It is not uncommon for people with symptoms of ADHD such as restlessness, difficulties with attention, and impulsivity, to try different ways of managing these symptoms. This is particularly the case when people have not yet received a diagnosis of ADHD and therefore are either not sure what the cause of the difficulties is, or do not have access to appropriate treatment and support. This leads many people to try a variety of substances which impact the brain and behaviour in different ways. Many people who have a history of struggling to maintain focus or resist the urge to move constantly have found that certain drugs are the only things so far which have helped with the problem. This can lead to difficulties including developing a reliance on a substance to help manage what are actually undiagnosed symptoms of ADHD.
This page is designed to help explore the myths and facts around drug use in undiagnosed ADHD.
1. Drugs like cocaine and ecstasy don’t affect people with ADHD like everyone else
The facts: ADHD is associated with several of the ‘reward pathways’ in the brain being chronically under-stimulated. This is due to lower levels of the neurotransmitters (chemicals which transmit signals in the brain) dopamine and norepinephrine. This leads to reduced activity in the regions of the brain responsible for attention and behaviour control. Many medications for ADHD, such as methylphenidate (Ritalin, concerta) and lisdexamphetamine,
work by increasing the supply of dopamine and norepinephrine in the brain.
MDMA (ecstasy) and cocaine also impact the brain pathways associated with dopamine, serotonin, and norepinephrine. In individuals with an average level of these chemicals, this causes heightened stimulation and the effects of improved mood, increased energy, and motivation. In people with chronically lower levels of these neurotransmitters, this effect may be muted and instead the drugs may simply improve attention and reduce restlessness.
This explains why people with ADHD may notice that drugs such as cocaine and MDMA affect them differently compared with other people. Both cocaine and ecstasy also affect the serotonin pathway which is why people experience a “crash” of low mood after the drug has worn off. They can also lead to problems with addiction and poor physical health outcomes.
2. I can’t have an assessment for ADHD if I have a history of drug use
Myth! Many people worry that if they have a history of drug or alcohol use, they will be unable to have an assessment for ADHD. It is important that when you undergo a psychiatric assessment of any kind, including one for ADHD, you are not under the influence of alcohol or drugs at the time, as this may make it difficult to obtain an accurate picture of your symptoms. However, someone who has a history of drug use or is currently using drugs regularly should not be excluded from proper assessment and treatment. As outlined above, many people use drugs in order to manage the symptoms of ADHD. With proper evaluation, support and treatment, the impulse to self-medicate with drugs may well be significantly reduced.
3. Stimulant medication could be addictive and I should avoid it if I have a history of dependence problems
The facts: the stimulant medications used to treat ADHD, such as methylphenidate and lisdexamphetamine, work on the dopamine (or “reward”) pathway in the brain as explained above. Although the mechanism by which these medications work is very different to drugs such as cocaine and other stimulants, ultimately the same brain pathway is affected. Therefore, there is a potential to misuse stimulant medication to achieve a euphoric effect
similar to cocaine. People who do this generally take amounts far in excess of prescribed doses and either intranasally or intravenously. It is important to note that the vast majority of people who take stimulant medication for diagnosed ADHD as prescribed have no more than a therapeutic effect, and do not develop an addiction to the medication.
However, many people with a history of dependence problems feel more comfortable with a medication for ADHD that has fewer or no addictive properties. This may therefore be an important consideration when selecting a medication with the prescribing clinician.
4. Cannabis is as helpful for ADHD as prescribed medication
Myth! Many people with symptoms of ADHD may be attracted by the idea of the calming properties of cannabis. However, there is currently no good evidence to suggest that THC (the active component of cannabis) has a positive impact on ADHD symptoms. In fact, some studies have found that people with ADHD who use cannabis performed worse on memory, verbal, cognitive, decision-making, and response tests than those who didn’t. Because THC
is highly associated with tolerance (meaning you gradually need more of the substance to get the same effect), people are also likely to find that any perceived positive impact of the drug on ADHD symptoms is short lasting, which can lead to problems with addiction.
5. I may have caused ADHD because of drug use
Myth! ADHD is a neurodevelopmental condition, meaning that it arises alongside the early development of the brain. This means that the symptoms of ADHD will have developed before the onset of any drug or alcohol use. People with a long history of drug or alcohol use may experience chronic changes to the way their brain functions, however these symptoms are distinct from ADHD symptoms.
If you think you may have symptoms of ADHD but are unsure whether you want or need to progress to a full assessment, you may wish to consider arranging a pre-assessment service with the ADHD & Autism clinic. This will involve completion of pre-assessment questionnaires and a QbCheck, which is a computer-based objective measure of ADHD symptoms. These documents will then be reviewed by one of our consultant psychiatrists
who will advise whether there is enough evidence to progress to a full ADHD assessment.
There is no obligation to progress to a full assessment following this.