When the System Doesn’t See You

Individuals with ADHD are twice as likely to develop substance use disorder compared to those without ADHD. Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition that is characterized by impulsivity, hyperactivity, inattention, and challenges in executive functioning. ADHD is fairly common, affecting about 5% — 7.2% of youth and 2.5% — 6.7% of adults of the population, though experts indicate that the true number might be much higher. Most of us know and love someone with ADHD. Not only is the true prevalence of ADHD not really known, it is critically underdiagnosed in some populations such as: Black, Indigenous and other racialized communities.

Barriers to diagnosis can stem from racial bias in healthcare, socioeconomic status, and cultural stigmas around mental health. For many racialized individuals, symptoms of ADHD are overlooked, misattributed, or dismissed. Without an accurate diagnosis or appropriate support, individuals may internalize their struggles, experience chronic stress, and turn to substances in an attempt to self-regulate. Ensuring equitable access to ADHD assessment and care is an essential part of harm reduction.

Reframing ADHD

ADHD is often viewed through a deficit-based lens which limits our understanding of the brain’s potential. Take impulsivity, for example — it is a common trait of ADHD and is typically seen as negative. If we take on a strengths-based perspective, impulsivity can be a powerful asset in creative fields like art, music, and writing. People with ADHD are often resilient problem-solvers having adapted to a world that isn’t built for them. Similarly, hyperactivity — another misunderstood trait — can be an advantage in high energy or demanding environments or tasks. By shifting how we view ADHD, we can transform our approach to substance use challenges in the ADHD community.

The Links Between ADHD and Substance Use

In truth, there are a number of factors at play making the relationship between ADHD and substance use complex. It is likely the result of a combination of neurological, environmental, and systemic factors. Some individuals use substances as a form of self-medication, either to ease their symptoms or to cope with the burnout that comes with trying to navigate a neurotypical world. Increased impulsivity may also lead to more experimentation with substances. In addition, there may be differences in the ways that people with ADHD metabolize substances, impacting their experiences of both use and addiction. Understanding the connections between substance use and ADHD is essential for harm reduction efforts and for building more supportive communities.

Critically, many people with ADHD go undiagnosed and unsupported, leading to unmanaged symptoms that can increase vulnerability. Trauma plays a significant role. Research suggests that people with ADHD have higher rates of trauma, are more likely to develop PTSD, and may find recovery from trauma more difficult. Taken together, these factors highlight the unique risks faced by people with ADHD when it comes to substance use.

Strategies, Treatments, Harm Reduction

Effectively addressing substance use among individuals with ADHD requires a compassionate, strengths-based approach that centers each person’s unique needs and abilities. Importantly, complete abstinence from substance may be the goal for some but not for all. Harm reduction strategies can offer life-saving support. It may involve education, safer use practices, reduced frequency or quantity of use, or safety planning. Whatever approach is taken, it needs to be tailored to the individual.

Understanding the reasons behind someone’s substance use is key to supporting their safety and well-being. For individuals self-medicating symptoms of ADHD, cognitive-behavioral therapy (CBT) can provide coping tools and skill-building that is geared towards supporting their wellbeing. Support groups can help counter feelings of isolation or shame by offering opportunities to build community and shared understanding. It may also help individuals with ADHD process shame and/or trauma in a safer, less judgmental environment. There are non-stimulant medications that may be a better fit for those with substance use concerns. Understanding an individual’s unique goals, abilities, and needs is critical for building support that both leverages and amplifies their strengths. Above all, treatment should be personalized and rooted in compassion and empathy.

Final Thoughts

The link between ADHD and substance use demands a nuanced, trauma-informed response. Many individuals with ADHD face heightened exposure to trauma, persistent ableism, and the unrelenting burnout cycle of adapting to a neurotypical world. In this context, the emergence of substance use as a coping strategy makes sense. This is a challenge that needs to be met with empathy, not judgement.

People with ADHD are more likely to use substances, more likely to face associated risks, and more likely to be criminalized. Yet, their stories are rarely centered in conversations about substance use. ADHD does not need to exist at the margins of our society. It is not a disease. It is a difference — one that encompasses a wide range of characteristics, challenges, and gifts. From an evolutionary standpoint, ADHD traits have very likely offered advantages to our communities, and us as a species. In today’s world, people with ADHD deserve the opportunity to thrive.

When we embrace neurodivergence as a vital part of human diversity, we open the door to innovation, empathy, and resilience. Communities enriched by different ways of thinking are better equipped to solve complex problems and imagine new possibilities. Supporting people with ADHD is an investment in a more creative, inclusive future.

ADHD can be a deeply stigmatized label, but it doesn’t have to be. Neurodiversity is needed, stigma is not.

Please note: this article was originally published on Medium.com.