ADHD and Potential Substance Abuse

The New Life House Recovery Community asked Dr. Martha Koo to discuss the high risk of substance abuse in individuals with Attention-Deficit Hyperactivity Disorder and the importance of early therapeutic intervention.

Many parents are confused about what ADHD is and is not.  To clarify, the essential features of ADHD involve a persistent pattern of inattention and/or hyperactivity/impulsivity that interferes with healthy functioning.  Inattention causes individuals with ADHD to struggle with task completion, organization and persistence. Hyperactivity manifests as excessive motor activity (for example: fidgeting, tapping, talkativeness). Impulsivity encourages hasty actions that are taken without forethought regarding consequences.

Parents sometimes misconstrue symptoms of ADHD as defiance or laziness. Or, a correct diagnosis and the need for treatment are dismissed because symptoms may be absent in one-on-one interactions, in novel settings or in especially interesting or consistently stimulating activities (for example: video-gaming).

ADHD individuals commonly exhibit low frustration tolerance, irritability and mood lability. They may have reduced behavioral inhibition, an increased need for novelty seeking, a desire for immediate rewards and an inability to delay gratification.  ADHD is also associated with poorer school performance and increased social rejection.

Children with ADHD carry approximately a 50% lifetime risk of substance abuse disorder.  Individuals with ADHD, as compared to peers without ADHD, abuse substances at an earlier age, and the abuse progresses more rapidly and continues longer.

It is easy to understand how a combination of impulsivity, mood lability, novelty-seeking behavior, and an inability to delay gratification, would result in an increased risk of self-medication and substance abuse.

Early Diagnosis of ADHD and Therapeutic Intervention May Significantly Reduce the Risk of Addiction

Historically, there was a concern that exposing the developing brain to even therapeutic doses of stimulants would actually facilitate a process of substance abuse.  But research has clearly documented no evidence that the therapeutic use of stimulants results in an increased propensity for addictive behavior.  In contrast, evidence suggests that if you control ADHD and improve academic performance, interpersonal relationships and self-esteem, there are fewer chances an ADHD child will engage in substance abuse when he/she becomes an adolescent.

The treatment of ADHD may involve stimulant medications but should also include cognitive-behavioral therapy, social skills training and parental education.

Early and adequate diagnosis and treatment of ADHD is essential to reduce the risk for subsequent drug and alcohol use disorders.  Yes, we all realize that misuse of stimulants, particularly in high school and college, for enhanced performance or recreation is a pervasive problem. However, it is still important that ADHD be treated and stimulant medication be used, if indicated, with appropriate professional monitoring.


Dr. Martha B. Koo, M.D. completed her undergraduate studies at Princeton University and her medical training at UCLA Medical School, where she earned membership to the AOA and Sigma Xi Society for academic excellence. She completed her residency in psychiatry at the UCLA Neuropsychiatric Institute and then pursued psychoanalytic training at the New Center for Psychoanalysis. For the past seventeen years Dr. Koo has enjoyed her private practice, providing outpatient psychotherapy, psychoanalysis and pharmacological treatment for individuals, couples and families. A pioneer in the development and application of Transcranial Magnetic Stimulation (TMS), Dr. Koo is the Medical Director of the South Bay TMS Therapy Center. Additionally, she is the Medical Director of the Manhattan Beach Professional Group. Dr. Koo is Board Certified in Psychiatry. She is an active member of the American Psychiatric Association, the New Center for Psychoanalysis, the California Psychiatric Society and the Southern California Psychiatric Society.

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