The relationship between ADHD and addictive behaviours, a review

Although attention-deficit hyperactivity disorder (ADHD) has long been thought to be a disabling and common disorder that occurs only in childhood, more recent research, including prospective longitudinal follow-up studies, suggests that ADHD persists into adulthood in a high proportion of cases (1). Attention-deficit hyperactivity disorder is a serious risk factor for comorbid psychiatric disorders including substance misuse, antisocial personality disorder, and affective disorders (1). the presence of ADHD complicates the treatment of the addiction (2). Moreover, the correlation between ADHD, impulsivity symptoms, and behavioural addictions such as internet and shopping addiction highlights the necessity of managing ADHD symptoms in adults, particularly when coupled with substance use disorders (3). Research also suggests a bidirectional relationship between ADHD and addictive behaviours, with ADHD symptoms potentially contributing to the development of substance dependence and behavioural addictions (4). Chronic use of addictive substances has been observed to exacerbate ADHD symptoms like poor impulse control (5). In adults, the use of stimulants in comorbid ADHD and SUD has always been challenging because of their addictive properties, which carry a greater risk of misuse, especially in individuals with a history of stimulant/cocaine abuse. Concerning treatment management, in clinical practice, an important distinction is between ADHD subjects with and without stimulant/cocaine addiction (6). The complexity of the relationship between ADHD and addiction is underscored by studies emphasizing the role of ADHD in both the development and severity of addictive behaviours (7), (8), often leading to a faster progression from mild to severe substance use disorders (9). In terms of a management plan, routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings (10). Long-acting stimulants are recommended as the first line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. (10).

In conclusion, the current literature supports the association between ADHD and addictive behaviours, emphasizing the need for conducting a comprehensive assessment and tailored interventions to address ADHD symptoms as well as addictive behaviours for enhancing outcomes and effectively managing both conditions.

Dr Hamid‑Reza Rahmanian is a Consultant Psychiatrist at South West London and St George’s NHS Trust, where he also serves as Associate Clinical Director for Sutton Community Mental Health Services. He is an Honorary Senior Lecturer at St George’s, University of London, where he contributes to undergraduate and postgraduate medical education, supervises research, and mentors trainees. He qualified as a medical doctor in 1998 and went on to complete specialist training in psychiatry,  gaining his CCT in General Adult Psychiatry in 2014. He is a fellow  of the Royal College of Psychiatrists (FRCPsych)  and has subspecialty experience in perinatal psychiatry.

Dr Rahmanian’s clinical interests span mood disorders, psychosis, ADHD, eating disorders, personality disorders, and neurodevelopmental conditions. He has a strong commitment to transcultural psychiatry and is fluent in Farsi, ensuring culturally sensitive assessments and treatments for diverse populations. His leadership work includes service redesign, quality improvement, and innovation in community psychiatry. He has recently led on transformation initiatives such as implementing a single consultant model and skill‑mix workforce strategies in community services. Dr Rahmanian is also actively involved in medical education, delivering lectures, supervising projects, and contributing to training programmes. His approach to psychiatry is holistic, grounded in the biopsychosocial model, and always aligned with NICE evidence‑based guidelines.