ADHD
ADHD and alcohol, smoking and substances: why they are linked and what helps
Why adult ADHD is linked with alcohol and substance use, what the studies show, and how the two are treated together.
Short answer
ADHD and substance use disorders often coexist. About 1 in 4 people treated for addiction also has ADHD. If both are present, they need to be treated together. Treating only one often leaves the other to undermine it.
What the studies show
In people with addiction: in a meta-analysis of 29 studies, 23.1% of patients with a substance use disorder also had ADHD. The rate was lower in cocaine dependence than in alcohol and opioid dependence. The study did not include smoking.
In children with ADHD, years later: in a meta-analysis of studies that followed children into adulthood, those with ADHD were more likely to develop abuse or dependence on nicotine, alcohol, cannabis, cocaine and other substances.
A detail that matters: in the same study, children with ADHD were not more likely to have tried alcohol, but they were more likely to reach abuse or dependence. So the issue is less “whether they will drink” and more “how they will drink”.
Why they are linked
There is no single cause. Possible mechanisms:
Impulsivity: “one more drink”, difficulty stopping where someone else would stop.
Seeking intensity and escaping boredom: the substance makes the day “more interesting”.
Self-medication: some adults describe alcohol or cannabis as “quieting the mind”, helping them sleep or feel at ease socially. The relief is short and the cost grows over time.
In the practice we put it simply: a treatment with medical supervision is healthier than alcohol to feel at ease. If the glass has become the only way to quiet the mind, that is information for the assessment, not a reason for shame.
How the assessment works when there is substance use
In every ADHD assessment I ask directly about alcohol, cannabis, other substances, smoking and caffeine, because they affect both the symptoms and the choice of treatment. The diagnosis relies on the history from childhood and the structured DIVA-5 interview, so that we can separate what was there before the substance use from what the substance itself causes. See also ASRS or DIVA-5: test or diagnosis?.
Treatment: the two together
Treatment is individualised and takes substance use into account in the choice and in follow-up. The options are explained in Adult ADHD treatment options.
Psychotherapy helps find other ways to deal with boredom, anxiety and sleep.
If there is physical dependence, stopping must be done with medical help. Suddenly stopping alcohol after heavy daily use can be dangerous.
If you are worried about yourself
Some questions to consider:
Do you drink or smoke more than you planned?
Do you need the substance to sleep, calm down or go out?
Has it affected your work, your driving or your relationships?
Have you tried to cut down and not managed?
If you answered “yes” to any of these, it is worth a conversation with a doctor. Things do not need to have reached “the edge”.
Safety: If there are signs of poisoning, confusion, seizures or thoughts of self-harm, call 166 (EKAB ambulance) or 112. Addiction helplines: KETHEA 1145 and OKANA 1031. Their services now belong to the National Organisation for the Prevention and Treatment of Addictions (EOPAE).
Sources
van Emmerik-van Oortmerssen K et al. Prevalence of ADHD in substance use disorder patients: a meta-analysis and meta-regression analysis. Drug Alcohol Depend. 2012;122(1-2):11-19. https://doi.org/10.1016/j.drugalcdep.2011.12.007
Lee SS, Humphreys KL, Flory K, Liu R, Glass K. Prospective association of childhood ADHD and substance use and abuse/dependence: a meta-analytic review. Clin Psychol Rev. 2011;31(3):328-341. https://doi.org/10.1016/j.cpr.2011.01.006
Greek Ministry of Health, reply to Parliament 12/5/2026 (establishment of EOPAE, Law 5129/2024). https://www.hellenicparliament.gr/UserFiles/67715b2c-ec81-4f0c-ad6a-476a34d732bd/13292582.pdf
Greek Ministry of Health, “Telephone helplines for addictions”. https://www.moh.gov.gr/articles/health/domes-kai-draseis-gia-thn-ygeia/antimetwpish-eksarthsewn/eksarthsiogones-oysies/plhrofories-gia-prolhpsh-ndash-antimetwpish-ths-eksarthshs-apo-eksarthsiogones-oysies/5270-thlefwnikes-grammes-bohtheias-gia-tis-eksarthseis
