eventually resumed treatment, those with ADHD and SUD did so at a much lower rate. Notably, individuals with substance-related criminal justice involvement were the least likely to reinitiate ADHD treatment.

“ADHD is often overlooked in prison populations and seldom treated appropriately,” the researchers wrote.² “Whether this is due to patients experiencing difficulties engaging and adhering to treatment regimens or whether healthcare providers are reluctant to prescribe stimulants to patients with ADHD and SUD in the presence of criminal history, or consider treating this patient group riskier and therefore more often discontinue treatment, is unclear. It is, however, increasingly clear that healthcare services need to be adapted to the specific needs of patients with ADHD, SUD, and criminality to reach more patients and improve long-term outcomes.”³

Though guidelines recommend stimulants as the first-line treatment for ADHD in adults, some clinicians remain wary of using stimulant medication to treat patients with coexisting SUD. Concerns often center on the abuse potential of stimulants; however, ADHD treatment with stimulant medication does not cause future drug misuse or addiction, explained Timothy E. Wilens, M.D., during the ADDitude webinar, “Substance Use Disorder and ADHD: Safe, Effective Treatment Options.”

“In fact, the opposite appears to be true,” Wilens said. “Studies show that early treatment of ADHD and its continued treatment across the lifespan reduce risk for substance use and SUDs.”⁴

Some clinicians prescribe lower doses of ADHD medication for SUD populations out of caution. However, findings showed lower doses did not improve adherence; higher doses did.

This finding suggests that patients who tolerate stimulants well are more likely to continue treatment, which could prevent criminal behaviors. Patients with ADHD, early onset SUD, and coexisting conduct disorder are at a higher risk for criminality, but those who adhere to their ADHD treatment are better able to avoid it, according to a 2012 population-based Swedish study involving 26,000 adults with ADHD who had criminal convictions. The study, published in the New England Journal of Medicine, found that the crime rate decreased by 32% for men who had taken their ADHD medication. The drop in crime was even bigger for women: 41%.⁵

A 2025 BMJ study found that ADHD medication use is significantly associated with lower rates of first-time and recurring suicidality, criminal behaviors, vehicular accidents, and substance misuse.⁶

“This may be because people with multiple occurrences of such events typically have more severe ADHD, making them more likely to benefit from drug treatment,” the study’s authors wrote. “Additionally, the cumulative effect of ADHD drug treatment may lead to additive improvements over time, whereas negative consequences may accumulate the longer an individual goes untreated.”

Factors Influencing Treatment Discontinuation and Reinitiation

The researchers on the BMJ Mental Health study stressed the need to improve medication continuity for individuals with ADHD and SUD. They recommended that treatment providers consider the specific needs of individuals with ADHD and SUD to improve outcomes, especially in young males, who were more likely to discontinue treatment compared to females.

Study results showed those with ADHD and SUD were more likely than those with ADHD only to change providers and medication type between discontinuation and reinitiation of treatment.

“SUD patients, especially those with more severe SUD, have difficulties accessing and engaging with the healthcare system, due to stigma and low health literacy,” the researchers wrote. “Such factors, although impossible to explore using register data, may contribute to the increased risk of treatment discontinuation and lower reinitiation.”

Age also influenced treatment discontinuation and reinitiation. In the ADHD and SUD group, young adults between the ages of 18 and 24 years or younger at the time of their first SUD event were more likely to stop and less likely to restart treatment compared to those with only ADHD.

“Given that treatment adherence has been associated with positive outcomes in both ADHD and SUD, it is important to improve treatment access and continuity of care, especially in the susceptible period during the transition between adolescence and adulthood, a period marked by heightened vulnerability for both SUD onset and for treatment discontinuation,” the researchers wrote.

The study included a total of 55,684 people between the ages of 16 and 26 from Swedish national registers (9,283 people with ADHD and SUD and 46,401 with ADHD only), who had ongoing ADHD medication treatment.

According to Wilens, about one in two adolescents and one in four adults with an SUD has co-occurring ADHD; the risk for SUD is even higher among adolescents and adults with untreated ADHD.^{7, 8}

“Given the known links between ADHD and SUD, adolescents and adults with SUDs or problematic substance use should be screened for ADHD,” he said. “For individuals with both SUDs and ADHD, structured therapies such as cognitive behavioral therapy (CBT) and pharmacological approaches appear most effective. Treatment may start, for example, with CBT that focuses initially on SUD than on the ADHD. Throughout treatment, providers may alternate between focusing on the SUD and ADHD, helping patients understand and identify their thoughts and feelings around substance cravings and urges, and managing symptoms and other ADHD-related issues that may interfere with substance use treatment. Patients also learn how to keep themselves out of high-risk situations.”

Sources

¹Capusan AJ, Zhang L, Larsson H, et al. (2026). Discontinuation and reinitiation of pharmacological treatment for ADHD among individuals with ADHD and substance use disorder. BMJ Ment Health. https://mentalhealth.bmj.com/content/29/1/e302138

²Retz, W., Ginsberg, Y., Turner, D., et al. (2021). Attention-deficit/hyperactivity disorder (ADHD), antisociality, and delinquent behavior over the lifespan. Neurosci Biobehav Rev. https://doi.org/10.1016/j.neubiorev.2020.11.025

³Mariani, J.J., Levin, F.R. (2007). Treatment strategies for co-occurring ADHD and substance use disorders. Am J Addict. https://doi.org/10.1080/10550490601082783

⁴Boland, H., DiSalvo, M., Fried, R., Woodworth, K.Y., Wilens, T., Faraone, S.V., & Biederman, J. (2020). A literature review and meta-analysis on the effects of ADHD medications on functional outcomes. Journal of psychiatric research. https://doi.org/10.1016/j.jpsychires.2020.01.006

⁵Lichtenstein, P., Halldner, L., Zetterqvist, J., Sjölander, A., Serlachius, E., Fazel, S., Långström, N., & Larsson, H. (2012). Medication for attention deficit-hyperactivity disorder and criminality. The New England Journal of Medicine. https://doi.org/10.1056/NEJMoa1203241

⁶Zhang. L., Zhu, N., Sjölander, A., Nourredine, M., Li, L., Garcia-Argibay, M. et al. (2025). ADHD drug treatment and risk of suicidal behaviours, substance misuse, accidental injuries, transport accidents, and criminality: emulation of target trials. BMJ. https://doi.org/10.1136/bmj-2024-083658

⁷van Emmerik-van Oortmerssen, K., van de Glind, G., van den Brink, W., Smit, F., Crunelle, C. L., Swets, M., & Schoevers, R. A. (2012). Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug and alcohol dependence. https://doi.org/10.1016/j.drugalcdep.2011.12.007

⁸Wilens, T.E., & Morrison, N.R. (2012). Substance-use disorders in adolescents and adults with ADHD: focus on treatment. Neuropsychiatry. https://doi.org/10.2217/npy.12.39

At our fingertips is unfettered, unprecedented access to novelty and stimulation. Social media, streaming, sports betting, gaming, dating apps, and pornography deliver massive dopamine hits – on demand and without limit. The hidden architecture of online platforms is meant to hijack our evolutionary reward circuitry, the same pathways implicated in addiction; they are addictive by design.

ADHD brains are especially vulnerable. Naturally novelty-driven, impulse-control-impaired, and dopamine-reactive, people with ADHD are prime candidates for behavioral addictions. About 20 percent of young adults with ADHD have Internet addiction, and roughly a quarter of people with gambling disorder have ADHD¹ – though actual rates may be higher.

ADHD Brains Seeking Sensation

ADHD brains are wired for addiction in large part because lower baseline dopamine levels drive sensation-seeking behaviors and a desire for instant gratification. Strong dopamine responses, in turn, reinforce addictive behaviors. What’s more, gambling, gaming, and the like provide an escape from boredom, anxiety, loneliness, and low self-esteem.

[Take This Self-Test: Are You Showing Signs of Screen Addiction?]

According to gambling studies, anticipation is the biggest thrill: the largest dopamine spike happens before the wheel spins or the dice roll. Repeated surges create tolerance and weaken executive control. Over time, the brain reaches a reward deficiency state. Ordinary activities feel unrewarding, driving people to seek more thrills.

The Lure of Short-Form Videos

TikTok, YouTube Shorts, and Instagram Reels have transformed the digital landscape. Chronic exposure to rapidly changing, algorithm-driven content trains the brain to seek constant novelty and instant reward. They temporarily weaken attention and impulse control (mimicking ADHD symptoms), increase stress, and even disrupt sleep.

While research on short-form video addiction is emerging, their design maps almost perfectly onto ADHD traits, making neurodivergent brains uniquely vulnerable.

Behavioral Addiction Signs

Behavioral addiction withdrawal isn’t shakes and sweats – it’s a negative mood state from losing artificially elevated dopamine. Symptoms include:

• mood swings
• anxiety
• fatigue
• headaches
• poor concentration
• depression
• insomnia
• irritability
• social isolation
• restlessness

How to Overcome Behavioral Addictions

If you feel trapped in a behavior that is interfering with your mental health, work, finances, sleep, or relationships, take the following steps and/or seek professional help.

1. Treat Your ADHD
Whether you’re dealing with problematic use or full addiction, treating ADHD is essential. Treatment stabilizes dopamine signaling and supports recovery. Delaying evidence-based treatment, like prescription stimulant medication, because of addiction concerns is counterproductive.

2. Create Safe Havens
Break behavioral patterns by disabling tech notifications, installing accountability apps, enabling website blockers, and implementing no-WiFi zones.

3. Seek Community
Peer support reduces loneliness and shame while providing accountability. Internet and Technology Addicts Anonymous is a well-known, 12-step group that helps people facing social media, gaming, pornography, shopping, and other behavioral addictions.

4. Honor Your Wiring

Your ADHD brain craves novelty. Instead of fighting or letting algorithms exploit it, commit to intentionally feeding your brain in healthy ways.

• Seek novelty through movement, learning, creativity, or nature. Invest time in new hobbies or revisit old passions. Many people in recovery find meaning in volunteer work.
• Understand your triggers. Which situations or activities compel you to engage in such behaviors? Where must you set non-negotiable boundaries to aid in recovery?
• Prioritize exercise, sleep, and adequate nutrition to stabilize the mind and body.
• Be patient. Trust your brain’s capacity to rewire and find joy in everyday life. Slip-ups are part of recovery. Take it one day at a time.

Find more recovery resources at additu.de/102125

Dopamine Addiction: Next Steps

• Read: Screens Are Embezzling Your Attention. Steal It Back — Now.
• Read: The Dope on Dopamine Fasting
• Read: Never Enough? Why ADHD Brains Crave Stimulation

ADDITUDE IS HUMAN
Artificial intelligence does not write or edit any content published by ADDitude. Our team is 100% human, and our mission is simple: listen to and serve our readers with hand-crafted, expert-informed resources. To support ADDitude, please consider subscribing. Your readership and support help make our commitment possible. Thank you.

Sources

¹ Waluk, O. R., Youssef, G. J., & Dowling, N. A. (2016). The Relationship Between Problem Gambling and Attention Deficit Hyperactivity Disorder. Journal of gambling studies, 32(2), 591–604. https://doi.org/10.1007/s10899-015-9564-8