The Spanish Society of Dual Pathology (SEPD) underlines that Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that begins in childhood, usually persists into adulthood, and whose connection with addictions represents one of the main clinical challenges associated with this diagnosis.
Available data indicate that around 2.6% of the adult population presents with ADHD. Despite its impact on academic performance, work performance, social relationships, and emotional well-being, it continues to be an underdiagnosed disorder, especially when hyperactivity is not so visible and difficulties with attention, organization, impulsivity, or behavioral regulation stand out.
"ADHD does not necessarily disappear upon reaching adulthood. In many patients, its form of expression changes, and this can make clinical recognition difficult," explains Dr. José Martínez-Raga, psychiatrist and secretary of the SEPD, who adds that diagnostic delay leads to "years of functional deterioration and increases the probability that the person will reach health services due to other psychiatric complications, including addictive disorders."
As Dr. Ignacio Basurte, vice president of the Dual Pathology Foundation (FPD), details, ADHD and addictive disorders are not two isolated conditions that coincide by chance in the same individual, "Impulsivity, difficulties in inhibitory control and self-regulation, the search for immediate reward, and a greater difficulty in delaying gratification can increase vulnerability to substances or behaviors with a high capacity for reinforcement," he states.
Basurte specifies that this does not imply that all individuals with ADHD will develop dependence, as the final risk is conditioned by biological, psychological, and environmental factors; "but it does mean that we must consider people with ADHD as a particularly relevant population for the prevention and early detection of addictive disorders," he adds.
Treating ADHD does not increase the risk of addiction
SEPD specialists insist on the need to dispel one of the myths that still influence ADHD treatment: the fear that pharmacological therapy, and specifically the use of adequately prescribed and controlled stimulants, may favor the onset of addiction.
"The most recent evidence points precisely in the opposite direction," states Basurte, who acknowledges that for years there was concern that the pharmacological approach to ADHD would increase the risk of substance use. However, current research confirms that "leaving ADHD unidentified and untreated can be much more detrimental," so the goal should not be to avoid medication, "but to make a correct diagnosis, individualize it, and maintain adequate clinical supervision."
For José Martínez-Raga, these conclusions highlight the urgency of strengthening ADHD detection at all care levels. "We must actively look for substance use disorders and other addictive behaviors in people with ADHD, but also do the reverse: explore the possible existence of ADHD in patients who consult for addiction," he points out.
Along these lines, the Spanish Society of Dual Pathology advocates for a global and personalized approach, which jointly considers all psychopathological manifestations present in each case.
"The message should not be limited to diagnosing ADHD earlier, but to diagnosing it better and treating it comprehensively. Treatment can include medication, evidence-based psychological interventions, psychoeducation, and modifications of the family, academic, or work environment. And when addiction exists, both disorders must be incorporated from the beginning into the same therapeutic plan," adds Ignacio Basurte.
The Vice President of the SEPD, finally, highlights that recognizing and correctly treating ADHD not only contributes to improving care or reducing impulsivity, but that "it can modify a person's life trajectory and reduce the impact of serious psychiatric complications such as addictive disorders."