Substance Use Disorder in Children and Teens with ADHD

For Parents & Caregivers

Substance Use Disorder in Children and Teens with ADHD

Teenagers sometimes experiment with substances that can put them at risk. Children and teens with ADHD are more likely to try alcohol, tobacco, marijuana, and other illegal substances than those without ADHD. When substance use is severe or happens often, it can become a substance use disorder. Substance use disorder happens when a person repeatedly uses a substance despite the negative effects on their body, school or work, personal life, or family. This quick fact will help you:

Recognize symptoms of substance use disorder in children and teens with ADHD
Know what to do if you think your child may have a substance use disorder
Learn how your doctor will diagnose and treat both substance use disorder and ADHD

What are the signs and symptoms?

Smelling like alcohol or smoke
Bloodshot eyes
Flushed face
Sudden changes in mood
Withdrawal from friends and family
Secretive or deceitful behavior
Less motivation to do things they used to do
Loss of interest in going to school and doing well
Hanging out with new friends

How common is substance use disorder in children and teens with ADHD?

Children and teens with ADHD are two or three times more likely to try cigarettes, alcohol, marijuana, and other substances than children without ADHD [2,5]. They are more likely to take risks. Stress at school or home may cause them to use substances to cope, which raises their risk of developing a substance use disorder. Children and teens who use substances like tobacco, marijuana, or alcohol may feel like they can cope with their ADHD symptoms better. Teens with ADHD may go from experimenting to abusing substances more quickly than their peers. Research studies suggest that both ADHD and substance use disorder may run in families [7].

Strategies for prevention of substance use disorder for children with ADHD

Take the following steps if you think your child with ADHD may be using substances.

Have conversations with your child at an early age about substance use and abuse risks. Let them know that they need to be even more careful with exposure to substances than their peers.

Keep your face, voice, and body calm. Show your child how you cope with stress other than using substances. Children learn by watching the behaviors of those around them.

Make sure that your child knows your family’s rules about illegal substances and what the consequences will be if those rules are broken.

Let your child know that having ADHD can make it harder to talk with friends and deal with peer pressure.

Help your child understand what to expect and what to do if a friend asks them to take drugs or alcohol.

Roleplay possible things your child can do if they are ever in a situation where alcohol, tobacco, or other substances are available.

Talk about possible things they could say if a peer is pressuring them to try illegal substances. Practicing what they could say may protect your child from being caught off guard and help them resist peer pressure.

If your child uses stimulant medication, talk with them about the dangers of misusing their medication and about saying no to requests to share or sell their medication.

Diagnosis and Treatment

If you suspect that your child or teen has a substance use disorder, contact their doctor right away and, if possible, ask for a referral for a professional that specializes in treating ADHD and substance use disorder.

When diagnosing ADHD, the doctor may use interviews with parents, teacher behavior ratings, observations, and/or psychological tests. When diagnosing substance use disorder, they may include a mental health evaluation. The doctor may ask that older teens complete a self-rating scale. However, some teens may find it challenging to describe symptoms or remember when their symptoms first began. In this case, the doctor may instead rely on parent interviews.

A child or teen is less likely to develop substance use disorder if they get the right treatment for their ADHD, including stimulant medication. Using stimulant medication without following a doctor’s order can cause substance use disorder, but when stimulants are carefully prescribed and properly used to treat ADHD, they don’t make a substance use disorder more likely.

The recommended treatment for substance use disorder and ADHD requires a combined approach that may include medication such as extended-release or transdermal stimulants that are less likely to be abused, family therapy, and cognitive behavioral therapy.

Depending on the severity of the substance use disorder, your child may need to be referred to an in-patient treatment program to help them withdraw safely. When your child receives treatment, communicate regularly with their care team. Make sure that you and your child understand the treatment plan and know what to do if your child suffers a setback. Keep in mind that recovery from substance use disorder can be a long process that requires patience.

Additional reading and references