ADHD and Addiction

Why the Brain Craves Stimulation and How to Break the Cycle

Jan 26, 2025

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Addiction is a significant concern for many of us with ADHD, as the condition’s unique neurobiology and psychological characteristics create vulnerabilities to substance use and other addictive behaviours. Understanding why ADHD increases the risk for addiction—particularly as a form of self-medication—and exploring how different substances or actions affect the nervous system can offer deeper insight into this link. Additionally, examining how ADHD medications work sheds light on why certain addictions may align with the brain’s unmet needs.

Why ADHD Increases the Risk of Addiction

1. Dopamine Deficiency and the Drive for Self-Medication

At the core of ADHD is a dysregulated dopamine system. Dopamine is a neurotransmitter associated with reward, motivation, and pleasure. People with ADHD often have lower baseline levels of dopamine, making everyday tasks less rewarding and stimulating. Substances like alcohol, nicotine, and drugs—as well as behaviours such as gambling, shopping or excessive screen time—provide a dopamine boost, temporarily improving focus, mood, or energy levels. This creates a feedback loop where these activities become highly reinforcing.

The need to self-medicate is a natural consequence of the brain’s drive to correct its dopamine imbalance. Substances or behaviours that stimulate dopamine production can feel like a solution to the internal restlessness or emotional dysregulation that ADHD brings.

2. Nervous System Regulation: Activation vs. Shutdown

In ADHD, the nervous system often oscillates between states of underactivation and overstimulation. This dysregulation can drive the choice of addictive substances or behaviours:

Activating Substances/Behaviours:
- Examples: Nicotine, caffeine, stimulants, gambling, high-intensity gaming.
- Effect: These substances or activities increase dopamine and norepinephrine levels, providing a sense of focus, energy, or excitement. They help combat the underactivation that often accompanies ADHD, allowing people to feel “awake” or “switched on.”
Shutting Down the Nervous System:
- Examples: Alcohol, cannabis, sedatives, binge eating.
- Effect: These substances or actions provide relief from overstimulation or emotional overwhelm, helping to soothe and calm an overactive nervous system. This is particularly appealing during periods of stress or emotional dysregulation.

The choice of addiction often reflects a person’s immediate need: to either amplify focus and energy or to escape and shut down overwhelming emotions.

Some people also develop a dual dependency where they rely on both stimulants and another substance. For example, using a stimulant to function during the day and sedatives or alcohol to relax at night. This creates a cycle of dependence, as one substance is used to balance the effects of the other, often worsening overall health.

3. Impulsivity and Poor Inhibitory Control

ADHD is characterised by impulsivity, which can lead to difficulties in delaying gratification or weighing the long-term consequences of decisions. This impulsivity makes it harder to resist substances or addictive behaviours, especially in moments of stress or temptation.

4. Emotional Dysregulation

People with ADHD often struggle with managing intense emotions, including stress, frustration, and feelings of inadequacy. Substances or addictive behaviours may be used as a way to self-medicate and escape from emotional discomfort, leading to dependency over time.

5. Co-Occurring Conditions

ADHD frequently occurs alongside other mental health conditions, such as anxiety and depression. These co-occurring challenges can further increase vulnerability to addiction as people seek relief from compounded emotional or psychological distress.

The Role of ADHD Medications in Addiction

For those that are medicated for ADHD the type of medication can also have an impact.

Stimulant Medications

Stimulants like methylphenidate (Ritalin) and lisdexamfetamine (Elvanse) are commonly prescribed medications for ADHD. They work by increasing the availability of dopamine and norepinephrine in the brain, helping to regulate attention, focus, and impulse control. For many, stimulants provide the dopamine boost that their brains lack, reducing the drive to seek out external sources of stimulation like nicotine or drugs.

Non-Stimulant Medications

Non-stimulant medications, such as atomoxetine (Strattera) or guanfacine (Intuniv), work differently. These medications target norepinephrine pathways or help regulate the autonomic nervous system, reducing emotional reactivity and promoting a sense of calm. While they may not provide the immediate dopamine boost of stimulants, they address other aspects of ADHD, such as emotional dysregulation and anxiety, which can also drive addictive behaviours.

How Medications Help Reduce Addiction Risk

Improved Self-Regulation: By addressing core ADHD symptoms, medications reduce the need for self-medication through substances or behaviours.
Dopamine Regulation: Stimulants, in particular, correct the dopamine deficiency, reducing the brain’s craving for external sources of stimulation.
Enhanced Emotional Stability: Medications help manage emotional dysregulation, a key driver of using substances to escape negative feelings.

However, when ADHD is left untreated or inadequately managed, people are at risk of turning to substances or behaviours that mimic the effects of these medications, leading to cycles of addiction.

How Non-Stimulant Medications Work

Atomoxetine (Strattera):
- Mechanism: Atomoxetine is a selective norepinephrine reuptake inhibitor (NRI). It increases norepinephrine levels in the brain, which helps improve attention, reduce impulsivity, and regulate emotions.
- Dopamine Connection: Unlike stimulants, it does not directly act on dopamine, reducing the "reward-seeking" effect that can contribute to addiction risk.
Guanfacine (Intuniv):
- Mechanism: Guanfacine works on alpha-2 adrenergic receptors, regulating the prefrontal cortex to improve emotional regulation, reduce hyperactivity, and promote calmness.
- Sedative Effect: Its calming nature can help address emotional dysregulation and sleep issues, reducing the need for substances like alcohol or cannabis to "wind down."

Addiction Risks with Non-Stimulant Medications

1. Lower Risk of Addiction:

Non-stimulants are not habit-forming but they do not provide the immediate dopamine "boost" associated with stimulants.
These medications are typically less reinforcing, meaning they are less likely to be sought out for euphoric or performance-enhancing effects. So the individual may have less chance of becoming physiologically addicted to the ADHD medication.

2. Risk of Misuse or Dependency on Other Substances:

Calming Properties and Sedatives: Non-stimulants like Guanfacine, which promote relaxation, may still lead individuals to seek out additional sedatives (e.g., alcohol or benzodiazepines) to amplify the calming effect, especially during high-stress periods.
Compensatory Stimulation: For those who still feel under-stimulated on non-stimulants, there might be a temptation to turn to substances like nicotine, caffeine, or stimulants to create a sense of focus and energy.

3. Self-Medication Patterns Persist:

Because non-stimulants act more gradually and may not fully address ADHD symptoms (such as focus or energy deficits), some individuals may continue seeking substances or behaviours to fill those gaps. Examples include: reliance on sugar, caffeine, or high-stimulation activities like gaming to provide the stimulation their brain craves.

4. Co-Occurring Emotional Dysregulation:

If non-stimulants are prescribed but emotional dysregulation remains poorly managed, people may turn to substances like alcohol or cannabis to regulate emotions or manage stress.

Advantages of Non-Stimulants in Reducing Addiction Risk

While they don't provide the immediate effects of stimulants, non-stimulants offer specific benefits in addressing addiction risks:

Gradual Onset: Non-stimulants build up over time, making them less likely to produce the "highs" associated with addictive substances or behaviours.
Focus on Emotional Regulation: By improving emotional stability (particularly with Guanfacine), these medications can reduce the need for substances used to "numb" or escape difficult feelings.
No Dopamine Highs: Since non-stimulants don't directly act on dopamine, they reduce the cycle of reward-seeking behaviours linked to addiction.

How Addiction Interacts with Non-Stimulant Medications

If non-stimulants do not adequately address core ADHD symptoms (like focus and energy deficits), people may continue seeking external substances for relief. Unlike stimulants, non-stimulants are less likely to exacerbate issues like overstimulation, jitteriness, or sleep disturbances when used alongside other substances. However, combining them with depressants like alcohol can dull their calming effects.

How Addiction Interacts with Stimulant Medications

The biological impact of someone on stimulant medication for ADHD who then seeks additional stimulant or depressant substances or activities can be significant, as it involves complex interactions in the brain and body.

Seeking additional stimulants (e.g., recreational drugs like cocaine or methamphetamine, excessive caffeine) floods the brain with even more dopamine. This can lead to:

Dopamine Overload: Causing euphoria initially but leading to depletion ("crash"), which worsens ADHD symptoms over time and increases dependence on substances.
Desensitisation: Overactivation of dopamine receptors can reduce their sensitivity, making it harder to feel pleasure or motivation naturally (anhedonia).

Substances like alcohol or cannabis affect the dopamine system differently, often causing a temporary dopamine boost followed by suppression. Over time, this can:

Disrupt the balance created by the medication.
Increase cravings for substances to "rebalance" mood and reward pathways.

The prefrontal cortex (PFC) is responsible for executive functions like decision-making, impulse control, and emotional regulation. In ADHD, the PFC is often underactive or inefficiently regulated. Medications help the PFC function better by improving neurotransmitter activity. Additional stimulants can overstimulate the PFC, leading to anxiety, restlessness, or even paranoia. Depressants suppress PFC activity, which can worsen ADHD-related difficulties with self-control and focus.

High doses of stimulants (from medications or substances) can cause neurotoxicity over time, damaging dopamine receptors and transporters in the brain. This can impair cognitive function, emotional regulation, and motivation long-term. Chronic use of alcohol or sedatives can lead to brain shrinkage in areas like the hippocampus (memory) and PFC, exacerbating ADHD challenges.

ADHD can bring with it heightened sympathetic nervous system (SNS) activity (fight or flight), which can make people feel constantly "on edge." Stimulants increase SNS activity (fight-or-flight response). Additional stimulants can exacerbate this further with increased heart rate, blood pressure, and cortisol (stress hormone) levels and bring risk of cardiovascular issues like arrhythmias or hypertension.

Overuse of depressents suppresses the SNS leading to a phenomenon in which symptoms of hyperactivity, impulsivity, or other behavioural challenges temporarily intensify as the effects of a medication or substance wear off. It is commonly observed in those with ADHD who take stimulant medications or use substances that influence brain activity that they have rebound hyperactivity (a phenomenon in which symptoms of hyperactivity, impulsivity, or other behavioural challenges temporarily intensify as the effects of a medication or substance wear off) or dysregulation (e.g., severe anxiety or panic during withdrawal).

Stimulants can disrupt sleep by delaying melatonin production and increasing arousal, especially if taken later in the day. This worsens ADHD symptoms, as sleep is crucial for attention, memory, and emotional regulation. Depressants may initially help with sleep (e.g., alcohol or cannabis), but they reduce REM sleep quality. This can impair cognitive processing and increase fatigue, perpetuating the cycle of stimulant and depressant use.

Chronic use of substances can disrupt the hypothalamic-pituitary-adrenal (HPA) axis, which regulates stress hormones like cortisol. ADHD brains are already prone to stress reactivity, and this dysregulation can worsen emotional dysregulation and then increase cravings for substances to manage stress. Over time, the brain adjusts to higher dopamine levels, reducing the medication's effectiveness. This can lead to seeking more stimulants to achieve the same effect, increasing the risk of addiction and withdrawal symptoms.

Regular use of depressants to "calm down" can lead to physical and psychological dependence, with withdrawal causing heightened anxiety, irritability, or even seizures.

Chronic overstimulation or suppression of the nervous system can lead to:

Mood Disorders: Increased risk of anxiety, depression, or bipolar-like symptoms.
Cognitive Decline: Impaired memory, focus, and decision-making.
Behavioral Dysregulation: Heightened impulsivity and compulsive behaviours.

Substance use (stimulants or depressants) can also disrupt gut health, which is closely linked to ADHD symptoms and mental health. Effects include:

Imbalances in gut bacteria (dysbiosis), which can worsen inflammation and neurotransmitter production.
Poor nutrient absorption, affecting brain function and overall energy levels.

Stimulants can increase the risk of heart problems, especially when combined with recreational stimulants or excessive physical stress. Chronic use of depressants can damage the liver, weaken the immune system, and lead to weight gain or malnutrition.

Strategies To Reduce Substance Use Once Medicated

It is key to be open with your doctor as they may suggest that you adjust timing, dosage, or consider non-stimulant/stimulant options if current medication exacerbates cravings or side effects.

Raise awareness and seek therapy to address underlying patterns driving substance use (e.g., reward-seeking, self-soothing). Set a context for health in your life and emphasise sleep, exercise, and nutrition to naturally regulate dopamine and cortisol.

Become aware of how the substances or behaviours you feel compelled to continue are interacting with your ADHD biology and medication if you are taking this.

Non-stimulant medications can offer a safer option for those with ADHD who are at higher risk for addiction, as they lack the immediate reinforcing properties of stimulants. However, addressing gaps in symptom management like emotional dysregulation, and the brain's need for stimulation remains critical to breaking the cycle of addiction. For stimulant medication, extended-release formulations (e.g., Concerta XL or Elvanse) can reduce the likelihood of misuse by providing a steady release of medication over time.

Combining medication with therapy and lifestyle changes can create a balanced approach to recovery and ADHD management.

When someone with ADHD is on stimulant medication but has a history of substance or behavioural addiction, the habitual element of addiction needs to be addressed carefully alongside their medication. Addiction often has a strong habitual or learned behavioural component as well as the biology component. This behavioural component is influenced by the ADHD brain's wiring for impulsivity, reward-seeking, and difficulty with self-regulation.

At the end of this post, paid subscribers can see how this may be worked with and gain access to 30 journal prompts to help you discover the unmet needs beneath your addiction.