Substance Use Prevention in Teens With ADHD

ADHD teens face substance use risks due to impulsivity and poor regulation.

Reviewed by Davia Sills

Key points

• ADHD increases the likelihood of substance use due to impulsive behaviors.
• Watch for signs like changes in friendships and behavior as indicators of substance use.
• Strong family ties and routines can protect against substance use.
• Strategies like therapy and medication can help prevent substance use in ADHD teens.

Teens with attention-deficit/hyperactivity disorder (ADHD) face several unique challenges that can make navigating academics, friend circles, and home life challenging. There's even a link between ADHD and substance use in teens. This reality doesn't have to be scary for parents. However, you also can't tune out the risks.

There's no map for parenting ADHD teens. In addition to being concerned that their children may be at greater risk for addiction, parents of ADHD teens worry that they may not be able to tell the difference between core symptoms or typical ADHD behaviors and signs of substance use.

However, it's far from a forgotten conclusion that untreated childhood ADHD may lead to substance use or addiction. With the right information, parents and teens can stay ahead of risk factors.

Understanding Substance Use Risk in ADHD Teens

Why is ADHD connected with an increased risk for substance use? Both ADHD and substance abuse are said to be disorders of disinhibition [1]. This increases an ADHD teen's underlying vulnerability to impulsive and destructive behaviors.

Let's look at the numbers. With impulsive decisions and a maladaptive reward system making individuals with ADHD more vulnerable to alcohol and drug use, it may not be surprising that people with ADHD are 43 percent more likely to develop alcohol use disorder (AUD) [2]. It's estimated that 25 percent of adolescents with substance use problems fit the criteria for having ADHD [3].

There are many misconceptions about ADHD and substance use that prevent teens and parents from being properly prepared. The biggest misconception is that substance use is only a concern for "bad" kids. Many teens with ADHD are drawn to using alcohol and drugs as a form of self-medicating. Drug-seeking behaviors are often used to soothe the discomfort or emotional pain that teens with ADHD may experience from feeling like an outsider.

The other misconception held by parents is that they would be able to "tell" if their child was using substances. Research shows that a significant proportion of parents are unaware of their children's alcohol (30 percent) and substance use (50 percent) problems [4].

What Are the Warning Signs of Substance Use in Teens With ADHD?

One of the earliest warning signs of teen drug use, in general, is a change in behavior or mannerisms [5]. Other signs may include:

• A change in friendships to include peers you've never met or heard about before
• Withdrawing from family bonding, routines, or activities
• Preferring to stay home instead of partaking in family outings or trips
• A new preference to be left alone in their room
• Being uncommunicative with parents and siblings
• Aggressiveness or anger
• Missing agreed-upon curfew hours
• Offering suspicious "stories" to account for lost time or strange behaviors
• Dramatic changes in appearance, which can include weight gain, gauntness, bloodshot eyes, bruising, unexplained sores, or strange marks
• Dilated pupils or rapid eye movement
• Appetite changes
• Slurred or sped-up speech patterns

ADHD-Specific Risk Factors and Protective Factors

ADHD's connection to substance use is closely tied to the impulsivity, poor frustration tolerance, and emotional regulation challenges that are characteristic of ADHD. Drug use disorders are often accompanied by deficits in the capacity to efficiently process reward-related information and to monitor, suppress, or override reward-controlled behavior when goals conflict with aversive or immediate outcomes [6].

The dopamine hit that comes from substance use can become a singular obsession. Unfortunately, this can mean that teens with ADHD can be at a disadvantage compared to peers who experiment with alcohol and other substances. For parents of teens with ADHD, this can seem unfair.

The emotional dysregulation that accompanies ADHD is another risk factor. People with substance use disorders appear to have greater difficulties in emotion regulation than people without substance use disorders [7]. Fortunately, some protective factors can mitigate risks in ADHD teens [8]. These include:

• Extended family support
• Family structure with limits, rules, monitoring, and predictability
• Supportive relationships with family members
• Clear expectations for behavior and values
• Consistent discipline focused on language-based interventions over physical discipline
• Presence of mentors and support for the development of skills and interests
• Opportunities for engagement within school and community
• Physical and psychological safety
• Opportunities to develop social skills, emotional self-regulation, high self-esteem, healthy coping skills, and good problem-solving skills
• Engagement and connections tied to school, peer groups, athletics, employment, religion, or culture

Fostering strong executive functioning (EF) may also play a role in helping to deter drug use in ADHD teens. EF controls your emotional regulation, planning and decision-making, and behavioral impulse control. Emotional control is predictive of youth alcohol, cigarette, and e-cigarette use [9]. In studies looking at targeting EF as a method of youth substance use (SU) prevention, results suggest that EF skills training integrating mindfulness could help mitigate substance use risks.

Immediate Strategies for ADHD Teens Facing Substance Use Opportunities

What can be done when parents discover that their teens are in environments where substances are obtainable? It's essential to introduce ADHD-friendly refusal skills and strategies that empower teens to say "no" without fear of isolation or alienation from their peers.

Additionally, at-risk teens should know how to utilize both home-based and school-based systems effectively. If teens are facing internal temptations to use substances, having a toolkit of positive redirected behaviors is crucial.

ADHD-Focused Prevention and Intervention Options

ADHD management looks different for everyone. For many families, medication management can play an important role in helping a teen stay regulated. If you're wondering about the role of ADHD medication in substance use prevention, current research shows that ADHD medication is not associated with an increased rate of substance abuse [10]. Data suggests that there may be a slight long-term protective effect against substance use. With that said, parents and doctors must both remain alert to potential stimulant misuse among ADHD patients. If you are curious about medication to treat ADHD, contact a qualified mental health professional for more information.

Therapists and other mental health professionals also employ many cognitive behavioral therapy (CBT) approaches, which can be especially helpful if ADHD co-occurs with other mental disorders, such as anxiety, depression, or substance use disorders. For teens who have struggled with negative beliefs, CBT can offer a way to reframe the way they look at their abilities. This "brain training" can be essential for building the confidence needed to make better choices and help teens with ADHD navigate life.

Of course, home-based family interventions are also important for providing the consistency teens with ADHD need to thrive. Creating an organized household where rules and expectations are clear can provide much-needed guardrails that allow teens with ADHD to stay on track.

Building a Supportive Environment for ADHD Teens

ADHD teens need to learn to be their own best advocates. This starts with setting clear boundaries with peers about substance use. ADHD teens need to recognize that they may need to leave situations where substances are being shared. Additionally, they may need to let peers know that their vulnerability to substance use means they cannot associate with people who drink or use drugs.

For parents, having an open-door policy to talk about substance use is important. ADHD teens need to know that they can ask their parents to pick them up from locations where substances are being used without fear of judgment or punishment. Additionally, parents can help kids recognize scenarios and situations that could put them at risk of being exposed to substance use. Parents should also collaborate with schools to see that a teen's unique needs are being met to ensure that risk-reducing behaviors are being promoted.

ADHD-Specific Coping Strategies

As mentioned earlier, strong executive function can play a role in insulating ADHD teens against substance use. Minimizing distractions and establishing a routine are the two most important ways teens can boost executive function.

Additionally, parents should consider exploring emotional regulation techniques that are tailored for ADHD. By learning how to self-regulate, teens may be able to avoid the temptation to self-medicate. Additionally, having healthy outlets for hyperactivity and impulsivity can be important. This might look like enrolling in an organized sport, pursuing art, or taking up a hobby.

Long-Term Prevention and Resilience in ADHD Teens

ADHD risks for substance use don't end when the teenage years end. This will be a lifelong battle! However, developing compensatory strategies for ADHD symptoms in the adolescent and teen years can provide the structure a person needs to avoid substance use and addiction later in life.

For parents, helping teens to build self-esteem and self-efficacy is important. When challenges arise, your teen will rely on these skills, which could tempt them to self-medicate. Additionally, creating a fulfilling, substance-free lifestyle that accommodates ADHD traits instead of constantly putting a teen in conflict with their personality is important.

Supporting an ADHD Teen at Risk for Substance Use

Parents of ADHD teens need to be vigilant about any behavioral changes they observe. Heightened reckless behavior and impulsivity can indicate substance use. Additionally, falling behind in schoolwork or falling off course with the schedule your family has lived by for years could indicate substance use.

Of course, parents shouldn't be quick to accuse their teens of drug use just because they notice changes. Like all young adults, ADHD teens sometimes undergo shifts in behavior due to stress, relationship issues, or mental health issues that are independent of ADHD. Let your teen know you're there to help them through whatever they're going through. Parents must balance giving the support and structure their ADHD teens need to feel secure with fostering the independence they need to thrive on the journey to adulthood.

How the Future Looks in Teens With ADHD

We know more about ADHD treatment and substance use prevention than ever before. While it's clear that ADHD increases the risk of substance use in teens, the outlook is not bleak. Quality support from healthcare providers, along with proper diagnosis and treatment of ADHD, can protect your teen from vulnerability to substance use.

Many paths to ADHD treatment may help to reduce substance use risks. For example, the Food and Drug Administration (FDA) has recently approved several delayed-release stimulant and non-stimulant medications [11].

Conclusion

Understanding the increased risk of substance use in ADHD teens is the first step in preventing harm. By creating an empowering, structured environment that works around ADHD symptoms instead of stigmatizing them, families can set their teens up for substance-free lifestyles. Cognitive behavioral therapy, medications, and lifestyle management can all help teens to thrive.

If you're a parent with questions about ADHD teens and substance use, the most important thing to know is that early intervention and ongoing support are critical. There doesn't have to be a straight line between ADHD and substance use. Being your child's partner in helping them define the direction of their own lives starts with the right resources.