ADHD and Marijuana

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder most commonly diagnosed in childhood and often lasting into adulthood.1 The main symptoms of ADHD include difficulty paying attention, trouble controlling impulsive behavior, and hyperactivity.1

Although all of these are normal childhood behaviors, children with ADHD experience them to a more frequent and severe degree that interferes with daily functioning and their own development.2 

Types of ADHD

There are three different types of ADHD:1,2

  1. Predominantly hyperactive-impulsive: Symptoms are predominantly indicative of hyperactivity and impulsivity. Behavior such as fidgeting, talking a lot, or running/jumping/climbing indicates hyperactivity. Impulsivity symptoms might include interrupting others or not waiting ones turn or listening to directions.
  1. Predominantly inattentive: Symptoms of inattention are predominantly present, making it hard for a person to pay attention to details, organize or finish a task, or follow instructions.
  2. Combined hyperactive-impulsive and inattentive: Symptoms from both hyperactive-impulsive and inattentive are experienced equally.

ADHD is more common in males than females in both childhood onset (12.9% vs. 5.6%) and adult onset.3,4 Females are more likely than males to have predominantly inattentive ADHD.3 It is estimated that approximately 9-10% of American children have the disorder.5 The number of diagnoses is increasing each year.5

Other mental health concerns and conditions, such as learning disabilities, anxiety disorder, conduct disorder, depression, and substance use disorder, are common in people with ADHD.1,3

ADHD and the Risks of Substance Use

Up to 60% of children with ADHD continue to struggle with symptoms of the disorder throughout their teenage years and into adulthood, with studies estimating the prevalence of adult ADHD to be somewhere between 2.5 to 4.4%.6

Individuals with ADHD (both diagnosed and undiagnosed) are at risk of some significant challenges, especially if the disorder is left untreated or if symptoms are particularly severe. Risks include vulnerability to mood and anxiety disorders as well as substance use disorder.6 In fact ADHD has been associated with a twofold increased risk for substance use disorder (SUD).7 The National Comorbidity Survey Replication study estimates that 15.2% of adults with ADHD also have a substance use disorder (SUD), compared to 5.6% of those without ADHD.8

When symptoms of ADHD co-occur with symptoms of a SUD, symptoms of both disorder are likely to increase, making them more difficult to treat vs. those who have symptoms of only one disorder.6,7

ADHD and Marijuana Use

Marijuana is the second most common drug, after alcohol, used by adolescents and adults in the United States.9 Individuals with ADHD are more likely to use marijuana, with ADHD youth nearly three times as likely to report marijuana use in later life.10 Those diagnosed with ADHD are more vulnerable to developing an SUD, and it’s estimated that individuals with ADHD make up 33-38% of people who develop a marijuana use disorder.11

Marijuana is well-known to impair short-term memory, attention, and judgement. Individuals with ADHD are already vulnerable to experiencing these impairments, and marijuana use may actually have an additive effect, thereby worsening many symptoms and furthering impairing the executive function of those ADHD.12

It is perplexing, then, that marijuana use is high in these individuals, and it is further puzzling to see that is an increasingly popular perception that marijuana can be therapeutic for ADHD.11,12 For example, in an analysis of 268 separate Internet forum threads, 25% of people endorsed marijuana use as improving ADHD or symptoms of ADHD compared to only 8% saying it is helpful.11 Further research is needed to fill in the gap and explain the difference between perceived benefit vs. the evidence showing that marijuana likely exacerbates symptoms and puts individuals at risk of worsening ADHD symptoms and a higher risk of developing a cannabis use disorder.

Treatment of Co-Occurring ADHD and Substance Use Disorder

Mental health and addiction treatment professionals acknowledge that treating co-occurring ADHD and SUD is “a formidable challenge.”6 However, there are both pharmacologic and nonpharmacological therapies available to clinicians as they build an individual’s treatment strategy. Which therapies are used and when will depend on a person’s symptoms and their severity, but it is important for both disorders to be treated simultaneously, as they so closely affect each other.6

If you have been diagnosed with ADHD, or if you have symptoms of ADHD, and are struggling with marijuana or other substance use, quality treatment and innovative individualized care is available. There’s no reason to continue putting your physical and mental health at risk when treatment is available. Contact us at 972-846-8995 to discuss your options.

References

  1. Centers for Disease Control and Prevention. (2020). What is ADHD?
  2. National Institute of Mental Health. (2019). Attention-Deficit/Hyperactivity Disorder.
  3. Diagnostic and Statistical Manual of Mental Disorders: DSM-5 (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  4. Centers for Disease Control and Prevention. (2020). Data and Statistics About ADHD.
  5. Centers for Disease Control and Prevention. (2020). ADHD Throughout the Years
  6. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  7. Biederman, J., Wilens, T. E., Mick, E., Faraone, S. V., & Spencer, T. (1998). Does attention-deficit hyperactivity disorder impact the developmental course of drug and alcohol abuse and dependence? Biological Psychiatry, 44(4), 269–273. https://doi.org/10.1016/s0006-3223(97)00406-x
  8. Kessler, R. C., Adler, L., Barkley, R., Biederman, J., Conners, C. K., Demler, O., Faraone, S. V., Greenhill, L. L., Howes, M. J., Secnik, K., Spencer, T., Ustun, T. B., Walters, E. E., & Zaslavsky, A. M. (2006). The prevalence and correlates of adult ADHD in the United States: Results from the National Comorbidity Survey Replication. The American Journal of Psychiatry, 163(4), 716–723.
  9. Center for Behavioral Health Statistics and Quality. (2020). Key Substance Use and Mental Health Indicators in the United States: Results from the 2019 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration, Rockville, MD.
  10. Lee, S. S., Humphreys, K. L., Flory, K., Liu, R., & Glass, K. (2011). Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: A meta-analytic review. Clinical Psychology Review, 31(3), 328–341.
  11. Mitchell, J. T., Sweitzer, M. M., Tunno, A. M., Kollins, S. H., & McClernon, F. J. (2016). “I Use Weed for My ADHD”: A Qualitative Analysis of Online Forum Discussions on Cannabis Use and ADHD. PloS One, 11(5), e0156614.
  12. Tamm, L., Epstein, J. N., Lisdahl, K. M., Molina, B., Tapert, S., Hinshaw, S. P., Arnold, L. E., Velanova, K., Abikoff, H., Swanson, J. M., & MTA Neuroimaging Group (2013). Impact of ADHD and cannabis use on executive functioning in young adults. Drug and Alcohol Dependence, 133(2), 607–614.