ADHD Found Connected to Substance Use Disorder, With Sex Prevalence Differences

Attention deficit hyperactive disorder (ADHD) was found to be associated with substance use disorder across both men and women for all substances studied, according to a recent study. Researchers found individuals with ADHD were diagnosed more often with substance use disorder than those without ADHD. Analysis of most substances individually showed higher rates of prevalence in men with ADHD than women with ADHD.

Data were taken from national registries in Norway, using individuals aged 7 to 31 (born between 1988 and 2001), with their data followed until 2019. Individuals with ADHD were defined as those who received ADHD medication or had an ADHD diagnosis (by ICD-10 criteria). ADHD medications included methylphenidate, amphetamine, dexamphetamine, lisdexamphetamine, and atomoxetine. Participants’ data were excluded if they were prescribed central stimulants for narcolepsy or died or emigrated from Norway before 2008.

Substance use disorders were defined with ICD-10 as well, with specific substance-related disorders in alcohol, opiate, cannabis, sedative (eg, benzodiazepines), stimulant (eg, cocaine), “other” substances like hallucinogens and volatile solvents, as well as multiple drug use or other psychoactive substances included. Nicotine dependency was not included.

Other psychiatric disorders included for comorbidity analysis were schizophrenia/psychosis, mood/affective disorders, anxiety/somatoform disorders, eating/sleeping disorders, personality disorders, psychological development disorders (including learning disabilities and autism spectrum), conduct disorders, and mixed disorders of conduct and emotion; all were based on the ICD-10 criteria.

In terms of sex differences, the largest difference found was between men and women with ADHD with any substance use disorder (rather than a specific substance). Smallest sex differences were found for hallucinogen and opioid-related substance use disorders. There were significantly larger prevalence differences for males than females in substance use disorders involving cannabis, sedatives, cocaine, and amphetamines.

In both men and women, the largest prevalence difference was associated with comorbid ADHD and schizophrenia/psychosis (females: 40.6% prevalence vs males: 49.0% prevalence). ADHD comorbid with both personality disorders and eating/sleeping disorders were associated with high prevalence differences in men and women (personality disorders: 33% in females, 37.6% in males; eating/sleeping disorders: 23.1% in females, 30% in males). Sex-associated differences in those with ADHD, comorbid psychiatric illness, and substance use disorder were dependent on the specific comorbid illness. Those with ADHD and comorbid psychiatric illnesses had the largest differences in substance use disorder rates compared with individuals without ADHD and with a psychiatric illness.

The finding that individuals with ADHD have higher rates of substance use disorder is consistent with many previous studies on the topic.^2,3 The study noted that further research should be conducted on the temporal associations between ADHD and substance use disorder which may be different between men and women, such as more frequent delayed ADHD diagnosis in women. Authors noted “the results point to younger males and females with ADHD as important target groups for close follow-up to prevent development of later comorbid disorders, including SUD and severe psychiatric disorders.”

References

1. Molekleiv CD, Lundervold AJ, Solberg BS, et al. Prevalence of substance use disorder in individuals with attention deficit/hyperactivity disorder: associations with sex and psychiatric comorbidity. BMC Psychiatry. 2025;25:936.

2. Solberg BS, Halmøy A, Engeland A, et al. Gender differences in psychiatric comorbidity: a population-based study of 40 000 adults with attention deficit hyperactivity disorder. Acta Psychiatr Scand. 2018;137(3):176–86.

3. van Emmerik-van OK, van de Glind G, van den Brink W, et al. Prevalence of attention-deficit hyperactivity disorder in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend. 2012;122(1):11–9.